بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

3. ANORECTAL ABSCESS An anorectal abscess is caused by obstruction of an anal gland, resulting in retrograde infection. People with regional enteritis or immunosuppressive conditions such as AIDS are particularly susceptible to these infections. Many of these abscesses result in fistulas.

5. ANORECTAL ABSCESS An abscess may occur in a variety of spaces in and around the rectum. It often contains a quantity of foul-smelling pus and is painful: 1. If the abscess is superficial, swelling, redness, and tenderness are observed 2. A deeper abscess may result in toxic symptoms, lower abdominal pain, and fever.

6. ANORECTAL ABSCESS *sits baths and analgesics. *incision and drainage is the treatment of choice. *When a deeper infection exists with the possibility of a fistula, the fistulous tract must be excised. If possible, the fistula is excised when the abscess is incised and drained, *The wound may be packed with gauze and allowed to heal by granulation

7. Anal Fistula An anal fistula is a tiny, tubular, fibrous tract that extends into the anal canal from an opening located beside the anus. Fistulas usually result from: infection. trauma Fissures regional enteritis.

8. Signs and symptoms Pus stool may leak from the cutaneous opening. passage of flatus or feces from the vagina or bladder, depending on the fistula tract Untreated fistulas may cause systemic infection with related symptoms.

9. Anal Fistula *Surgery is always recommended, because few fistulas heal spontaneously. *A fistulectomy is the recommended surgical procedure.

10. Anal fissure Is a longitudinal tear or ulceration Symptom 1.Extremely painful defecation, 2. burning, 3.Bleeding 4.Bright-red blood seen on the toilet tissue

11. Anal Fissure cauuses****

12. Treatment OF ANAL FISSURE conservative measures: which include: stool softeners and bulk agents increase water intake sits baths emollient suppositories. A suppository combining an anesthetic with a corticosteroid helps relieve the discomfort. surgery: If fissures do not respond to conservative treatment lateral internal sphincterotomy with excision of the fissure;

13. HEMORRHOIDS Hemorrhoids are dilated portions of veins in the anal canal. They are very common. By the age of 50, about 50% of people have Hemorrhoids. Shearing of the mucosa during defecation results

14. CLASSIFICATIONS OF HEMORRHOIDS Internal hemorrhoids: Those above, appearing the internal sphincter are called internal hemorrhoids External hemorrhoids: Appearing outside the external sphincter are called external hemorrhoids

15. HEMORRHOIDSsign and symptom **

16. HEMORRHOIDSsign and symptom External hemorrhoids: severe pain from the inflammation and edema caused by thrombosis (ie, clotting of blood within the hemorrhoid). ischemia of the area necrosis. Internal hemorrhoids: Not usually painful until they bleed or prolapse when they become enlarged

17. TREATEMENT OF HEMORRHOIDS Good personal hygiene Avoid excessive straining during defecation A high-residue diet that contains fruit Increase fluid intake Hydrophilic bulk-forming agents such as psyllium and mucilloid Warm compresses Sits baths Analgesic ointments and suppositories

18. TREATEMENT OF HEMORRHOIDS nonsurgical treatments for hemorrhoids *Infrared photocoagulation * bipolar diathermy *lasertherapy are newer techniques that are used to affix the mucosa tothe underlying muscle. *Injecting sclerosing solutions is also effective for small, bleeding hemorrhoids. These procedures help prevent prolapse A conservative surgical treatment of internal hemorrhoid The rubber-band ligation procedure. The hemorrhoid is visualized through the anoscope

19. Assessment health history to determine the presence and characteristics of itching, burning NURSING DIAGNOSES Constipation related to ignoring the urge to deficate Anxiety related to impending surgery and embarrassment Acute pain related to irritation, pressure, and sensitivity in the anorectal area from anorectal disease and sphincter spasms after surgery Urinary retention related to postoperative reflex spasm and fear of pain • Risk for ineffective therapeutic regimen management

20. Planning and Goals Adequate elimination patterns Reduction of anxiety Pain relief Promotion of urinary elimination Managing the therapeutic regimen Absence of complications

21. Nursing Interventions RELIEVING CONSTIPATION REDUCING ANXIETY RELIEVING PAIN PROMOTING URINARY ELIMINATION MONITORING AND MANAGING COMPLICATIONS

22. EvaluationEXPECTED PATIENT OUTCOMES Attains a normal pattern of elimination Is less anxious Voids without difficulty Adheres to the therapeutic regimen Exhibits no evidence of complications