proctologie pratique (2)
TRANSCRIPT
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PROCTOLOGIE PRATIQUE
Service de Chirurgie DigestiveCHC
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PROCTOLOGIE PRATIQUE
Service de Chirurgie DigestiveCHC
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PROCTOLOGIE PRATIQUE
Examen CliniqueDouleur Aiguë et traitement
Pathologie Hémorroïdaire
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Anamnèse
• se fait avant l’examen clinique
• conduit souvent au diagnostic par
déduction
• oriente l’examen clinique
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Examen clinique
• dirigé par anamnèse• proctologie: position de Sims• examen proctologique systématique:
inspectionTRanuscopierectoscopie
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Examen clinique: inspection
• anite• hémorroïdes• fissure• abcès, fistule• tumeur• prolapsus• ...
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Anite
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Lésions de grattage
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Prolapsus muco-hémorroïdaire
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Fissure
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Thrombose Hémorroïdaire Externe
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Abcès
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Tumeur
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Prolapsus
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Examen clinique: anuscopie
• exploration visuelle directe du canalanal et du bas rectum
• ne nécessite pas de préparationparticulière
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anuscopie
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Examen clinique: rectoscopie
• exploration visuelle du canal anal, durectum et souvent du colon sigmoïdedistal
• nécessite préparation minimale
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PROCTOLOGIE PRATIQUE
Examen CliniqueDouleur Aiguë et traitement
Pathologie Hémorroïdaire
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Anamnèse: douleur
Hémorroïdes: en fait peu douloureusesen dehors d ’épisodes aigus tels quethrombose ou poussée aigüe.
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Thrombose Hémorroïdaire Externe
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Fissure
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Abcès
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Thrombose Hémorroïdaire Externe
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Traitement
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Traitement
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Fissure Anale
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TRAITEMENT de la fissure anale
traitement médicamenteux classique traitement local original traitement chirurgical
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traitement médicamenteuxclassique
calmer la douleur (médicaments antalgiques ou anti-inflammatoires)
régulariser le transit intestinal (laxatifs)appliquer des agents locaux (suppositoires et crèmes)protéger la paroi du canal anal (crèmes et suppositoires)
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traitement local original
Rp Cedocard 200mgOnguent simple 20g
pf 1 pommadeSp appliquer 4x/j
Durée: 5-6 sem
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traitement chirurgicalsphinctérotomie latérale
interne
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traitement chirurgicalsphinctérotomie latérale
interne
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Abcès anal
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Traitement de l ’abcès anal
Drainage
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PROCTOLOGIE PRATIQUE
Examen CliniqueDouleur Aiguë et traitement
Pathologie Hémorroïdaire
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Clinique
• Hémorragie
• Douleur
• Suintement et prurit
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Maladie évolutive
• 4 stades– Stade I– Stade II– Stade III– Stade IV
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A chaque stade, son (ses) traitement(s)
• Stade I Traitement médical– Mesures hygiéno-diététiques– Phlébotoniques– Injections sclérosantes
• Stade II Injections sclérosantesLigatures élastiquesInfra-rouges(Chirurgie)
• Stade III Ligatures élastiquesChirurgie
• Stade IV Chirurgie
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Mesures hygiéno-diététiques
• Régime alimentaire
• Transit
• Hygiène locale
• Habitudes de vie
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Phlébotoniques
• Anti-inflammatoires
• " Topique hémorroïdaire ", ...
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Injections sclérosantes
• Importance du site de l'injection
• A ne pas renouveler indéfiniment
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Photocoagulation infra-rouge
• Indications:
– Hémorroïdes hémorragiquesnon procidente
– Hémorroïdes procidentes( < LE)
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Ligature élastique• Importance du site de placement• Indications : hémorroïdes II
hémorroïdes III• Contre-indications :
Tout phénomène proctologique aigu• Complications:
Pesanteur - Douleur - HyperthermieRétention urinaire - Hémorragies
• Résultats :80 % patients améliorés 7 % patients → Chirurgie
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CHIRURGIE
• Milligan-Morgan• (Fergusson)• PPH• KM 25
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PROCTOLOGIE PRATIQUE
Examen CliniqueDouleur Aiguë et traitement
Pathologie Hémorroïdaire
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PROCTOLOGIE PRATIQUE
Examen CliniqueDouleur Aiguë et traitement
Pathologie Hémorroïdaire
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