Common Anorectal Disease
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Anorectal Disorders Satish S
Gastroenterology 2016;150:1430–1442 Anorectal Disorders Satish S. C. Rao,1 Adil E. Bharucha,2 Giuseppe Chiarioni,3,4 Richelle Felt-Bersma,5 Charles Knowles,6 Allison Malcolm,7 and Arnold Wald8 1Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia; 2Department of Gastroenterology and Hepatology, Mayo College of Medicine, Rochester, Minnesota; 3Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; 4Division of Gastroenterology and Hepatology and UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 5Department of Gastroenterology/Hepatology, VU Medical Center, Amsterdam, The Netherlands; 6National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, United Kingdom; 7Division of Gastroenterology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia; 8Division of Gastroenterology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin This report defines criteria and reviews the epidemiology, questionnaires and bowel diaries are correlated,5 some pathophysiology, and management of the following com- patients may not accurately recall bowel symptoms6; hence, mon anorectal disorders: fecal incontinence (FI), func- symptom diaries may be more reliable. tional anorectal pain, and functional defecation disorders. In this report, we examine the prevalence and patho- FI is defined as the recurrent uncontrolled passage of fecal physiology of anorectal disorders, listed in Table 1,and material for at least 3 months. The clinical features of FI provide recommendations for diagnostic evaluation and are useful for guiding diagnostic testing and therapy. management. These supplement practice guidelines rec- ANORECTAL Anorectal manometry and imaging are useful for evalu- ommended by the American Gastroenterological Associa- fl ating anal and pelvic oor structure and function. -
Rare Diseases: GI/Metabolic
Rare Diseases: GI / Metabolic Ciara Kennedy, PhD, MBA – Head of Cholestatic Liver Disease David Piccoli, MD – Chief of Gastroenterology, Hepatology & Nutrition, Children’s Hospital Of Philadelphia Our purpose We enable people with life-altering conditions to lead better lives. The “SAFE HARBOR” Statement Under the Private Securities Litigation Reform Act of 1995 Statements included in this announcement that are not historical facts are forward-looking statements. Forward-looking statements can be identified by words such as “aspiration”, “will”, “expect”, “forecast”, “aspiration”, “potential”, “estimates”, “may”, “anticipate”, “target”, “project” or similar expressions suitable for identifying information that refers to future events. Forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, Shire’s results could be materially adversely affected. The risks and uncertainties include, but are not limited to, that: . Shire’s products may not be a commercial success; . revenues from ADDERALL XR are subject to generic erosion and revenues from INTUNIV will become subject to generic competition starting in December 2014; . the failure to obtain and maintain reimbursement, or an adequate level of reimbursement, by third-party payors in a timely manner for Shire's products may impact future revenues, financial condition and results of operations; . Shire conducts its own manufacturing operations for certain of its products and is reliant on third party contractors to manufacture other products and to provide goods and services. Some of Shire’s products or ingredients are only available from a single approved source for manufacture. Any disruption to the supply chain for any of Shire’s products may result in Shire being unable to continue marketing or developing a product or may result in Shire being unable to do so on a commercially viable basis for some period of time. -
Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain
Acta Interna The Journal of Internal Medicine Vol. 6 No. 2 December 2016 Website Journal : http://jurnal.ugm.ac.id/jain Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain Suharjo Broto Cahyono,1 Putut Bayupurnama,2 Neneng Ratnasari,2 Siti Nurdjanah2 1Department of Internal Medicine, Charitas Hospital, Palembang 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Gadjah Mada University-Sardjito General Hospital, Yogyakarta ABSTRAK Gangguan gastrointestinal fungsional (GGIF) mewakili gangguan yang sering dijumpai dan perlu mendapatkan perhatian dalam bidang gastroenterologi. Gangguan ini menyebabkan kecemasan, distress dan morbiditas. Pasien dengan gangguan ini sering memperlihatkan manifestasi klinis secara tumpang tindih. Pasien dispepsia fungsional seringkali tumang tindih dengan gangguan gastrointestinal lain, termasuk nyeri anorektal fungsional. Keadaan tumpang tindih ini dapat menimbulkan keluhan yang makin berat, kualitas hidup yang lebih buruk dan skor somatisasi yang lebih tinggi, dan pasien mengalami kecemasan, depresi atau insomnia lebih sering dibandingkan pasien yang tanpa problem tumpah tindih. GGIF ditegakkan berdasarkan kriteria Rome III dan eksklusi penyakit organik. Pendekatan multimodalitas dibutuhkan dalam mengatasi pasien yang menderita gangguan gastrointestinal fungsional. Pada tinjaun kasus ini, dilaporkan seorang pasien laki laki menderita gangguan dispepsia fungsional dan nyeri anorektal fungsional tidak spesifik. Kata kunci : gangguan -
European Guideline Chronic Pruritus Final Version
EDF-Guidelines for Chronic Pruritus In cooperation with the European Academy of Dermatology and Venereology (EADV) and the Union Européenne des Médecins Spécialistes (UEMS) E Weisshaar1, JC Szepietowski2, U Darsow3, L Misery4, J Wallengren5, T Mettang6, U Gieler7, T Lotti8, J Lambert9, P Maisel10, M Streit11, M Greaves12, A Carmichael13, E Tschachler14, J Ring3, S Ständer15 University Hospital Heidelberg, Clinical Social Medicine, Environmental and Occupational Dermatology, Germany1, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland2, Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany3, Department of Dermatology, University Hospital Brest, France4, Department of Dermatology, Lund University, Sweden5, German Clinic for Diagnostics, Nephrology, Wiesbaden, Germany6, Department of Psychosomatic Dermatology, Clinic for Psychosomatic Medicine, University of Giessen, Germany7, Department of Dermatology, University of Florence, Italy8, Department of Dermatology, University of Antwerpen, Belgium9, Department of General Medicine, University Hospital Muenster, Germany10, Department of Dermatology, Kantonsspital Aarau, Switzerland11, Department of Dermatology, St. Thomas Hospital Lambeth, London, UK12, Department of Dermatology, James Cook University Hospital Middlesbrough, UK13, Department of Dermatology, Medical University Vienna, Austria14, Department of Dermatology, Competence Center for Pruritus, University Hospital Muenster, Germany15 Corresponding author: Elke Weisshaar -
Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-In-Ano, and Rectovaginal Fistula Jon D
PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Jon D. Vogel, M.D. • Eric K. Johnson, M.D. • Arden M. Morris, M.D. • Ian M. Paquette, M.D. Theodore J. Saclarides, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Sur- and submucosal locations.7–11 Anorectal abscess occurs geons is dedicated to ensuring high-quality pa- more often in males than females, and may occur at any Ttient care by advancing the science, prevention, age, with peak incidence among 20 to 40 year olds.4,8–12 and management of disorders and diseases of the co- In general, the abscess is treated with prompt incision lon, rectum, and anus. The Clinical Practice Guide- and drainage.4,6,10,13 lines Committee is charged with leading international Fistula-in-ano is a tract that connects the perine- efforts in defining quality care for conditions related al skin to the anal canal. In patients with an anorec- to the colon, rectum, and anus by developing clinical tal abscess, 30% to 70% present with a concomitant practice guidelines based on the best available evidence. fistula-in-ano, and, in those who do not, one-third will These guidelines are inclusive, not prescriptive, and are be diagnosed with a fistula in the months to years after intended for the use of all practitioners, health care abscess drainage.2,5,8–10,13–16 Although a perianal abscess workers, and patients who desire information about the is defined by the anatomic space in which it forms, a management of the conditions addressed by the topics fistula-in-ano is classified in terms of its relationship to covered in these guidelines. -
