merit & de-merits.PPT of blood disorders

Merits

1. Merits and Demerits of
Ksharsutra In the management of
Fistula in Ano with compare to
modern management
By
Vd. Sushil P. Wairagade
Asst. Prof. , Dept Of Shalyatantra
Govt. Ayurved College, Nagpur.

2. Fistula : Latin meaning A Pipe Or flute
Fistula : A communicating tract between two
hollow viscera or viscera &exterior surface
Fistula in ano: Is tract lined by granulation
tissue which connects deeply in the anal canal
or rectum and superficially on the skin around
the anus.

4. Anatomy of anal canal
Anal canal is terminal part of
Alimentary Canal
Length : 3.8 cm
Inferior of anal canal :
divides into three parts
i) Upper part –mucus
ii) Middle Part-Transitional zone
iii) Lower part- cutaneous

5. Anatomy of Anal Canal

6. Musculature of anal canal
i) Anal sphincters
a.Internal anal sphincters
b. External anal sphincters
:Deep
:Superficial
:Subcutaneous
ii)conjoint longitudinal coat
iii)Anorectal Ring
iv)Surgical spaces related to anal
canal

7. Arterial blood supply
1.Superior Rectal Artery
2.Inferior Rectal Artery
Venous Blood supply
1.Internal Venous plexus
2.External venous plexus
Nerve Supply
1. Above Dentate line
2. Below Dentate line

8. Causes of fistula in Ano
i)Abscess
ii)Anal fissure
iii)Prolapsed piles
iv)Haematoma
v)Hard stool
vi)Chronic Diarrhea
vii)Foreign body
Other Causes
i)Tuberculosis
ii)Amoebiasis
iii)Ulcerative colitis
iv)Crohns disease
v)Actinomycosis
Ayurvedic Causes
i)Nija
ii)Agantuja

9. Pathophysiology of Fistula in Pathophysiology of Fistula in
AnoAno
Stages Four
1. Involvement of anal crypts.
2. Process of Boring
3. Spreading into spaces
4. Bursting into surface

10. Involvement of
Anal Crypts
Process of Boring

11. Spreading Bursting

12. Types of Fistula in Ano
Park Davids
i)inter
sphincteric
ii)Transe
sphincteric
iii)Extra
sphincteric
Milligon Morgan
Vertical Depostion
Simple
i)Submucous
ii)Subcutaneous
iii)Anal
a.Low Anal
b.High Anal
Complicated
i)Pelvirectal
ii) Anorectal
According to
Anal opening
i)Blind Internal
ii)Blind External
iii)Complete
iv)bilateral
v)radial
vi)Curved
vii)horse Shoe
Goodsals
Rule
Horizontal
Deposition

13. Fistula in Ano (Classification)

14. Types of Bhagandara
Sushrut
Shatponak
Usthagriv
Parisravi
Shambukavarta
Unmargi
Parachin
Arvachin
Vagbhat
Shatponak
Usthagriv
Parisravi
ShambukavartaUn
margi
Parisravi
Ruju
Arshobhagandara
Madhav Nidan
Shatponak
Usthagriv
Parisravi
Shambukavarta
Unmargi

15. Examination & Investigation
i)Per-Rectal Examination
ii)Proctoscopy
iii)Probing
iv) Radiography
Investigation
All Routine Investigation
Other investigation related to
disease

16. Management
Ayurvedic
i)Preventive
ii)Medicine
iii)Surgical Method
iv)Parasurgical Method
Modern Method
i)Fistulotomy
ii)Fistulectomy

17. KSHARSUTRA
It is medicated thread prepared by
applying Snuhi Kshir, Apamarga
Kshar and Haridra on it.
: Snuhi Kshir- Euphorbia Nerifolia
: Apamarga Kshar-Acaranthus Aspera

: Haridra- Curcuma Longa
: Linen No. 20

18. ACTION OF KSHARSUTRA
Apamarga Kshar Snuhi Kshir Haridra
Caustic cauterization Chemical irritant
Antiinflammatory
Coagulant
Lysis of Cells Smooth cutting Antibacterial
(cytotoxic Action) Antifungal

19. KSHARSUTRA
•MERITS
•Ambulatory Procedure
•Less tissue handling
•Low cost treatment
•Recurrence is low
•Negligible
Complication
•DEMERITS
•Long Term Treatment
•Painful while
changing the thread
•Less successful when
when posterior cavity
of fistula is big

20. COMPARISION
•SURGERY
•Hospitalization
•More Tissue Handling
•Highly Expensive
•Complication like
bleeding ,Anal
Incontinence
•Recurrence is more
•Less painful as
compared to
Ksharsutra
•Short term Treatment
•KSHARSUTRA
•Ambulatory Procedure
•Less Tissue Handling
Low cost treatment
•No such Complication
•Recurrence is very
low
•More Painful while
changing the thread
•Long Term Treatment

21. Thank You