• Derived from proktoderm• (and the outer skin surrounding) somatic

sensory innervation is rich-Pain!• Size: ~ 3cm• Axis leads to ventrokranial (toward umbikus)

and an angle of the real to the dorsal to the rectum in a resting state. -Defecation: angle to> the

• a. hemoraidalis soup. -Branch a.mesentrika inf; into left and right branches. Right branched into 2 again (the location of hemorrhoids)

• Hemorrhoids are normal tissue, of all those who comprised the arterial-venous plexus, serves as a valve inside the anal canal to assist system of the anal sphincter, preventing flatus incontinence and fluid.

• Distinguished anatomically to the dentate line-internal and external

• Hemoroidalis venous plexus is superior to the line of mucocutaneous

• mucosa covered• Bearing in vascular

submucosal tissue in the lower rectum

• Three primary positions: right anterior, right posterior, left lateral.

• Formed from the ectoderm

• Is widening and the protrusion of the inferior hemorrhoidal plexus

• Distal mucocutaneous line in the epithelial tissue beneath the anus

Factor: straining, chronic constipation, pregnancy, obesity

Pressure on the internal and external hemorrhoids

abnormal swelling pads anal

<Venous return

Dilatation and swelling plexus arteriovenosus

Suspensory muscle stretching and rectal tissue prolapse through the anal canal

Swollen mucosa-easy to trauma - bleeding red (high oxygenated blood in arteriovenous anastomosis)

Prolapse-leads to fouling and expenses mucosa (pruritus) and predispose to incarceration and strangulation

• not innervated by cutaneous nerves ~ no pain

• Prolapsed internal hemorrhoids - perianal pain and spasm of sphincter complex around the hemorrhoids.

• Acute pain when incarceration and strangulation (also complex sphincter spasm)

• + external hemorrhoidal thrombosis - hemoroidal acute crisis ...! management of immediately

• External hemorrhoidal vein thrombosis – coz rapid distention of the skin that is innervated veins and edema

• 7-14 days - gone but anoderm thrombosis being stretched will remain there and live as excess skin - constrict high cleanliness and cause recurrence.

• swollen, uncomfortable, difficult hygienic, severe pain in the event of thrombosis

• do not cause pain, bright red bleeding, prolapse associated defecation. 4 levels of classification. Prolapse below the dentate line - leakage of mucus and pruritus

• inspection during straining, digital rectal examination, anoscopy

• hemorrhoidal disease is not impressive, the characteristic anamnesis or patients> 40 years of age or have a higher risk of colon cancer (family history)

• Eating a high fiber diet, taking enough fluids, stool softeners, topical and systemic analgesics, anal hygiene, topical ointments sterod

• Rubber band ligation with:• With the help anuskop,

mucosal hemorrhoids that protrude above the clamped and pulled or sucked into the tube Ligator special. Rubber band driven from Ligator and placed tightly around hemoroidalis the mucosal plexus.

• -ve: pain due to the mucocutaneous line, infection, bleeding after 7-10 days

• Surgical freeze: cool down to low temperatures once.

• -ve: the necrotic mucosa is difficult to determine• Sclerotherapy: A chemical solution is injected

directly into the hemorrhoid or the area around it. This solution causes a local reaction that damages the blood flow in the hemorrhoids.

• The technique of laser or electrocoagulation techniques: these techniques use special devices to burn hemorrhoidal tissue.

• Hemoroidopeksi with stapler: Interesting mucosal and submucosal tissue distal rectum up to the kind of stapler, so back to the starting position

• In internal hemorrhoids Grade II & IV

• Surgery• Hemoroidektomi:• Indications: Os with chronic complaints,

internal hemorrhoids degree III & IV, recurrent bleeding, anemia is not cured by other therapies

• How to: excision of tissue completely overdone. In anoderm & normal skin without disturbing the anal sphincter.

• Definition: elongated epithelial wound parallel to the axis of the anus.

• Beginning: the epithelium, the old-old: full-thickness rectal mucosa.

• Usually a single, in the line of the posterior• Papillae in the column - edema - hypertrophy• The area next to the aboral fissure also experienced

chronic inflammatory skin with lymph dam & akhirnynya fibrosis. - Skin tag.

• Trias: anal fissure, hypertrophic papillae on the inside, skin tags

• history of constipation, hard stools, severe pain during defecation, fresh blood in the stools

• Digital rectal - tap on the side of the fissure after repeated administration of topical anesthesia

• The exact cause - not known• Factors: large stools passed, improper diet,

previous anal surgery, parturition, abuse laksan

• - Pressure of the anal canal> normal & anal blood drainage in the midline posterior <- hipertonia sphincter and mucosal ischemia

• Eating a diet rich in fiber, drink enough, the topical anesthetic

• Internal sphincterotomy: sphincter of the split on the left side or right side, left fissures, skin tags removed.

• Definition: a collection of pus in the area of the anus and rectum.

