Hemorrhoidectomy is a surgery to remove hemorrhoids - enlarged veins that is found in and around the rectum and anus. Hemorrhoids may result from straining frequently due to constipation or child birth. Hemorrhoids can be classified into two types namely - external and internal. While external hemorrhoids occur below the anal sphincter and protrude at the anus, internal hemorrhoids occur above the anal sphincter and may be classified as first, second, third or fourth degree. External thrombosed hemorrhoids cause pain and they contain clotted blood. Normally the thrombosed external hemorrhoids are incised and the clot evacuated.
Hemorrhoidectomy becomes necessary when conservative measures fail to alleviate the severe burning, itching, swelling, protrusion, bleeding and pain in the anal area. Hemorrhoidectomy becomes appropriate when there are very large internal hemorrhoids, sometimes when internal hemorrhoids continue to cause symptoms after surgical treatment, when large external hemorrhoids cause significant discomfort in the anal area.
During the surgical procedure of hemorrhoidectomy, general anesthesia or spinal anesthesia is administered on the patient so that no pain is felt. Incisions are made in the tissue around the hemorrhoid. The hemorrhoid is removed and the swollen vein inside the hemorrhoid is tied off to prevent bleeding. The surgical area could either be closed with suture or left open. Surgery is performed using a scalpel, a cautery pencil or laser. Sometimes a circular stapling device is used to remove the hemorrhoid and close the wound. Here no incision is made. The hemorrhoid is lifted and stapled into place in the anal area. Recovery from hemorrhoidectomy may take about two to three weeks.
Normally the patient experiences pain after surgery . The doctor prescribes medicine to alleviate the pain. Some bleeding is normal after hemorrhoidectomy is performed, especially with the first bowel movement. Ice packs are recommended to be applied in the anal area to reduce swelling and pain. Sitz bath, with frequent soaks in warm water helps to relieve pain and muscle spasms. Stool softeners that contain fiber may help to make bowel movements smooth.
Hemorrhoids are found to recur in about 5% after hemorrhoidectomy. Hematoma, incontinence and infection in the surgical area and fecal impaction are some of the early side effects of hemorrhoidectomy. Late problems of hemorrhoidectomy could include stenosis or narrowing of the anal canal, formation of fistula between the anal and the rectal canal and rectal prolapse when the rectal lining slips out of the anal opening.
Angelman syndrome is a neurological disorder predominantly caused in children. It was first discovered by Harry Angelman in 1965. This disorder is also popularly known as the happy puppet syndrome. Angelman syndrome is associated with genetics of the affected person and the symptoms that proceed as a result of it are developmental in origin. Children who are affected by this disorder show delayed developmental characteristics and sometimes impaired functionalities associated with it. Although Angelman syndrome is a rare disorder, studies indicate that one among every forty thousand children born is affected by it. The children are normal at birth but exhibit the symptoms of this disorder gradually.
Clinical Manifestations of Angelman syndrome
The clinical manifestations of the Angelman syndrome are associated with the developing stages of the child after birth. The initial sign are seizures indicating the probability of Angelman syndrome. The first appearance of seizures happens around the age of two. The head size is usually below the average. Mental retardation associated with speech difficulty or total speech impairment along with jerky and quick movements are classical symptoms of the Angelman syndrome.
This disorder is also remarkably noticed by visual facial disorientation such as reduced lip size, wide and constant smiling expression and protruding or prominent chin. Children affected by Angelman syndrome have poor motor skills and also face difficulties in sitting, standing and also walking. Apart from these symptoms, children who are affected by this disorder have strong affinity towards water. Behavior abnormalities such as frequent laughter, hyperactive nature and lack of consistent attention are predominant. Anatomical observations for Angelman syndrome include hypopigmentation, wide mouth with distantly spaced teeth and prominent jaw. People suffering from this disorder also experience heat sensitivity and difficulty in swallowing food.
Diagnosis of Angelman syndrome
The initial diagnosis of the Angelman syndrome is difficult because the symptoms begin to surface around the age of three. Many disorders such as autism have cohesive symptoms like the Angelman syndrome and hence careful analysis of the clinical symptoms and genetic parameters are done to avoid misinterpretation. Genetic testing can be done along with the detection of birth defects in the babies by keeping a track of developmental stages and behavioral patterns. Diagnostic genetic tests such as methylation tests are administered to confirm the Angelman syndrome.
Treatment of Angelman syndrome
Angelman therapy management is predominantly done by effective counseling. Top priority is given to patients who are prone to seizures. Clinical management techniques such as speech therapy, physiotherapy and occupational therapy are done to improve the motor skills. Monitoring and treating epileptic attacks and controlling hyperactive behavior are effective methodologies to treat and manage Angelman syndrome. Consistent monitoring of the general motor skills of the child followed by skills such as learning abilities, self-help and communication can aid in the identification of the disorder at an early stage.
Since sleep disturbance is also a common factor in the Angelman syndrome, consistently monitoring the sleep patterns can help evaluate the condition. Use of hypnotics such as benzodiazepines is recommended only for a short duration as they become addictive after a certain stage. Monitoring young children during the onset of puberty is of much significance as it helps in the effective counseling process involving sexual health and other related issues. Other therapies such as reflexology, hydrotherapy and also music help in the healing process.
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Bibliography / Reference
Collection of Pages - Last revised Date: February 21, 2020