Office Examinations for Basic Anorectal Disorders Junichi Iwadare 1 1Colorectal Disease Center, Social Insurance Central General Hospital Keyword: 直腸肛門診察 , 直腸肛門部の解剖 , 痔核 , 痔瘻 , 裂肛 pp.1225-1237
Published Date 2003/8/25
DOI https://doi.org/10.11477/mf.1403100767
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 Proper understanding of frequent anorectal lesions and sufficient anorectal examinations are crucial for accurate differential diagnosis of anorectal disorders. Care must be taken not to let patients unnecessarily feel embarrassment, fear, anxiety, or pain when the anorectal examinations are performed. The order of the standard office anoarectal examinations are as follows history taking, inspection, digital examination, anoscope, and romanoscope. Of these, especially digital examination and anoscope are important.

 Most frequent lesions of the anus are hemorrhoids(developed submucosal cushion causing bleeding or prolapsing), anal fistula(acquired tracts connected to the anorectal lumen), and anal fissure(tear of the anoderm in which blood flow is poor). Hemorrhoids and anal fissures are diagnosed mainly by using an anoscope, and anal fistulas are confirmed by careful digital examination. Differential diagnosis of anal fistulas includes hidradenitis suppurativa, pilonidal sinus, necrotizing fasciatis, and fistula cancer. Differential diagnosis of hemorrhoids includes malignant melanoma and polypoid type of mucosal prolapse syndrome. Differential diagnosis of cancer includes ulcerative type of mucosal prolapse syndrome and lipoglanuloma. Differential diagnosis of pruritus ani includes Paget's disease and Bowen's disease.

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