Anorectal Sinuses, Fistulae/ #Fistula #Fissure, Rectal Bleeding

I was searching for some information and happened to run across this "different" online manual that almost explains how you would treat and perform certain surgeries for various gastrointestinal problems. They write it up in laymans terms maybe in order to understand the material.  They give minimal instruction on how to actually do each procedure/surgery (as this is probably a good thing, some of the broad details are difficult to read)  

When I was done reading the Proctology section, I went to the Home page which is states the following about this manual  The manual contains the collective views of an international group of experts. The methods and techniques described correspond to the state of the art with regard to their feasibility in rural hospitals, where sophisticated technical equipment may not be available. These manuals cannot, however, replace personal instruction by a qualified expert. Neither the editors, nor the publisher may be held responsible for any damage resulting from the application of the described methods. Any liability in this respect is excluded.:  http://www.meb.uni-bonn.de/dtc/primsurg/index.html

Volume One: Non-trauma

Nelson Awori, Anne Bayley, Alan Beasley, James Boland, Michael Crawford, Frits Driessen, Allen Foster, Wendy Graham, Brian Hancock, Branwen Hancock, Gerald Hankins, Neville Harrison, Ian Kennedy, Julius Kyambi, Samiran Nundy, Joe Sheperd, John Stewart, Grace Warren, Michael Wood 
Edited by Maurice King, Peter C. Bewes, James Cairns, Jim Thornton
Online Edition on special wish of the editors Maurice King and Peter C. Bewes expressed on the 8th. DTC Symposium in Jena 1999;
realisation by : Bernd Michael Schneider, Gustav Quade, Jürgen Quade, H. Woltering, P. Sommer, and B.D. Domres
The production of this manual on Surgery was sponsored by the German Federal Ministry for Economic Co-operation within the scope of the Technical Co-operation Agreement with the Republic of Kenya, under project number 78.2048.3-01.100. It was compiled by Maurice King Peter Bewes, James Cairns, and Jim Thornton in close collaboration with Kenyan and other experts. 
The manual contains the collective views of an international group of experts. The methods and techniques described correspond to the state of the art with regard to their feasibility in rural hospitals, where sophisticated technical equipment may not be available. These manuals cannot, however, replace personal instruction by a qualified expert. Neither the editors, nor the publisher may be held responsible for any damage resulting from the application of the described methods. Any liability in this respect is excluded.

Das Copyright ^© und alle Rechte für 'Primary Surgery' liegen bei der Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH und bleiben unberührt.
"GTZ does not accept any liability or give any guarantee for the validity, accuracy and completeness of the information provided in this title. GTZ assumes no legal liabilities for damages, material or immaterial in kind, caused by the use ore non-use of provided information or the use of erronenous or incomplete information."
we thank GTZ for giving us the revocable rigth for distributing this information for non-profit purpose according to the above mentioned wishes of the editors M. King and P.Bewes as expressed on the general assembly of the 8th DTC Symposium in Jena on 13th 11.1999 and thank the team of AGKM Uni Tuebingen; for the support during the implementation and G. Quade for the technical support provided during the realisation of this online - project.

Blocking Tumor-Elicited Inflammation & The Impact on Cancer Growth

Interesting short article published in Nature.  It discusses how tumor-associated inflammatory reaction can lead to cancer, but what happens when this inflammatory response is disrupted, blocked, interrupted?  Something to think about.

Blocking Tumor-Induced Inflammation Impacts Cancer Development The findings are published in the October 3, 2012 Advanced Online Edition of Nature.

Oct. 3, 2012 — Researchers at the University of California, San Diego School of Medicine report the discovery of microbial–dependent mechanisms through which some cancers mount an inflammatory response that fuels their development and growth.

The association between chronic inflammation and tumor development has long been known from the early work of German pathologist Rudolph Virchow. Harvard University pathologist Harold Dvorak later compared tumors with “wounds that never heal,” noting the similarities between normal inflammation processes that characterize wound- healing and tumorigenesis or tumor-formation.

Indeed, 15 to 20 percent of all cancers are preceded by chronic inflammation – a persistent immune response that can target both diseased and healthy tissues. Chronic hepatitis, for example, may result in hepatocellular carcinoma (liver cancer) and inflammatory bowel disease can eventually cause a form of colon cancer, known as colitis-associated cancer.

