In both scenarios, patient need a bowel management program. If your sphincters are poor and your dentate line is deficient, probably mechanical, as we mentioned before, with an enema program. If the sphincters and dentate line are intact, we could potentially start with a mechanical and then switch them over to laxative program.
So, um, I think in both cases we can start off with constipating diet, add bulking agents, in add PPIs, um, but if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with, um, irrigations or, um, say like small enemas, small volume enemas.
So I think in both cases, we can start off with constipating diet, add bulking agents, add PPIs. But if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with irrigations or say like small enemas, small volume enemas.
So their external sphincters are working, um, and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.
So their external sphincters are working and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
▶Ep 41 · 2:12
quoteSo their external sphincters are working and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
▶Ep 41 · 2:12
clinicalIf a patient has voluntary bowel movements during the day but accidents at night when sleeping, their external sphincters are working but internal sphincters are not—when sleeping they relax the external sphincter and lose control.↗
▶Ep 41 · 13:55
clinicalOn contrast study, a colon that moves too fast shows smaller caliber with many haustrations (appearing as contractions), while a colon that moves too slow shows dilation with lack of haustrations.↗
▶Ep 41 · 13:55
quoteSo it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.↗
▶Ep 41 · 14:11
quoteSo just reading the contrast enema, it doesn't look like there's a lot of postrations in the colon that are causing these potentially you could interpret as like postrations as contractions of the colon. And usually the colon moves too fast. You have a smaller caliber colon with a lot of postrations and not as dilated. When you're concerned about it moving too slow, there's a dilation of the colon. There's lack of postrations.↗
▶Ep 41 · 15:41
quoteIn both scenarios, patient need a bowel management program. If your sphincters are poor and your dentate line is deficient, probably mechanical, as we mentioned before, with an enema program. If the sphincters and dentate line are intact, we could potentially start with a mechanical and then switch them over to laxative program.↗
▶Ep 41 · 15:41
clinicalFor a hypomotile (slow-moving) colon with intact sphincters and dentate line, treatment can start with mechanical emptying then switch to laxative program; if sphincters and dentate line are deficient, mechanical enema program is needed.↗
▶Ep 41 · 17:11
quoteSo in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.↗
▶Ep 41 · 17:45
quoteSo I think in both cases, we can start off with constipating diet, add bulking agents, add PPIs. But if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with irrigations or say like small enemas, small volume enemas.↗
▶Ep 41 · 17:45
clinicalFor hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient...
▶Ep 41 · 2:17
quoteSo their external sphincters are working, um, and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
clinicalIn both scenarios (intact or deficient sphincters/dentate line), patients with slow-moving colon need a bowel management program; if sphincters are poor and dentate line deficient, mechanical emptying with enema program is needed; if intact, can start mechanical and potentially switch to laxative program.↗
▶Ep 41 · 17:55
quoteSo, um, I think in both cases we can start off with constipating diet, add bulking agents, in add PPIs, um, but if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with, um, irrigations or, um, say like small enemas, small volume enemas.↗
▶Ep 41 · 24:19
quoteSo if you guys had to pick a soiling or an obstructive problem, which one would you pick?↗
Hira's statements about Colorectal / ARM & Hirschsprung34 statements
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
▶Ep 105 · 6:45
clinicalPost-pull-through obstruction can be caused by stricture, twist (any pull-through type), Soave cuff (Soave procedure), Duhamel spur or non-functional distended segment (Duhamel procedure), or non-functional segment (Rehbein procedure).↗
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 107 · 1:36
clinicalFor exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis↗
▶Ep 107 · 1:43
quoteI usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.↗
▶Ep 107 · 1:57
clinicalHagar dilator can be used to size the anastomotic opening to ensure adequate caliber↗
▶Ep 107 · 2:04
clinicalFoley catheter passage can determine if there is a twist in the pull-through segment↗
▶Ep 107 · 2:11
quoteSometimes if you're blessed with longer fingers, you may be able to feel that and enter the peritoneum, but I have size 6 gloves, so I usually use the Foley catheter to determine if there's a twist or not.↗
