Coloproctology: Diagnosis and Outpatient Management by John Nicholls MChir, FRCS, Richard Glass MS, FRCS (auth.)

By John Nicholls MChir, FRCS, Richard Glass MS, FRCS (auth.)

In this age of specialization so much sufferers with illnesses of the hind intestine and anus are nonetheless controlled by way of basic physicians or surgeons. The speciality of coloproctology has grown from the artwork of 'anology', a learn of stipulations restricted to that distance from the anal verge which may be inspected simply via torch- or candlelight or by means of an easy speculum. centuries in the past many proctological ills have been usually handled via itinerant quacks, partially as the health care professional thought of himself really too grand to meddle round the anus and the clinical career more often than not tended to appear down on those that studied anal disorder. this present day, in convinced international locations, coloproctology has turn into a speciality every piece as unique as urology or orthopaedic surgical procedure, with its personal education programme and examinations, often undertaken after the tip of common surgical education. Such super-specialization has indisputable merits with swiftly advancing know-how and healing percentages. there is not any doubt that for the sufferer being affected by a low rectal carcinoma or critical inflammatory bowel disorder there are benefits in being handled by way of surgeons who're facing a number of instances in a yr instead of through a basic health professional who sees such difficulties really infrequently. Such really expert colorectal surgical procedure devices makes strong feel medically and economically in huge centres of inhabitants with sturdy communications.

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Extra resources for Coloproctology: Diagnosis and Outpatient Management

Sample text

Examination of extensive pelvic tumours may indicate involvement of other structures and help the surgeon to assess operability or to plan the extent of resection. It is also useful in identifying liver metastases or areas of recurrent tumour. Colonoscopy Colonoscopy is the most accurate method of investigating the large bowel mucosa and has the advantage over barium enema that tissue can be obtained for histological examination. It is, however, more time-consuming and in about 200,10 of patients it is technically impossible to examine the entire cdlon owing to redundancy or flexures in the bowel or to stricture formation.

It is also useful in identifying liver metastases or areas of recurrent tumour. Colonoscopy Colonoscopy is the most accurate method of investigating the large bowel mucosa and has the advantage over barium enema that tissue can be obtained for histological examination. It is, however, more time-consuming and in about 200,10 of patients it is technically impossible to examine the entire cdlon owing to redundancy or flexures in the bowel or to stricture formation. There is no indication for diagnostic colonoscopy if the barium enema examination is satisfactory and adequate for a clinical decision.

While it may not be logistically possible to examine all new patients, there are two strong indications for the examination: first where symptoms suggest a neoplasm but rigid sigmoidoscopy is negative, and secondly in cases of proctitis where the proximal extent of the inflammation cannot be determined by rigid sigmoidoscopy. It is also desirable that patients with an increased risk of having a carcinoma should be examined, including those with a previous history of adenoma or carcinoma, and with a family history of large bowel cancer.

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