Clinical Characteristics and Incidence of Perianal Diseases in Patients with Ulcerative Colitis
Annals of Original Article Coloproctology Ann Coloproctol 2018;34(3):138-143 pISSN 2287-9714 eISSN 2287-9722 https://doi.org/10.3393/ac.2017.06.08 www.coloproctol.org Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis Yong Sung Choi1, Do Sun Kim2, Doo Han Lee2, Jae Bum Lee2, Eun Jung Lee2, Seong Dae Lee2, Kee Ho Song2, Hyung Joong Jung2 Departments of 1Gastroenterology and 2Surgery, Daehang Hospital, Seoul, Korea Purpose: While perianal disease (PAD) is a characteristic of patients with Crohn disease, it has been overlooked in pa- tients with ulcerative colitis (UC). Thus, our study aimed to analyze the incidence and the clinical features of PAD in pa- tients with UC. Methods: We reviewed the data on 944 patients with an initial diagnosis of UC from October 2003 to October 2015. PAD was categorized as hemorrhoids, anal fissures, abscesses, and fistulae after anoscopic examination by experienced proctol- ogists. Data on patients’ demographics, incidence and types of PAD, medications, surgical therapies, and clinical course were analyzed. Results: The median follow-up period was 58 months (range, 12–142 months). Of the 944 UC patients, the cumulative in- cidence rates of PAD were 8.1% and 16.0% at 5 and 10 years, respectively. The incidence rates of bleeding hemorrhoids, anal fissures, abscesses, and fistulae at 10 years were 6.7%, 5.3%, 2.6%, and 3.4%, respectively. The cumulative incidence rates of perianal sepsis (abscess or fistula) were 2.2% and 4.5% at 5 and 10 years, respectively. In the multivariate analyses, male sex (risk ratio [RR], 4.6; 95% confidence interval [CI], 1.7–12.5) and extensive disease (RR, 4.2; 95% CI, 1.6–10.9) were significantly associated with the development of perianal sepsis. -
Update of the Guideline on Chronic Pruritus
Update of the Guideline on Chronic Pruritus Developed by the Guideline Subcommittee “Chronic Pruritus” of the European Dermatology Forum Subcommittee Members: Prof. Dr. Elke Weisshaar, Heidelberg (Germany) Prof. Dr. Sonja Ständer, Münster (Germany) Prof. Dr. Erwin Tschachler, Wien (Austria) Prof. Dr. Torello Lotti, Florence (Italy) Prof. Dr. Johannes Ring, Munich (Germany) Prof. Dr. Laurent Misery, Brest (France) Dr. Markus Streit, Aarau (Switzerland) Prof. Dr. Thomas Mettang, Wiesbaden (Germany) Prof. Dr. Jacek Szepietowski, Wroclaw (Poland) Prof. Dr. Joanna Wallengren, Lund (Sweden) Dr. Peter Maisel, Münster (Germany) Prof. Dr. Uwe Gieler, Gießen (Germany) Prof. Dr. Malcolm Greaves (Singapore) Prof. Dr. Ulf Darsow, Munich (Germany) Prof. Dr. Julien Lambert, Antwerp (Belgium) Members of EDF Guideline Committee: Prof. Dr. Werner Aberer, Graz (Austria) Prof. Dr. Dieter Metze, Münster (Germany) Prof. Dr. Martine Bagot, Paris (France) Dr. Kai Munte, Rotterdam (Netherlands) Prof. Dr. Nicole Basset-Seguin, Paris (France) Prof. Dr. Gilian Murphy, Dublin (Ireland) Prof. Dr. Ulrike Blume-Peytavi, Berlin (Germany) Prof. Dr. Martino Neumann, Rotterdam (Netherlands) Prof. Dr. Lasse Braathen, Bern (Switzerland) Prof. Dr. Tony Ormerod, Aberdeen (UK) Prof. Dr. Sergio Chimenti, Rome (Italy) Prof. Dr. Mauro Picardo, Rome (Italy) Prof. Dr. Alexander Enk, Heidelberg (Germany) Prof. Dr. Johannes Ring, Munich (Germany) Prof. Dr. Claudio Feliciani, Rome (Italy) Prof. Dr. Annamari Ranki, Helsinki (Finland) Prof. Dr. Claus Garbe, Tübingen (Germany) Prof. Dr. Berthold Rzany, Berlin (Germany) Prof. Dr. Harald Gollnick, Magdeburg (Germany) Prof. Dr. Rudolf Stadler, Minden (Germany) Prof. Dr. Gerd Gross, Rostock (Germany) Prof. Dr. Sonja Ständer, Münster (Germany) Prof. Dr. Vladimir Hegyi, Bratislava (Slovakia) Prof. Dr. Eggert Stockfleth, Berlin (Germany) Prof. Dr. -
Prevalence of Functional Disorders of the Bowel, Rectum, and Anus in a Tertiary Urogynecology Population
