Coloproctology introduction

Question 1

Methods of investigation in Coloproctology

Answer 1

1.Digital rectal examination
Indications-any functional disturbances of the
bowels
-presence of pathological discharge in fenced
-diagnosis of rectal tumors
I.e in women vaginal examination is also done

The rectum is investigated by a rectal speculum
An anascope allows to investigate all anal walls

2. Proctosigmoscopy
   Indications- for any patient having disturbances of intestinal cavity
   It allows examination of the intestine for a distance of 30cm
   Preparations for the procedure is cleansing enemas or microclysters(micro lax)

3.Rectoscope
Indications -biopsy is done
-eloctrocoagulation of polyps is done
-removal of foreign bodies
- introduction of pharmaceutical substances
4. X-ray examination
Indications-mobility, function of the rectum,relief of the mucous membrane, determination of flexibility of walls of the rectum

5.Colonoscopy
-performed by means of fibre optical apparatus
-allows to examine the whole large intestine , Bauhins valve,part of the illeum
Indications-biopsy
- introduction of drugs
-removal of polyps
-tumor biopsy
Contraindications-patients with psychic impairments
-severe concomitant diseases of other organs
-bowel preparation is made by purgatives(for tans) or cleansing enema
-other radiological methods include -fistulography, X-ray lymphography,selective aortography by Seldinger, retropneumoperitoneum
-selective aortography is used for diagnosis of ischemic colitis and for hemostasia.
Fistulography is done incase of extra spincter fistulas

6.Radionuclide method
Indications
-allows to determine volume of circulating blood
-examine motor-evacuation function of large intestine

7. Sphincterometry
   - used to determine functional state of sphincter muscle of anus
8. Balloonography
9. Electrography
   - both used for examination of motor function of large intestine
10. Ultrasound
11. CT
12. Irigoscopy(with contrast)
13. MRI
14. Histological examination
15. Capsule endoscopy

Question 2

Anatomy of the Colon

Answer 2

The large intestines extend from from illeocecal angle to external anal canal.
The colon and rectum are distinguished in it
Average length of the colon is about 150cm
There are haustrations of the colon, taeniae,appendices epiploica on its walls
Parts of colon
-ascending colon
-flex urea coil dextra
-transverse colon
-flexura coli sinistra
-descending colon
-sigmoid colon

Question 3

Anatomy of the rectum

Answer 3

-starts from the rectosigmoid border situated at the level of the third sacral vertebrae
-length of the rectum with the anal canal is 15-17cm
Parts of rectum;
-supraampular
-ampullar
-perineal
-In the area where mucosa of ampullar part turns into anal canal there is a pectineal line.
-in the submucosal there are Morgagnis columns, bases of which form crypts(6-12)
The length of the anal canal is from 1,5-3,5cm

Blood supply of large intestine 
From system of superior and inferior mesenteric arteries
In the zone of the left flexure an anastamoses forms between these (the arc of Riolan)
Branches of superior mesenteric are;
-ileocolic
-right colic
-middle colic 
Branches of inferior mesenteric are;
-colic sinistra 
-sigmoidal 
-rectalis superior 
The rectum is also supplied by internal iliac 

Lymph drainage-

Functions of large intestine

• absorptive
• digestive
• motor
• excretory

Question 4

Clinical signs of coloproctologic diseases

Answer 4

1-pain

• in the anus and perineum incase of acute anal fissure, acute paraproctitis, thrombophlebitis of hemorrhoids and tumor of the anal canal
• Abdominal pain typical for diseases of large intestine
• Cramp like pains for bowel obstruction
• constant abdominal pains are characteristic for progressive inflammatory process(acute appendicitis, peritonitis)

2.Feces containing blood
Typical for rectal diseases
3.Mucus discharge with slightly changed blood incase of renal tumors , colitis etc
4. Patients can have prolapsed hemorrhoids,polyps,fecal and gas incontinence, fistulas
5.Abdominal distention
6. Constipation
7. Diarrhea