الشرخ الشرجي / تعريفه/ أعراضه/ تشخيصه/ علاجه/ مضاعفاته

	الشرخ الشرجي / تعريفه/ أعراضه/ تشخيصه/ علاجه/ مضاعفاته تعريفه / هو تمزق الأغشيه المخاطيه المبطنه لفتحة الشرج ، نتيجة للإمساك غالباً، و تحدث ألالاماً شديدة أثناء التبرز مصحوباً بالنزيف أحياناً ، و تكثر معاناه الأطفال و كبار السن من هذه المشكله بسبب الإمساك و الجفاف و قله تناول الألياف و السوائل خلال اليوم. الأعراض و العلامات / الشعور بالألم الشرجي أثناء و بعد التبرز، مصحوباً بالإمساك المستمر. اختلاط البراز بالدم أحياناُ ، أو وجود قطرات من الدم في الملابس الداخليه بعد انتهاء عمليه التبرز. في الحالات المزمنه عند الإناث البالغات خصوصاً ، قد تظهر أعراض فقر الدم (الأنيميا). الأسباب و عوامل الخطر/ الإمساك المستمر غالباً . قله تناول الفواكه و الخضراروات لاحتوائها على نسب عاليه من الالياف التي تقلل الإمساك. الإسهال إحياناً . التهابات الشرج و قله النظافه و العلاقات المحرمه ، و جفاف منطقة الشرج لأسباب مرضية. الإصابات و الكدمات التي تصيب المنطقة المذكورة. المستوى العمري فالأطفال و كبار السن اكثر الناس عرضة لهذه المشكله ، بالإضافه للنوع فالنساء معرضات لنفس المشكله إثناء الولادة الطبيعيه . التشخيص/ يتم تشخيص هذه الحالات من خلال معرفه التاريخ الصحي و الأعراض و العلامات ، ثم الفحص السريري ، حيث يمكن ملاحظة الشرح الشرجي بالعين دون اجراء أي فحوصات أخرى . العــــــــلاج / يعتمد العلاج على إزاله المسبب الرئيسي للمشكله ، و قد ذكرت أنه الإمساك ، بالاضافه لما يلي : المغاطس ( الجلوس في اناء أو بانيو أو جاكوزي به ماء درجه حرارته 45درجه مئويه) الحقن الشرجيه ، و الأدويه المخففه من الأمساك . النظافه المستمره بالماء الدافء دون استخدام الصابون المهيج. مسكنات الألم و مخففات انقباض العضلات و مضادات المضادات الحيويه الموضعيه. المستحضرات البتروليه المرطبه في حالات الجفاف. البوتوكس قد يستخدم و يعمل على تسريع التئام الشرخ الشرجي. و أخيراً / في حاله عدم كفاءة العلاج الدوائي ، يتم تحضير المريض للجراحه . المضاعفات / الشرخ الشرجي المزمن . فقر الدم ( الأنيميا). مضاعفات الأدويه المستخدمه في العلاج أحياناً . قد يتطور الأمر بسبب الإمساك إلى البواسير. إبراهيم بالحارث

أخوي ابراهيم مشكور ..

وسلـمت يـداك ..

تقبل مروري ..

أختكـ .. حنيــــــــن

شكراًاخ ابراهيم ويعطيك العافيه

دائما مادخل للمنتدى لارى جديدك يا مبدع

ANAL FISSURE

Introduction
An anal fissure (AY-nul FISH-er) is a tear in the anus causing a painful linear ulcer at the margin of the anus. An anal fissure, also known as fissure-in-ano, may cause itching, pain or bleeding. Fissures can extend upward into the lower rectal mucosa; or extend downward causing a swollen skin tab or tag to develop at the anal verge, also known as a sentinel pile

Causes of Anal Fissure

Either extreme constipation or diarrhea, usually combined with nervous tension over a prolonged period of time, may produce anal abrasions, simple slit-like fissures, or acute ulcers at the anal verge. With constipation, this condition is usually caused by the passage of a hard dry stool that tears the anal lining upon defecation. With diarrhea, this condition is usually caused by an over use and over-wiping of an inflamed anal canal

Because of an associated anal crypt infection, causing cryptitis, a fissure, an ulcer, or possibly even an abscess may occur at the superior aspect of the anal canal where it attaches to the lower rectal mucosa

In some patients, the anal fissure doesn't heal and becomes a painful sore that is constantly re-injured or torn with each bowel movement. The fissure usually develops a white fibrous base over time. Additionally, an external anal skin tag called a sentinel pile, and an enlarged papillae at the superior anal margin may develop

A patient can pass shards of undigested material (i.e., stone ground corn chips, and sunflower seed shells) through the anus, tearing the anal skin, thus causing a fissure. Anal fissures also may be secondary to anorectal surgery, proctitis, tuberculosis, or cancer of the anus