200 Jelovsek J E1, Barber M D1, Walters M D1, Paraiso M F1 1. The Cleveland Clinic Foundation PREVALENCE OF FUNCTIONAL DISORDERS OF THE BOWEL, RECTUM, AND ANUS IN A TERTIARY UROGYNECOLOGY POPULATION Hypothesis / aims of study Straining is frequently mentioned as a possible etiologic factor in pelvic floor disorders and pelvic denervation. Constipation is a disease that results in frequent straining often seen in patients with pelvic floor disorders. The overall prevalence of constipation in the U.S. population is 14.7%, with 4.6% being functional constipation, 4.6% outlet subtype, 2.1% IBS- constipation subtype, and 3.4% IBS-outlet[1]. The prevalence and clinical subtypes of constipation and other functional bowel, rectal and anal disorders have not been well characterized in women with urinary incontinence (UI) and pelvic organ prolapse (POP). The specific aims of this study were: (1) to determine the prevalence of functional bowel disorders as defined by the Rome II criteria in a tertiary urogynecology clinic, (2) to determine the prevalence of subtypes of constipation, and (3) to determine whether demographic, clinical, or physical exam factors are associated with different types functional bowel, anal, and rectal disorders in patients with prolapse and incontinence. Study design, materials and methods This was a cross-sectional study design. One hundred and fifty consecutive female subjects presenting to a tertiary referral, urogynecology clinic were identified. Demographic, general medical, and physical exam information were collected. The prevalence of functional bowel disorders and functional disorders of the anus and rectum as defined by the Rome II criteria[2] were collected. -
Perianal Abscess in a 2-Year-Old Presenting with a Febrile Seizure and Swelling of the Perineum Gregory M
Oxford Medical Case Reports, 2019;01, 26–28 doi: 10.1093/omcr/omy116 Case Report CASE REPORT Perianal abscess in a 2-year-old presenting with a febrile seizure and swelling of the perineum Gregory M. Taylor, DO* and Andrew H. Erlich, DO Emergency Medicine Physician, Beaumont Hospital, Teaching Hospital of Michigan State University, Department of Emergency Medicine, Farmington Hills, MI, USA *Correspondence address. Beaumont Hospital, Teaching Hospital of Michigan State University, Farmington Hills, MI, USA. E-mail: Gregory.Taylor@ Beaumont.org Abstract An anorectal abscess, specifically a perianal abscess, is a relatively uncommon infection in children. It is a purulent fluid collection under the soft tissue outside the anus. Some of these abscesses may spontaneously drain and heal by themselves, while others may result in sepsis and require surgical intervention. The transition to a systemic illness requiring hospital admission is considered rare. We present the case of a 2-year-old male presenting with a febrile seizure and found to be systemically ill secondary to a perianal abscess. To our knowledge, this is the first case reported in the literature of a febrile seizure secondary to a perianal abscess. INTRODUCTION Vitals on arrival to the ED were as follows: 103.1°F, blood pressure of 96/78 mmHg, respiratory rate 27 breaths/min, heart A perianal abscess occurs most often in male children <1 year rate 126 beats/min, weight 12.8 kg and 100% oxygen saturation of age; however, they can occur at any age and in either sex [1]. on room air. As soon as he was brought back to the treatment In one study, an incidence was reported of up to 4.3% [1]. -
Pruritus Ani (Itchy Bottom)
PRURITUS ANI (ITCHY BOTTOM) What is pruritus ani? Pruritus ani means a chronic (persistent) itchy feeling around the anus. The main symptom is an urge to scratch your anus which is difficult to resist. The urge to scratch may occur at any time. However, it tends to be more common after you have been to the toilet to pass faeces, and at night (particularly just before falling asleep). The itch may be made worse by heat, wool, moisture, leaking, soiling, stress, and anxiety. About 1 in 20 people develop pruritus ani at some stage. It is common in both adults and children. What causes pruritus ani? Pruritus ani is a symptom, not a final diagnosis. Various conditions may