• Infections originating in intersfingter level, most likely in one of the anal-gland abscess or widespread intersfingter

• Expansion - up / down, horizontal, or circular• Etiology: pararektum chamber inflammation

caused by bacterial infection usu., Anus skin infection, hematoma, anal fissure, sclerotherapy

• (a) The various types of the spread of the primary locus in the canal zone midanal intersfingter. M.puborectalis has been pleased to be recognized for the sectional. (b) The diagram demonstrates two types of roads where pararektal abscess may form. It is important drainage done the right way. If it is not true, or suprasfingter ekstrasfingter fistula may occur. (c) Diagram illustrating the three plana where deployment occurs circumferential or "horseshoeing", it could happen.

• Inspection and palpation: perianal abscess - which probably blue swelling, pain, heat, fluctuating

• Systemic: fever, • s

• Pain when the abscess is located in or around the anus or perianal skin

• No defecation disorder

• intermuskular abscess in the rectal wall or an abscess may form supralevator

• passing through the internal sphincter into the anal canal or to the contrary by the external sphincter into the fossa iskiorektal

• spread from one place to another in the space intersfingter, supralevator, or iskiorektal fossa, forming a horseshoe abscess complex

• post-anal space should be drained through an incision in the midline of the posterior portion of the external sphincter subcutaneous abscess through to the end koksis, separating the superficial external sphincter and cause pascaa nal space and not roofed extension iskioanal

• Definition: A fistula is an abnormal connection between the 2 places berepitel. Fistula ani is fisula that connects the anal canal to the skin around the anus or to other organs such as the vagina.

• Epidemiology:> 20-40 years old male. 1-2 kasus/1000 people

•Tract located between the surface intersfinkter

•Fistula connect at the level of the fossa intersfinkter memperforasi iskiorektal the external sphincter

•Just like transfinkter, but the loop fistula in the external sphincter penetrated muskula levator ani

•Passage through the fistula from the rectum to the perianal skin without penetrating the sphincter complex

Kriptoglandular gland infection and a small abscess formed

Abscesses can not get out of the gland

nflammation extends to the perineum, anus or entirely

Perianal abscess formed, then a fistula

• Itching around the anus and fistula hole• Irritation or ulcers in the skin around the fistula hole• Fever and general signs of infection• Pain, who gain weight while on the move, defecation, and cough• Bleeding or pus from the fistula orifice constant or unusual

discharge from the anus (outside of the time of defecation) is usually in the form of pus or fluid like liquid blood.

• Pain in the anus• Swelling on the edge of the anus are repeated• Often having anal abscess previously• Ulcers or blisters on the buttocks

• Physical examination:• Inspection: ≥ 1 external opening or fistula

palpable beneath the surface.• Digital rectal examination: palpable induration

of the internal opening of the fistula and

• Guddel's law says if a line is made transversely through the anus, an external opening anterior to this line would lead to a tract of radial straight, when an external opening located posterior to the line will bring to the tract curve and an opening internal kommisura posterior.

• involving the sphincter muscles are slightly primary fistulotomi

• anterior fistula and fistula in women involving a quarter of that half

• laying seton selected rather than primary fistulotomi

• tumors that are often found in the rectum (75%)

• initially -> bulge easily moved, but at later stages there is much induration and ulceration anorektum into walls. Satellite tumor may be found in the skin and lymph nodes inguinal metastases.

• Often these tumors metastasized entered the rectum and sphincter so that in addition to the inguinal lymph nodes no spread to lymph nodes and mesentery perirektal.

• Local and small tumors local excision.• Radiation therapy may be useful as a

palliative effort when the tumor is radiosensitive.

• Radical surgery should be recommended for invasive tumors without spread outside the lokoregional.

• rare, usually alongside the anus.

• Its the same as ulcers rodens upfront.

• Local excision gives good prognosis, for metastasis almost never exist.

• bleeding from the anus or rectum or lump near the anus.

• Pain or pressure in the area around the anus.

• Itching or excrement from the anus.

• Clumps near the anus.• Changes in bowel

habits.

• uses high-powered x-rays or other types of radiation to kill cancer cells.

• The way the radiation therapy -> depending on the type and stage of the cancer being treated

• 2 types ->• External: uses a machine outside

the body to send radiation toward the cancer

• Internal use radioactive elements are sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

• uses drugs to stop the growth of cancer cells, to eradicate the cells or by stopping the cells to divide

• How to chemotherapy depends on the type and stage of the cancer being treated

• Procedure: the tumor is cut from the anus along with some of the surrounding healthy tissue.

• may be used if the cancer is small and has not spread.

• This procedure may save the sphincter muscles so the patient can still control bowel movements (bowel movements).

• Tumors that develop on the bottom of the anus can often be removed with local resection.

• Procedure: anus, rectum, and part of the sigmoid colon removed / removed through an incision made in the abdomen.

• Doctors sewed end of the intestine to the opening (mouth), called a stoma, created on the surface of the abdomen so that the disposal of the body can be collected in a disposable bag outside the body. This is called colostomi