▶Ep 107 · 2:23
clinicalSwabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself↗
▶Ep 107 · 2:33
clinicalFor patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic↗
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
▶Ep 109 · 12:20
clinicalPatients with poor potential for bowel control (like anorectal malformation with poor spine/sacrum or spina bifida) need to be in a dedicated bowel management program with enemas or antegrade options.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
▶Ep 111 · 2:12
quoteSo their external sphincters are working and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
▶Ep 111 · 2:12
clinicalIf a patient has voluntary bowel movements during the day but accidents at night when sleeping, their external sphincters are working but internal sphincters are not—when sleeping they relax the external sphincter and lose control.↗
▶Ep 111 · 2:12
clinicalIf a patient has voluntary bowel movements during the day but accidents at night when sleeping, their external sphincters are working but internal sphincters are not—when sleeping they relax the external sphincter and lose control.↗
▶Ep 111 · 2:12
quoteSo their external sphincters are working and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
▶Ep 111 · 13:55
clinicalOn contrast study, a colon that moves too fast shows smaller caliber with many haustrations (appearing as contractions), while a colon that moves too slow shows dilation with lack of haustrations.↗
▶Ep 111 · 13:55
quoteSo it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.↗
▶Ep 111 · 13:55
quoteSo it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.↗
▶Ep 111 · 13:55
clinicalOn contrast study, a colon that moves too fast shows smaller caliber with many haustrations (appearing as contractions), while a colon that moves too slow shows dilation with lack of haustrations.↗
▶Ep 111 · 14:11
quoteSo just reading the contrast enema, it doesn't look like there's a lot of postrations in the colon that are causing these potentially you could interpret as like postrations as contractions of the colon. And usually the colon moves too fast. You have a smaller caliber colon with a lot of postrations and not as dilated. When you're concerned about it moving too slow, there's a dilation of the colon. There's lack of postrations.↗
▶Ep 111 · 14:11
quoteSo just reading the contrast enema, it doesn't look like there's a lot of postrations in the colon that are causing these potentially you could interpret as like postrations as contractions of the colon. And usually the colon moves too fast. You have a smaller caliber colon with a lot of postrations and not as dilated. When you're concerned about it moving too slow, there's a dilation of the colon. There's lack of postrations.↗
▶Ep 111 · 15:41
clinicalFor a hypomotile (slow-moving) colon with intact sphincters and dentate line, treatment can start with mechanical emptying then switch to laxative program; if sphincters and dentate line are deficient, mechanical enema program is needed.↗
▶Ep 111 · 15:41
quoteIn both scenarios, patient need a bowel management program. If your sphincters are poor and your dentate line is deficient, probably mechanical, as we mentioned before, with an enema program. If the sphincters and dentate line are intact, we could potentially start with a mechanical and then switch them over to laxative program.↗
▶Ep 111 · 15:41
quoteIn both scenarios, patient need a bowel management program. If your sphincters are poor and your dentate line is deficient, probably mechanical, as we mentioned before, with an enema program. If the sphincters and dentate line are intact, we could potentially start with a mechanical and then switch them over to laxative program.↗
▶Ep 111 · 15:41
clinicalFor a hypomotile (slow-moving) colon with intact sphincters and dentate line, treatment can start with mechanical emptying then switch to laxative program; if sphincters and dentate line are deficient, mechanical enema program is needed.↗
▶Ep 111 · 17:11
quoteSo in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.↗
▶Ep 111 · 17:11
quoteSo in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.↗
▶Ep 111 · 17:45
clinicalFor hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.↗
▶Ep 111 · 17:45
quoteSo I think in both cases, we can start off with constipating diet, add bulking agents, add PPIs. But if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with irrigations or say like small enemas, small volume enemas.↗
▶Ep 111 · 17:45
clinicalFor hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.↗
▶Ep 111 · 17:45
quoteSo I think in both cases, we can start off with constipating diet, add bulking agents, add PPIs. But if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with irrigations or say like small enemas, small volume enemas.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient...