Symptoms


An anal fissure, a thin slit-like tear in the anal tissue, is likely to cause itching, pain, and bleeding during a bowel movement. View hemorrhoid gallery for a detailed photo

A fissure produces pain at defecation and persists for hours. A small amount of bright red blood, which may or may not be mixed with stool, is common. A fissure produces pain disproportionate to its size. It is the third most painful common condition affecting the anus; the second most painful condition is an anal abscess, the first most painful condition is recovering from recent anal surgery

Rarely, a spasm of the levator ani muscles, also known as proctalgia fugax, can be associated with chronic anal fissures. This condition may contribute to lack of healing of fissures... or may be caused by it

Diagnosis

Diagnosis can be made by inspection. Closer inspection will frequently reveal a tag or sentinel pile. After gentle separation of the skin of the anal verge, the ulcer usually posterior can be seen. Frequently the fibers of the internal anal sphincter muscle can be seen at the base of this punched-out ulcer. A well-lubricated finger with lidocaine ointment and a small caliber anoscope will help delineate the extent of the lesion. A colonoscope or sigmoidoscope exam might be useful to rule out abscesses, colitis, and other causes of rectal bleeding

A fissure should be distinguished from an ulcer caused by Crohn's disease, leukemia, or malignant tumors, because it is not shaggy, large or indolent. Fissures are seldom multiple. A biopsy can help to determine the diagnosis

Medical Treatment

At least 50 percent of fissures heal by themselves without the need for an operation. The longer that a fissure has persisted over time, the less likely it will be to heal by itself. Oftentimes, acute fissures heal by themselves spontaneously, with good anal hygiene consisting of a thorough cleansing after each bowel movement with cotton and witch hazel. Cleaning gently after bowel movements with thick quilted baby wipes is just as effective as using cotton pads with witch hazel. The use of sitz baths (soaking the anal area in plain warm water for 20 minutes, several times a day) helps to relieve fissure symptoms, but may not actually aid in the healing process. A topical hydrocortisone preparation applied to the folds of the anal verge several times a day will help to relieve symptoms and aids the healing process

A high fiber, well balanced diet, and encouragement of regular normal stools are important in helping to heal the fissure. If pain is severe, an anesthetic ointment can be introduced freely and frequently with the finger, utilizing finger cots

Chemical sphincterotomy has been attempted using a wide range of agents, including nitric oxide and botulinum toxin. Since anal fissures are characterized by spasm of the internal anal sphincter and a reduction in mucosal blood flow, the aim of treatment is to relieve ischemia by reducing resting anal pressure and improving mucosal perfusion

It has been shown that a local application of topical nitrates reduces anal sphincter pressure and improves anodermal blood flow. This dual effect results in fissure healing in more than 80% of patients. The principal side effect is headaches in 20%-100% of cases

It has also been shown that local a local injection of botulinum toxin near the fissure, causes denervation, sphincter muscle weakness, and reduction of resting anal sphincter pressure, which allows the fissure to heal. Fissure healing occurs in more than 60% of patients. The principal side effect is incontinence of flatus and or feces, which last for up to two months in 2% to 21% of cases

Surgical Treatment

When surgical excision is required, the chronic fissure along with the sentinel pile, papilla, and adjacent crypts are dissected free from the underlying muscle. Associated internal and external hemorrhoids are removed. Usually the scar tissue in the posterior anal quadrant is completely denuded. The criteria for excision of fissures are chronicity and association with other anorectal disease such as hemorrhoids, mucosal prolapse, skin tags, enlarged papillae, anal contraction, and diseased crypts

Sometimes, an anal dilation is performed to gently disrupt the scar tissue in the base of the fissure. Other times, cauterization by: laser, electrosurgical, or a chemical (i.e., silver nitrate) method; is used to simply denude or resurface the fissure base, to encourage the growth of new anal tissue

Lateral partial internal sphincterotomy has been utilized for uncomplicated fissures. This surgery consists of a small operation to cut a portion of the anal muscle. This helps the fissure to heal by preventing pain and spasm, which interferes with healing. Cutting this muscle rarely interferes with the ability to control bowel movements

At least 90% of patients who require surgery for this problem have no further trouble from fissures. More than 95% of patients achieve prolonged symptomatic improvement. About 5-percent of patients with fissures are "chronic fissure formers", and for a variety of reasons (i.e., chronic constipation, failure to heal without scar tissue, etc.), will continue to develop new fissures despite all the efforts of medical and surgical treatment

أستاذي ابراهيم بالحارث

يعطيك العافية لهذا الجهد الرائع
وكذلك الشكر موصول لأختي انجل بيرد


ولاكن هل يظهر انتفاخ حول منطقه الشرج ؟

السلام عليكم ورحمة الله وبركاته



أشكرك / " ابراهيم بالحارث " على هذا الموضوع.........




الله يعطيك الصحة والعافيه ...............



أخوك /



الـــعـــا ذ ر