Clinical Measurement in Coloproctology

InhaltsangabeSection 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