Colonoscopy (biopsy and polyp removal) & Screening Guidelines

Colonoscopy (biopsy and polyp removal):

Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible fiberoptic or video endoscope. The colon begins in the right-lower abdomen and looks like a big question mark as it moves up and around the abdomen, ending in the rectum. It is 5 to 6 feet long. The colon has a number of functions including withdrawing water from the liquid stool that enters it so that a formed stool is produced.

Equipment | Reasons for the Exam | Preparation | Procedure | Results

Benefits | Alternatives | Side Effects and Risks | Summary

Equipment

The flexible colonoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the colon. Colonoscopes now come in two types. The original purely fiberoptic instrument has a flexible bundle of glass fibers that collects the lighted image at one end and transfers the image to the eye piece. The newer video endoscopes use a tiny, optically sensitive computer chip at the end. Electronic signals are then transmitted up the scope to a computer which displays the image on a large video screen. An open channel in these scopes allows other instruments to be passed through in order to perform biopsies, remove polyps, or inject solutions.

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Reasons for the Exam

There are many types of problems that can occur in the colon. A patient's medical history, physical exam, laboratory tests and x-rays can provide information useful in making a diagnosis. However, directly viewing the inside of the colon by colonoscopy is usually the best exam. Colonoscopy is used for:

• Colon cancer - a serious but highly curable malignancy
• Polyps - fleshy tumors which usually are the forerunners of colon cancer
• Colitis (Ulcerative or Crohn's) - chronic, recurrent inflammation of the colon
• Diverticulosis and Diverticulitis - pockets along the intestinal wall that develop over time and can become infected
• Bleeding lesions - bleeding may occur from different points in the colon
• Abdominal symptoms, such as pain or discomfort, particularly if associated with weight loss or anemia
• Abnormal barium x-ray exam
• Chronic diarrhea, constipation, or a change in bowel habits
• Anemia

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Preparation

To obtain the full benefits of the exam, the colon must be clean and free of stool. The patient will receive instructions on how to do this. It involves drinking a solution which flushes the colon clean or taking laxatives and enemas. Usually the patient drinks only clear liquids and eats no food for the day before the exam. The physician will advise the patient regarding the use of regular medications during that time.

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Procedure

Colonoscopy is usually performed on an outpatient basis. The patient is mildly sedated, the endoscope is inserted through the anus and moved gently around the bends of the colon. If a polyp is encountered, a thin wire snare is used to lasso it. Electrocautery (electrical heat) is applied to painlessly remove the ployp. Other tests can be performed during colonoscopy, including biopsy to obtain a small tissue specimen for microscopic analysis.

The procedure takes 15 to 30 minutes and is seldom remembered by the sedated patient. A recovery area is available to monitor vital signs until the patient is fully awake. It is normal to experience mild cramping or abdominal pressure following the exam. This usually subsides in an hour or so.

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Results

After the exam, the physician explains the findings to the patient and family. If the effects of the sedatives are prolonged, the physician may suggest an appointment at a later date. If a biopsy has been performed or a polyp removed, the results of further analysis may not be available for three to seven days.

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Benefits

A colonoscopy is performed to identify and/or correct a problem in the colon. The test enables a diagnosis to be made and specific treatment can be given. If a polyp is found during the exam, it can be removed at that time, eliminating the need for a major operation later. If a bleeding site is identified, treatment can be administered directly and accurately to stop the bleeding. Other treatments can be given through the endoscope when necessary.

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Alternatives

Alternative tests to colonoscopy include a barium enema or other types of x-ray exams that outline the colon and allow a diagnosis to be made. Study of the stools and blood can provide indirect information about a colon condition. These exams, however, do not allow direct viewing of the colon, removal of polyps, or the completion of biopsies.

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Side Effects and Risks

Bloating and distension typically occur for about an hour after the exam until the air is expelled. Serious risks with colonoscopy, however, are very uncommon. One such risk is excessive bleeding, especially with the removal of a large polyp. In rare instances a tear in the lining of the colon can occur. These complications may require hospitalization and, rarely, surgery. Quite uncommonly a diagnostic error or oversight may occur.

