Clinical Measurement in Coloproctology

ISBN-13: 9781447118244 / Angielski / Miękka / 2012 / 216 str.

Devinder Kumar; David J. Waldron; Norman S. Williams

Opis

Crucial decisions concerning surgical treatment are often based on the results of various methods used for assessing colorectal function. Yet the new methods which have resulted from recent technological advances are still often regarded as research tools or viewed with skepticism by the practicing physician. New horizons are opened up for the coloproctologist in this book which fully documents the scope of established and recently developed investigative techniques. These include manometry, electromyography, scintigraphy and defaecography. The discussion shows how each technique is conducted and in what way the results can be interpreted and used for the management of patients with colorectal disorders. Specialist areas such as the neorectum and the assessment of the pediatric patient are also included. This book clearly establishes the place of each technique in clinical practice. The text is clear and simple so that not only specialists but also non-specialists will be able to understand and set up the appropriate tests for specific colorectal disorders.

Spis treści

Section I. Morphology and Techniques.- 1. Morphology of the Colon and Anorectum.- Colonic and Anorectal Structure in Animals Other Than Man.- The Relative Extent of the Sacculated Colon.- The Relative Size of the Caecum.- Why Does Colonic Morphology Not Always Reflect Diet?.- Gross Colonic and Anorectal Structure in Humans.- The Parts of the Organ.- The Appendix, Caecum and Ileocaecal Junction in Humans.- The Ascending, Transverse, Descending and Sigmoid Parts of the Colon.- The Rectum and Anal Canal.- The Shape of the Colon and Anorectum in Cross-section.- The Construction of the Wall of the Colon and Anorectum.- The Major Layers of the Wall.- The Mucosa.- The Muscularis Propria.- The Serosa.- The Structure of Smooth Muscle in the Colon and Anorectum.- Smooth Muscle Cells.- The Innervation of the Colon and Anorectum.- The Extrinsic Nerves.- The Intrinsic or Intramural Nerves.- 2. Measurement of Colonic Motor Function.- Overview of Colonic Function.- Early Observations of Colonic Motility: Interspecies Differences.- General Observations of Colonic Function in Man.- Colonic Electromyography.- Neuromuscular Organization of the Human Colon.- Relationship Between Neuromuscular Organization and Myoelectric Activity.- In Vivo Recording of Human Colonic Myoelectric Activity.- Measurement of Colonic Contractile Activity.- Techniques for Recording Colonic Motility.- Basal Colonic Motility.- Colonic Peristalsis.- Future Directions.- Measurement of the Transit of Colonic Contents.- Historical Perspectives.- Rationale of Measures of Colonic Transit.- Which Transit Marker Is Best?.- Combined Measurement of Motility and Transit.- Clinical Measurement of Colonic Function.- Basic Assessment.- Colonic Electromyography.- Colonic Manometry.- Colonic Transit.- 3. Measurement of Anorectal Function.- Manometry.- Methods of Recording Anorectal Manometry.- Short Non-ambulant Anorectal Recordings.- Balloon Systems.- Perfused Catheters.- Effect of Bowel Preparation.- Ambulant Recordings.- Rectal Manometry.- Anal Canal Manometry.- Interpretation of Records.- Normal Values of Anorectal Manometry.- Electromyography.- Physiology.- Patient Position and Electrode Sterilization for Anal Sphincter Electromyography.- Technique of EMG Recording.- Surface Electrodes.- Needle Electrode Recordings, Concentric and Single Fibre.- Analysis of Concentric Needle Motor Unit Potentials.- Analysis of Single Fibre Motor Unit Potentials.- Fibre Density.- Fine Wire Electrodes.- Stimulation Techniques.- Pudendal and Perineal Nerve Terminal Motor Latencies.- Spinal Motor Latencies.- Spinal Latency Ratio.- Contribution of Electromyography to Knowledge of Pelvic Floor Physiology and Pathophysiology.- Relevance of Electromyography to the Practice of Coloproctology.- Dynamic Assessment of Anorectal Function.- Proctography.- Balloon Proctography.- Dynamic Synchronous Proctography.- Scintigraphy.- Proctometrogram.- Balloon Expulsion Tests.- Combined Urinary and Anorectal Assessment.- Conclusion.- The Measurement of Anorectal Sensation.- Sensory Endings in the Anorectum.- Methods of Measurement.- Rectal Sensation.- Anal Sensation.- 4. Measurement of Absorptive and Secretory Function.- In Vivo Techniques.- General Remarks.