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FISURA ANAL

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Eva Rodriguez

on 1 September 2013

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Transcript of FISURA ANAL

FISURA ANAL
Eva Lizzett Rodriguez Mendoza
La fisura anal es un desgarro
en el anodermo distal a la
línea dentada
AGUDAS
CRONICAS
MENOS DE 6 SEMANAS
SUPERFICIALES
BORDES BIEN DEFINIDOS
JOVENES AMBOS SEXOS
"TRIADA DE BRODIE"
MAYOR A 6 SEMANAS
BORDES QUERATINIZADOS
80 - 90 % linea media posterior
10% linea media anterior
1% multiples fisuras
más frecuente en mujeres
D. F. Altomare, G. A. Binda, S. Canuti, V. Landolfi, M. Trompetto and R. D. Villani; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


crhon
sífilis
ETS
herpes
cáncer anal
tuberculosis
D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6;
The management of patients with primary chronic anal fissure: a position paper;
Tech; Coloproctol. 2011 June; 15(2): 135–141.
Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


Karen N. Zaghiyan, M.D.1 and Phillip Fleshner, M.D.Copyright and License information Anorectal Disease Guest Editor Gerald A. Isenberg, M.D.Anal Fissure Clin Colon Rectal Surg. 2011 March; 24(1): 22–30.doi: 10.1055/s-0031-1272820
El estreñimiento con el paso de heces duras
Trauma anal
Diarrea Acuosa
Karen N. Zaghiyan, M.D.1 and Phillip Fleshner, M.D.Copyright and License information Anorectal Disease Guest Editor Gerald A. Isenberg, M.D.Anal Fissure Clin Colon Rectal Surg. 2011 March; 24(1): 22–30.doi: 10.1055/s-0031-1272820
Diagnóstico
DOLOR
ardiente
intenso
"hoja de afeitar o vidrio roto"


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


después o durante la defecación.



D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


SANGRADO
EXPLORACIÓN
La mayoría visibles a la divergencia de los glúteos
en algunos casos solo es posible ver la lesión con anoscopio
D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


Tratamiento
conservador
terapia farmacológica
cirugía
D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


dieta
laxantes formadores de masa/laxantes osmóticos
baños de asiento
anestésicos locales



D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7


Nitratos tópicos
trinitrato de glicerina (GTN) metabolismo celular para liberar óxido nítrico (NO) funciona como un neurotransmisor inhibidor en el esfínter anal interno del que resulta en relajación
terapia de primera linea
tasa de curación del 59-86%
0.2 y 0.4%

Karen N. Zaghiyan, M.D.1 and Phillip Fleshner, M.D.Copyright and License information Anorectal Disease Guest Editor Gerald A. Isenberg, M.D.Anal Fissure Clin Colon Rectal Surg. 2011 March; 24(1): 22–30.doi: 10.1055/s-0031-1272820

D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7

ANTAGONISTAS DE CALCIO
Bloqueadores de los canales de calcio (BCC) relajan el esfínter anal interno mediante el bloqueo de la entrada de calcio en el citoplasma de la musculatura lisa
nifedipina (0,2 a 0,5% en gel) y diltiazem (2% crema) promover la curación de fisuras por la disminución de la presión anal en reposo
Karen N. Zaghiyan, M.D.1 and Phillip Fleshner, M.D.Copyright and License information Anorectal Disease Guest Editor Gerald A. Isenberg, M.D.Anal Fissure Clin Colon Rectal Surg. 2011 March; 24(1): 22–30.doi: 10.1055/s-0031-1272820
Toxina botulinica
reducción en el tono del EAI
recurrencia 40-55% en 3-4 años
eventos adversos, tales como la incontinencia fecal (10%) , hematomas, infecciones y subcutánea
Karen N. Zaghiyan, M.D.1 and Phillip Fleshner, M.D.Copyright and License information Anorectal Disease Guest Editor Gerald A. Isenberg, M.D.Anal Fissure Clin Colon Rectal Surg. 2011 March; 24(1): 22–30.doi: 10.1055/s-0031-1272820
Esfinterotomía lateral interna ( LIS ) , realizado con una técnica abierta o cerrada , implica una incisión del esfínter interno , más o menos extendida , distal a la línea dentada , con la posible escisión del ganglio centinela y las papilas hipertrofiado
Standar de Oro
D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7
D. F. Altomare, 1 G. A. Binda,2 S. Canuti,3 V. Landolfi,4 M. Trompetto,5 and R. D. Villani6; The management of patients with primary chronic anal fissure: a position paper; Tech; Coloproctol. 2011 June; 15(2): 135–141. Published online 2011 May 3. doi: 10.1007/s10151-011-0683-7
Gracias
"El nacimiento de Cristo"
Paul Gauguin
1896
"CUARTO DE ARLES"
Van Gogh
"JUGADORES DE CARTAS"
Paul Cezanne
"LA NOVIA DEL VIENTO"
Oscar Kokoschka
Full transcript