▶Ep 118 · 2:17
quoteSo their external sphincters are working, um, and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
clinicalIn both scenarios (intact or deficient sphincters/dentate line), patients with slow-moving colon need a bowel management program; if sphincters are poor and dentate line deficient, mechanical emptying with enema program is needed; if intact, can start mechanical and potentially switch to laxative program.↗
▶Ep 118 · 17:55
quoteSo, um, I think in both cases we can start off with constipating diet, add bulking agents, in add PPIs, um, but if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with, um, irrigations or, um, say like small enemas, small volume enemas.↗
▶Ep 118 · 24:19
quoteSo if you guys had to pick a soiling or an obstructive problem, which one would you pick?↗
Hira's statements about Crohn's Disease2 statements
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
▶Ep 18 · 12:20
clinicalPatients with poor potential for bowel control (like anorectal malformation with poor spine/sacrum or spina bifida) need to be in a dedicated bowel management program with enemas or antegrade options.↗
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
▶Ep 18 · 12:20
clinicalPatients with poor potential for bowel control (like anorectal malformation with poor spine/sacrum or spina bifida) need to be in a dedicated bowel management program with enemas or antegrade options.↗
Hira's statements about Hirschsprung disease23 statements
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 44 · 1:36
clinicalFor exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis↗
▶Ep 44 · 1:43
quoteI usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.↗
▶Ep 44 · 1:57
clinicalHagar dilator can be used to size the anastomotic opening to ensure adequate caliber↗
▶Ep 44 · 2:04
clinicalFoley catheter passage can determine if there is a twist in the pull-through segment↗
▶Ep 44 · 2:11
quoteSometimes if you're blessed with longer fingers, you may be able to feel that and enter the peritoneum, but I have size 6 gloves, so I usually use the Foley catheter to determine if there's a twist or not.↗
▶Ep 44 · 2:23
clinicalSwabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself↗
▶Ep 44 · 2:33
clinicalFor patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic↗
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
▶Ep 47 · 12:20
clinicalPatients with poor potential for bowel control (like anorectal malformation with poor spine/sacrum or spina bifida) need to be in a dedicated bowel management program with enemas or antegrade options.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
▶Ep 48 · 2:12
quoteSo their external sphincters are working and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
▶Ep 48 · 2:12
clinicalIf a patient has voluntary bowel movements during the day but accidents at night when sleeping, their external sphincters are working but internal sphincters are not—when sleeping they relax the external sphincter and lose control.↗
▶Ep 48 · 13:55
clinicalOn contrast study, a colon that moves too fast shows smaller caliber with many haustrations (appearing as contractions), while a colon that moves too slow shows dilation with lack of haustrations.↗
▶Ep 48 · 13:55
quoteSo it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.↗
▶Ep 48 · 14:11
quoteSo just reading the contrast enema, it doesn't look like there's a lot of postrations in the colon that are causing these potentially you could interpret as like postrations as contractions of the colon. And usually the colon moves too fast. You have a smaller caliber colon with a lot of postrations and not as dilated. When you're concerned about it moving too slow, there's a dilation of the colon. There's lack of postrations.↗
▶Ep 48 · 15:41
quoteIn both scenarios, patient need a bowel management program. If your sphincters are poor and your dentate line is deficient, probably mechanical, as we mentioned before, with an enema program. If the sphincters and dentate line are intact, we could potentially start with a mechanical and then switch them over to laxative program.↗
▶Ep 48 · 15:41
clinicalFor a hypomotile (slow-moving) colon with intact sphincters and dentate line, treatment can start with mechanical emptying then switch to laxative program; if sphincters and dentate line are deficient, mechanical enema program is needed.↗
▶Ep 48 · 17:11
quoteSo in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.↗
▶Ep 48 · 17:45
quoteSo I think in both cases, we can start off with constipating diet, add bulking agents, add PPIs. But if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with irrigations or say like small enemas, small volume enemas.↗
▶Ep 48 · 17:45
clinicalFor hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient...