Due to the mild sedation, someone must be available to drive the patient home. The driver may leave, but must be available by mobile phone. The patient should not drive or operate machinery following the exam.

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Summary

Colonoscopy is an outpatient exam that is performed with the patient lightly sedated. The procedure provides significant information used to diagnose a colon condition and determine which specific treatment should be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications rarely occur from colonoscopy. The physician can answer any questions the patient may have.  

This material is provided by Medical Schedule, Inc and does not cover all information and is not intended as a substitute for professional medical care. Some of this material may have been adapted from materials provided both online and in print by other reputable medical resources.

Screening Guidelines

Screening Guidelines

Risk Procedure Onset Frequency 1. Asymptomatic low risk Digital and fecal occult blood Age 40 Yearly Sigmoidoscopy Age 50 3-5 years 2. Asymptomatic high risk Fecal occult blood Age 35 Yearly Colonoscopy or barium enema and sigmoidoscopy Age 40 3-5 years 3. Familial adenomatous polyposis Sigmoidoscopy Age 10 Yearly until adenomatous age 40; then polyposis follow asymptom atic high- risk guidelines 4. A. Ulcerative colitis (pancolitis) Colonoscopy Disease years 7 and 8 Every 2 years until 20 years of disease; then annually B.Ulcerative left-sided colitis (or Crohn's colitis) Colonoscopy Disease year 15 Every 2 years 5. Symptomatic patient Barium enema orcolonoscopy (preferred if bleeding, occult blood, or melena) -- 6. A. Polyp surveillance (adenoma) Colonoscopy -- Yearly until colon cleared; then every 3-5 years B. Hyperplastic Colonoscopy -- Repeat colonoscopy in one year; then revert to asymptom atic low risk if colon cleared Colorectal cancer Surveillance After Resection A. If colonoscopy Colonoscopy or barium or barium enema enema cleared colon preoperatively -- One year post-operatively; then every 3 years if colon cleared B. If colon not cleared pre-operatively by barium enema or colonoscopy Colonoscopy or barium enema -- Within 6 months; then every 3 years if colon cleared Surgical Treatment of Colorectal Cancer The most effective treatment of colorectal cancer is surgical removal. In the special case of small cancers found in polyps, removal of the polyp may be the only treatment needed; however, this type of treatment is recommended only after careful review of the pathology and with surgical consultation. Abdominal Surgery Most colorectal cancers are removed by an abdominal operation. The vast majority are done without the need for a colostomy. Surgery is the primary treatment for colorectal cancer because when it is performed for cure, it completely removes the primary cancer and allows for the staging, or evaluation, of the risks for cancer spread. Even if the cancer has spread, surgery will provide the best opportunity to relieve uncomfortable symptoms and prevent either bowel obstruction or bowel bleeding. Sections of the colon and rectum are removed along with the lymph glands that are associated with the particular part of the bowel. Team Approach Although surgery is the primary therapy for colorectal cancer, a team approach is essential for continuing care. Each colorectal cancer patient has their case discussed at a weekly meeting. At this meeting, colorectal surgeons, medical oncologists, radiation oncologists, pathologists, gastroenterologists and clinical nurse specialists review the treatment plans for each patient. These plans include a review of the most recent techniques and clinical studies that may benefit the patient.

This material is provided by Medical Schedule, Inc and does not cover all information and is not intended as a substitute for professional medical care. Some of this material may have been adapted from materials provided both online and in print by other reputable medical resources.

'via Blog this'

Swallowing a PillCam Colon Capsule *Many more benefits than colonoscopy*

How exciting!  A camera pill or colonoscopy?.... Pill/Scope? It's a given what people would choose if given the option.  

Does this mean we don't have to struggle to drink that nasty tasting drink or make a day of sitting on our most used seat (you know what seat I'm talking about).  I've had so many colonoscopies that they don't bother me anymore and the prep isn't even that bad either.  For some people, being scoped is a nightmare and some people actually refuse to have a colonoscopy because of the embarrassment of the whole procedure.  

Well, this PillCamera that is swallowed will make screening a breeze.  I bet more people would agree to the pill method and follow through with the screening.   It's said to be more effective at locating polyps and masses, it's non invasive and there's no need for sedation.  Awesome!! 

