Treatment of anal incontinence


Q) Newest treatment for anal incontinence?
a. Sacral nerve stimulation
b. Artificial sphincter.
c. Repair of sphincter
d. Gluteus maximus graft

More Questions 

Answer a)

Sacral nerve stimulation is the newest modality in treatment for anal incontinence. In it electrodes are placed via the sacral foramina. The nerve supply of anal sphincter is similar to lower extremity so their stimulation can lead to contraction of various foot muscles.

Others are all older methods

Shackelford page 1779

Colon Bleeding

Q) True statement about  colonic bleeding:

a) Bleeding from diverticulitis is severe and often requires interventional procedures to stop it

b) In colitis risk of brisk bleeding is less and diarrhea is absent

c) In haemaorrhoids haemodynamic compromise is rare

d) Bleeding from angiodysplasia is always slight and managed endoscopically

Answer

Q) 75 year old man complains of obstipation for 2 days. He has taken laxatives but continues to have worsening pain and distension associated with vomiting. He underwent b/l knee replacement  2 weeks back. He was on Inj fentanyl for pain control. He is on antihypertensives and lipid lowering agents for the past 15 years.

On examination  he is afebrile, oriented, pulse rate of 100 min/, BP 120/60 and abdomen is distended with mild tenderness. There are no signs of peritonitis, bowel sounds are sluggish.

TLC is 6,500, and  potassium is 3.2 . All other blood tests are normal. X ray abdomen and CT abdomen shows dilated large bowel loops and oral contrast upto splenic flexure.

What is the probable diagnosis

a) Ischemic colitis

b) CMV colitis

c) Colonic Pseudoobstruction

d) Caecal volvulus

Answer for premium members

Hirchsprung’s disease

Q) False statement about Hirchsprung's disease is:

a) Male and Female have equal incidence

b) In approximately 8% of the patients entire colon is affected

c) After surgery constipation is the most common problem

d) Down syndrome can be seen in up to 3-5% patients 

Answer

a

Hirchsprung's  disease is a developmental disorder characterized by absence of ganglion cells in both Auerbach's and Meissner's plexus and males are more frequently affected than females

Absence of these ganglion  cells lead to a very tight anal sphincter with resultant constipation.

This aganglionosis which is similar to Achalasia cardia  begins at anorectal junction and involves rectosigmoid in 80% and entire colon in 8% of cases.

Various surgical options like Duhamel, Swenson and Soave procedures can be done and in all constipation is a common problem

Down's syndrome is associated in 5%

Ref: Sabiston 20th edition page 1876