LOWER GASTROINTESTINAL BLEEDING

LOWER GASTROINTESTINAL BLEEDING

Introduction

bleeding may occur from any part from the gut .blood loss may be chronic and occult bleeding resulting in anaemia .overt blood loss varies widely in presentation .excluding haemorrhoidal bleeding .the lower gastrointestinal tract is less commonly a source of overt major
 bleeding than the stomach or duodenum

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TREATMENT OF ANAL FISTULA

TREATMENT OF ANAL FISTULA

treatment strategy consists of drainage of pus collections during acute stage (abscess)and eradication of all fistula tracts with
maximum preservation of sphincter muscles soon afterwardS

FISTULOTOMY WITH OR WITHOUT SPHINCTER REPAIR
fistulous tracts may be eradicated by excision or coring but this is rarely practised nowadays as laying open of tracts with curettage of blind tracts and cavities often achieve si

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CAUSES AND TYPES OF ANAL FISTULA

CAUSES AND TYPES OF ANAL FISTULA

CAUSES OF ANAL FISTULA

Most anal fistula result from pyogenic anorectal abscesses  some are secondary to specific causes such as Crohn,s disease TB or carcinoma rarely they are secondary to actinmomycosis or lymphogranuloma venerum

Clinical features and diagnosis

anal fistula and abscesses

the most frequent symptoms are anal discharge pain and swelling .discharge tend to occur intermittently while swelling and pain are usually associated with abscess formation when the external opening is closed clinical examination may reveal the presence of one or more external openings discharge and soiling of underclothes .bidigital

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Management of deep venous thrombosis

Management of deep venous thrombosis 

preventing first prevention of deep venous thrombosis as 1- general measures early mobilization , hydration 2- mechanical methods graduated compression stockings perioperative pneumatic compression electrical calf stimulation ,intermittent foot compression all reduce the incidence of perioperative DVT 3- pharmacological , warfarin - postoperative bleeding can be troublesme low- dose heparin (5000 in b.d) is effective in

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