Ilmu & Perianal Suppuration

اَلْعِلْمُ نُوْرٌ اَلنُّوْرُلاَ يُهْدَ ى لِلْعَصِ

“Ilmu adalah cahaya dan cahaya tak masuk dengan kemaksiatan”

– Imam Syafi’i (bukan hadis!)

Lecture; 9 January 2010 : Perianal Suppuration originally by Prof.  Youssri Gaweesh

1st of all, b4 we begin, its important to put in the mindset, that what we are about to learn contains many proofs of how great our Creator is. and try to think that all the knowledge that we gain everyday is coming from Him. always thank Him for giving us the ability to learn and remember. alhamdulillah

1st i think it’s better to start with the anatomy of the anus. the diagram should do the job .

also, we need to know what is suppuration. definition from thefreedictionary.com:

The formation or discharge of pus (A generally viscous, yellowish-white fluid formed in infected tissue, consisting of white blood cells, cellular debris, and necrotic tissue.)

Pathogenesis

in the anus of human, there are anal glands, which present in small amount in the internal sphincter and has no important function (but well developed in some animals like cats and dogs, and function mainly in sexual excitation). however, they may be obstructed by stools, leading to accumulation of secretion plus bacteria coming from the stool, this will lead to infections in the gland. then abscess develops into the intersphincteric space, from where it may expand to adjacent areas.

Classifications (P H L I P S)

classifications depends on the sites where the abscess expands:

1. Perianal

2. High Intersphincteric

3. Low Intersphincteric

4. Ischeorectal

5. Pelvirectal/supralevator

6. Submucus

*the superficial and deep postanal spaces of Courtney which are present posterior to the surgical anal canal in the midline in the loose areolar tissue joini2g the 2 ischeorectal fossae are being questioned. so i won’t put it in the classification for now
the ecpand of the abscess can also occur in circumferential way. but this is limited to spaces which are connected to each other posterior to the surgical anal canal with no septae in between. these are (L I P):
1. Low intersphincteric spaces
2. Ischeorecatal spaces
3. Pelvirectal spaces
Clinical Pictures ( P I P S ):
1. Pain: Throbbing severe pain (especially when sitting down and coughing(due to increase intraabdominal pressure))
2. Induration & Tenderness: local area of induration* and tenderness (around the anus or felt during PR)
3. Pus: Pus discharging from anus or from spontaneous external opening
4. Systemic disturbance: especially the ischeorectal and pelvirectal types due to their large size)
*ALERT!! in cases where the induration is felt, DO NOT wait till fluctuation to occur before seeking treatment. organs that have the ALERT!! sign:
1. Parotid gland.  sign: pitting edema
2. Breast. sign: pitting edema
3. Gluteal and deep muscle. sign: pitting edema
4. Hand. sign: local tenderness
5. ANUS. sign: local induration
Treatment
1. very early cases (only localized tenderness): high dose of quinolone and metronidazole (gram negative spectrum and anaerobe efficiency antibiotics) + sit baths + close follow up
2. presence of induration (low intersphincteric space, perianal and ischeorectal spaces): indicator for incision drainage
3. affection of the high spaces where induration cannot be felt (high intersphincteric and pelvirectal spaces):
examination under anesthesia –> ample drainage of abscess from internal opening and connecting intersphincteric tract + deroofing of the lower intersphincteric space to a wound outside the anus
thats all for now, any editing and additional info must wait for later.
will continue insyaAllah with perianal fistulae
wallahua’alam
….
study tak masuk? hafal tak ingat2? kata2 imam syafi’i kt atas tu mungkin blh menjawab persoalan2 ni.mungkin masa tlh tiba utk kita cek balik diri masing2. muhasabah betul2. muhasabah ni bukan kita nk condem org, tp ia utk manfaat diri sendiri.  pesanan khalifah Umar alKhattab kpd tenteranya yg nk pegi perang ni blh kita amik iktibar:

Sesungguhnya aku memerintahkan engkau dan seluruh tentera yang bersamamu agar bertaqwa kepada Allah swt dalam apa jua keadaan . Sesungguhnya Taqwa adalah sebaik – baik persediaan dan strategi yang paling kuat di dalam peperangan .

Aku perintahkan engkau dan siapa jua yang bersamamu bahawa kamu mestilah benar – benar berwaspada daripada maksiat yang tercetus dikalangan kamu jua dari musuh – musuh kamu . Sesungguhnya dosa yang dilakukan oleh tentera lebih ditakuti ke atas mereka berbanding musuh – musuh mereka .

Sesungguhnya orang – orang Islam diberi kemenangan dengan maksiat yang dilakukan oleh musuh mereka kepada Allah swt . Jika tidak demikian , tidaklah kita memiliki kekuatan untuk mengatasi mereka . Kerana bilangan kita tidaklah sama berbanding jumlah bilangan mereka dan persediaan material kita jua tidak lah sama berbanding persediaan material yang mereka miliki .

Andai kita juga turut melakukan maksiat sebagaimana mereka melakukan maksiat nescaya mereka lebih kuat dan hebat daripada kita .

-Saidina Umar al Khattab

kesimpulan utk sesi ni: bahaya maksiat, samada kpd seorg penuntut ilmu mahupun seorg pejuang Islam. moga kita termasuk golongan yg memelihara diri dari maksiat
muhasabah buat diri jua…
wallahua’lam

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