(RTTNews) - Given Imaging Ltd. (GIVN:News ) Wednesday reported positive data from the European multicenter study of PillCam COLON 2 confirming that the second-generation PillCam COLON capsule has higher sensitivity for colorectal polyp detection than the first generation technology.

Colon capsule endoscopy is a non-invasive, painless technology that can visualize the colon without sedation orair insufflation, potentially making it an excellent tool for encouraging broader compliance with colorectal cancer screening guidelines.
The study was conducted at eight European sites compared colon capsule endoscopy with conventional colonoscopy for the detection of colorectal polyps or masses greater than or equal to 6 mm in size in a cohort of patients at average or increased risk of colorectal neoplasia.
The goal of the study was to determine the feasibility, accuracy and safety of the upgraded PillCam COLON capsule by comparing it directly with colonoscopy. Per-patient colon capsule endoscopy sensitivity for polyps 6 mm and over and those 10 mm and over was 84 percent and 88 percent, with specificities of 64 percent and 95 percent, respectively.
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by RTT Staff Writer

IBS - More common among women than men

Dr Parul R Sheth

Posted On Monday, May 02, 2011   

Rekha Naik, 35 years old is suffering from irritable bowel syndrome (IBS) for the past ten years. “I have been having digestive problems for so long; almost life-long! Every time I eat, I get heartburn, abdominal distension and cramps. I am so tired and I feel miserable,” states Rekha. Like Rekha there are many people who may be inflicted with IBS. For some the signs and symptoms of IBS may be mild but could be disabling for others.

According to Dr OP Kapoor, Hon Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai and Dr Sharad Shah, Hon Gastroenterologist, Sir HN Hospital, Mumbai, IBS when properly diagnosed affects 15-20% of our population and people with IBS form nearly 50% of the cases seen in gastrointestinal clinics all over the world.

The good part is that even though the effects of IBS are uncomfortable and can be hard to live with, the disorder will not permanently harm the intestines or lead to a more-serious disease as reported by The National Digestive Diseases Information Clearinghouse, NIH, Bethesda, Maryland, US.

More common in women
According to the National Institutes of Health, IBS is two times more common in women than in men and people with IBS seem to have colons that are more sensitive and reactive than usual, so they respond to triggers that would not bother most people. Genetics and heredity plays a role. You may be at a higher risk of IBS if it runs in the family although you cannot predict whether a child of an affected parent will develop the disease. But the chances are about one in twenty that a blood relative also has IBS; either Crohn’s disease or ulcerative colitis.

For many women IBS worsens during or around the menstrual period suggesting the role of hormonal changes in causing IBS. A research team from London and Japan led by Professor Qasim Aziz, of the Wingate Institute for Neurogastroenterology, Queen Mary University of London found that women have more intense responses to pain of chronic conditions such as IBS than men.

Dr Philip Abraham, consultant gastroenterologist and hepatologist, PD Hinduja National Hospital, Professor, Department of gastroenterology, KEM Hospital, Mumbai puts up his views that there is a notable difference in India; it occurs more frequently in men as compared to women, which is the opposite of what is reported from elsewhere in the world. This may be either because men are truly more commonly affected or that they report to doctors with a lower threshold.

Signs of IBS

• Abdominal pain or cramping
• Diarrhoea or constipation, at times alternating bouts of constipation and diarrhoea
• Gas, flatulence, a bloated feeling
• Mucus in the stool

What happens and why?Wrong diet habits, certain foods, medications, anxiety, overwork and stress - all can trigger IBS. Up to 40% of people with IBS may have lactose intolerance; inability to digest the sugars found in milk and milk products. Sometimes other illnesses, such as an acute gastroenteritis can act as a trigger. A weak immune system may be responsible in triggering IBS.

The causes of IBS are not known. It affects the large intestine or colon causing irregular bowel movements. The walls of the intestines are lined with muscle layers. As the food that you eat moves from your stomach to the intestines and into your rectum, these muscles contract and relax in co-ordination.  With IBS the muscle contractions become stronger and last longer than normal causing the food to be forced through your intestines more quickly resulting in gas, bloating and diarrhoea.

At times with IBS, the opposite occurs when the food passage slows, stools become hard and dry giving rise to constipation. Problems with your nervous system or colon also may make you experience more discomfort.