▶Ep 49 · 2:17
quoteSo their external sphincters are working, um, and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
clinicalIn both scenarios (intact or deficient sphincters/dentate line), patients with slow-moving colon need a bowel management program; if sphincters are poor and dentate line deficient, mechanical emptying with enema program is needed; if intact, can start mechanical and potentially switch to laxative program.↗
▶Ep 49 · 17:55
quoteSo, um, I think in both cases we can start off with constipating diet, add bulking agents, in add PPIs, um, but if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with, um, irrigations or, um, say like small enemas, small volume enemas.↗
▶Ep 49 · 24:19
quoteSo if you guys had to pick a soiling or an obstructive problem, which one would you pick?↗
Hira's statements about Hirschsprung Disease19 statements
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
▶Ep 13 · 6:45
clinicalPost-pull-through obstruction can be caused by stricture, twist (any pull-through type), Soave cuff (Soave procedure), Duhamel spur or non-functional distended segment (Duhamel procedure), or non-functional segment (Rehbein procedure).↗
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 15 · 1:36
clinicalFor exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis↗
▶Ep 15 · 1:43
quoteI usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.↗
▶Ep 15 · 1:57
clinicalHagar dilator can be used to size the anastomotic opening to ensure adequate caliber↗
▶Ep 15 · 2:04
clinicalFoley catheter passage can determine if there is a twist in the pull-through segment↗
▶Ep 15 · 2:11
quoteSometimes if you're blessed with longer fingers, you may be able to feel that and enter the peritoneum, but I have size 6 gloves, so I usually use the Foley catheter to determine if there's a twist or not.↗
▶Ep 15 · 2:23
clinicalSwabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself↗
▶Ep 15 · 2:33
clinicalFor patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic↗
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
▶Ep 16 · 12:20
clinicalPatients with poor potential for bowel control (like anorectal malformation with poor spine/sacrum or spina bifida) need to be in a dedicated bowel management program with enemas or antegrade options.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
▶Ep 17 · 2:12
clinicalIf a patient has voluntary bowel movements during the day but accidents at night when sleeping, their external sphincters are working but internal sphincters are not—when sleeping they relax the external sphincter and lose control.↗
▶Ep 17 · 2:12
quoteSo their external sphincters are working and the internal sphincters are not. So when they're sleeping, they relax their external sphincters and that's how they lose the control.↗
▶Ep 17 · 13:55
quoteSo it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.↗
▶Ep 17 · 13:55
clinicalOn contrast study, a colon that moves too fast shows smaller caliber with many haustrations (appearing as contractions), while a colon that moves too slow shows dilation with lack of haustrations.↗
▶Ep 17 · 14:11
quoteSo just reading the contrast enema, it doesn't look like there's a lot of postrations in the colon that are causing these potentially you could interpret as like postrations as contractions of the colon. And usually the colon moves too fast. You have a smaller caliber colon with a lot of postrations and not as dilated. When you're concerned about it moving too slow, there's a dilation of the colon. There's lack of postrations.↗
▶Ep 17 · 15:41
quoteIn both scenarios, patient need a bowel management program. If your sphincters are poor and your dentate line is deficient, probably mechanical, as we mentioned before, with an enema program. If the sphincters and dentate line are intact, we could potentially start with a mechanical and then switch them over to laxative program.↗
▶Ep 17 · 15:41
clinicalFor a hypomotile (slow-moving) colon with intact sphincters and dentate line, treatment can start with mechanical emptying then switch to laxative program; if sphincters and dentate line are deficient, mechanical enema program is needed.↗
▶Ep 17 · 17:11
quoteSo in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.↗
▶Ep 17 · 17:45
quoteSo I think in both cases, we can start off with constipating diet, add bulking agents, add PPIs. But if the sphincters and dentate lines are not intact or it's deficient, then we may have to start with irrigations or say like small enemas, small volume enemas.↗
▶Ep 17 · 17:45
clinicalFor hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.↗
Hira's statements about Hirschsprung's-associated Enterocolitis8 statements
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
▶Ep 2 · 6:45
clinicalPost-pull-through obstruction can be caused by stricture, twist (any pull-through type), Soave cuff (Soave procedure), Duhamel spur or non-functional distended segment (Duhamel procedure), or non-functional segment (Rehbein procedure).↗
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
▶Ep 3 · 1:36
clinicalFor exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis↗
▶Ep 3 · 1:43
quoteI usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.↗
▶Ep 3 · 1:57
clinicalHagar dilator can be used to size the anastomotic opening to ensure adequate caliber↗
▶Ep 3 · 2:04
clinicalFoley catheter passage can determine if there is a twist in the pull-through segment↗
▶Ep 3 · 2:11
quoteSometimes if you're blessed with longer fingers, you may be able to feel that and enter the peritoneum, but I have size 6 gloves, so I usually use the Foley catheter to determine if there's a twist or not.↗
▶Ep 3 · 2:23
clinicalSwabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself↗
▶Ep 3 · 2:33
clinicalFor patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic↗
host summaryHira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.↗
▶Ep 20 · 25:43
host summaryHira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.↗
host summaryHira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.↗
▶Ep 32 · 25:43
host summaryHira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.↗
Summaries Hira gave as host · Colorectal / ARM & Hirschsprung2 summaries
host summaryHira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.↗
▶Ep 228 · 25:43
host summaryHira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.↗
Summaries Hira gave as host · Hydrocolpos2 summaries
host summaryHira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.↗
▶Ep 4 · 25:43
host summaryHira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.↗