cause pruritus ani. However, in many cases the cause is not clear. This is called ‘idiopathic pruritus ani’, which means ‘itchy anus of unknown cause’. Known causes of pruritus ani There are various causes which include the following: Inflamed anal skin is a common cause (a localised dermatitis). The inflammation is usually due to the skin ‘reacting’ to small amounts of faeces (sometimes called stools or motions) left on the skin, and/or to sweat and moisture around the anus. Young children who may not wipe themselves properly, adults with sweaty jobs, and adults with a lot of hair round the anus may be especially prone to this. Thrush and fungal infections. These germs like it best in moist, warm, airless areas, such as around the anus. Thrush is more common in people with diabetes. Other infections such as scabies, herpes, anal warts and some other sexually transmitted diseases can cause itch around the anus. -
Anorectal Disorders
View metadata, citation and similar papers at core.ac.uk brought to you by CORE HHS Public Access provided by Carolina Digital Repository Author manuscript Author ManuscriptAuthor Manuscript Author Gastroenterology Manuscript Author . Author Manuscript Author manuscript; available in PMC 2017 September 25. Anorectal Disorders Satish S. C. Rao1, Adil E. Bharucha2, Giuseppe Chiarioni3,4, Richelle Felt-Bersma5, Charles Knowles6, Allison Malcolm7, and Arnold Wald8 1Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia 2Department of Gastroenterology and Hepatology, Mayo College of Medicine, Rochester, Minnesota 3Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy 4Division of Gastroenterology and Hepatology and UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 5Department of Gastroenterology/Hepatology, VU Medical Center, Amsterdam, The Netherlands 6National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, United Kingdom 7Division of Gastroenterology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia 8Division of Gastroenterology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Abstract This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. -
Curriculum Outline General Surgery
CURRICULUM OUTLINE FOR GENERAL SURGERY 2018–2019 Surgical Council on Resident Education 1617 John F. Kennedy Boulevard Suite 860 Philadelphia, PA 19103 1-877-825-9106 [email protected] www.surgicalcore.org SCORE Curriculum Outline for General Surgery The SCORE® Curriculum Outline for General Surgery is a list of topics to be covered in a five- year general surgery residency program. The outline is updated annually to remain contempo- rary and reflect feedback from SCORE member organizations and specialty surgical societies. Topics are listed for all six competencies of the Accreditation Council for Graduate Medical Education (ACGME): patient care; medical knowledge; professionalism; interpersonal and communication skills; practice-based learning and improvement; and systems-based practice. The patient care topics cover 27 organ system- based categories, with each category separated into Diseases/Conditions and Operations/ Procedures. Topics within these two areas are then designated as Core or Advanced. Changes from the previous edition are indi- cated in the Excel version of this outline, avail- able at www.surgicalcore.org. Note that topics listed in this booklet may not directly match those currently on the SCORE Portal — this outline is forward-looking, reflecting the latest updates. The Surgical Council on Resident Education (SCORE) is a nonprofit consortium formed in 2006 by the principal organizations involved in U.S. surgical education. SCORE’s mission is to improve the education of general surgery residents through the development of a national curriculum for general surgery residency training. The members of SCORE are: American Board of Surgery American College of Surgeons American Surgical Association Association of Program Directors in Surgery Association for Surgical Education Review Committee for Surgery of the ACGME Society of American Gastrointestinal and Endoscopic Surgeons PATIENT CARE CONTENTS Page BY CATEGORY ............................................