- Balance Studies.- Bolus Infusions.- Mucosal Dialysis.- Transmucosal Potential Difference (PD).- Perfusion Techniques.- In Vitro Techniques.- General Remarks.- Short-circuit Current Techniques.- Other In Vitro Techniques.- Conclusions.- 5. Histological Measurement in Coloproctology.- Histometric Studies of Human Muscle Biopsies.- Smooth Muscle.- Other Tissues.- Striated Sphincter and Pelvic Floor Musculature.- Conclusions.- Section II. Coloproctological Disorders.- 6. Physiological Mechanisms.- Colonic Propulsive Activity.- Control of Colonic Contractions.- Myogenic Control.- Neurogenic Control.- Colonic and Anorectal Reflexes.- Peristaltic Reflex.- Gastro-colic Reflex.- Sampling Reflex.- Vesicoanal Reflex.- Passage of Flatus.- Mechanism of Defaecation.- Mechanism of Faecal Continence.- 7. Constipation.- General Investigations.- History and Physical Examination.- Dietary Assessment.- Haematological and Biochemical Evaluation.- Radiological Assessment.- Colonoscopy.- EUA and Full Thickness Rectal Biopsy.- Functional Assessment.- Anorectal Manometry.- Position of the Pelvic Floor.- Dynamic Evacuation Studies.- Neurological Assessment of the Pelvic Floor.- Large Bowel Transit Studies.- Intraluminal Manometric Studies.- Colonic Electromyographic Studies.- Upper Gastrointestinal Assessment.- Histological Studies.- Conclusion.- 8. Faecal Incontinence.- Pathophysiology.- Neurological Causes.- Local Sphincter Pathology.- Enteric Causes.- Multifactorial Causes.- Investigation of Faecal Incontinence.- Physiological Investigations.- Electrophysiological Tests.- 9. Neurological Disorders.- Neurological Lesions.- Central Lesions.- Spinal Lesions.- Cauda Equina.- Developmental Anomalies of the Spine.- Spinal Cord Disease.- The Effect of Spinal Anaesthesia and Other Anaesthetic Agents.- Nerve Lesions.- Ganglion Cell Lesions.- Miscellaneous.- 10. Rectal Prolapse, Solitary Rectal Ulcer Syndrome and Haemorrhoids.- Rectal Prolapse.- Clinical Assessment.- Investigations.- Anal Sphincter Function.- Solitary Rectal Ulcer Syndrome (SRUS).- Clinical Assessment.- Investigations.- Haemorrhoids.- Investigations.- 11. The Irritable Colon.- Hypersensitivity of the Colorectum.- Electromyographic Abnormalities in the Colon and Rectum.- Contractile Abnormalities in the Colon and Rectum.- Other Directions.- 12. Pseudo-obstruction.- Clinical Presentation.- Acute Pseudo-obstruction.- Chronic Pseudo-obstruction.- Diagnosis.- Acute Pseudo-obstruction.- Chronic Pseudo-obstruction.- Radiological Investigations.- Manometry.- Transit Studies.- Histopathology.- Treatment.- Acute Pseudo-obstruction.- Chronic Pseudo-obstruction.- Conclusion.- Section III. Anorectal Function Following Surgery.- 13. Neorectum and Assessment of Anorectal Function Following Surgery.- The Operation.- Rationale.- Indications.- Patients.- Technique.- Other Approaches.- Physiology of Ileal Pouch-Anal Anastomosis.- Methodology.- Results.- Anal Canal.- Anorectal Angle and Movements of the Pelvic Floor.- Anorectal and Anoneorectal Sensation and Reflex Mechanisms.- Rectal Anal Sphincter Inhibitory Response.- Neorectal Compliance and Capacity.- Neorectal Motility.- Proximal Small Bowel Motility.- Neorectal Motor Function.- Clinical Usefulness of Physiological Measurements After Beal Pouch—Anal Anastomosis.- Usefulness of Physiological Measurements in Patients with Specific Problems.- Conclusion.- 14. Colo-anal Anastomosis.- Considerations in Sphincter-Saving Surgery (for Rectal Cancer).- Factors Involved in the Recto-anal Continence Mechanism.- Surgical Procedures Associated with Low Pelvic Anastomoses.- Ileo-anal Anastomosis.- Low Anterior Resection.- Pull-Through Colo-anal Anastomosis.- Transanal Colo-anal Anastomosis.- Colonic Pouch—Anal Anastomosis.- Investigation of Poor Function Following Colo-anal Anastomosis.- Anorectal Manometry.- Proctometrogram.- Electromyography of the Pelvic Floor.- Proctography.- Conclusion.- 15. Assessment of the Paediatric Patient.- Anatomy and Physiology.- Equipment, Conduct and Results of Anorectal Physiological Tests.- Equipment.- Preparation of the Child for Testing.- Measurements.- Indications for Anorectal Physiology Tests.- Chronic Constipation With or Without Faecal Soiling.- Segmental Dilatation of the Colon.- Hirschsprung’s Disease (Aganglionosis Coli).- Chronic Intestinal Pseudo-obstruction.- Myelomeningocoele.- Anorectal Anomalies.- Anorectal Trauma.- Rectal Prolapse.- Neuromuscular Diseases.- Conclusion.