Hira Ahmad
84 statements · 7 topics · summaries given as host listed separately
Featured statements
So 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.
quote ·
Anorectal Malformation
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.
quote ·
Anorectal Malformation
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.
quote ·
Colorectal / ARM & Hirschsprung
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.
quote ·
Colorectal / ARM & Hirschsprung
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.
quote ·
Hirschsprung disease
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.
quote ·
Hirschsprung disease
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Hira's statements about Anorectal Malformation 15 statements
Open the Anorectal Malformation collection →
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
Quotation
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.
Open
Statement
If 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.
Open
Statement
On 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.
Open
Quotation
So it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.
Open
Quotation
So 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.
Open
Statement
For 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.
Open
Quotation
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.
Open
Quotation
So in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.
Open
Statement
For hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.
Open
Quotation
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.
Open
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient...
Quotation
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.
Open
Statement
In 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.
Open
Quotation
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.
Open
Quotation
So if you guys had to pick a soiling or an obstructive problem, which one would you pick?
Open
Hira's statements about Colorectal / ARM & Hirschsprung 34 statements
Open the Colorectal / ARM & Hirschsprung collection →
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
Statement
Post-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).
Open
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
Statement
For exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis
Open
Quotation
I usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.
Open
Quotation
Sometimes 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.
Open
Statement
Swabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself
Open
Statement
For patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic
Open
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
Statement
Patients 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.
Open
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
Quotation
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.
Open
Statement
If 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.
Open
Statement
If 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.
Open
Quotation
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.
Open
Statement
On 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.
Open
Quotation
So it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.
Open
Statement
On 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.
Open
Quotation
So it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.
Open
Quotation
So 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.
Open
Quotation
So 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.
Open
Quotation
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.
Open
Statement
For 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.
Open
Quotation
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.
Open
Statement
For 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.
Open
Quotation
So in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.
Open
Quotation
So in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.
Open
Statement
For hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.
Open
Quotation
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.
Open
Statement
For hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.
Open
Quotation
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.
Open
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient...
Quotation
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.
Open
Statement
In 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.
Open
Quotation
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.
Open
Quotation
So if you guys had to pick a soiling or an obstructive problem, which one would you pick?
Open
Hira's statements about Crohn's Disease 1 statement
Open the Crohn's Disease collection →
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
Statement
Post-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).
Open
Hira's statements about Enterocolitis 1 statement
Open the Enterocolitis collection →
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
Statement
Patients 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.
Open
Hira's statements about Hirschsprung disease 23 statements
Open the Hirschsprung disease collection →
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
Statement
For exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis
Open
Quotation
I usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.
Open
Quotation
Sometimes 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.
Open
Statement
Swabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself
Open
Statement
For patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic
Open
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
Statement
Patients 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.
Open
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
Quotation
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.
Open
Statement
If 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.
Open
Statement
On 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.
Open
Quotation
So it definitely doesn't look like the colon that moves too fast. It could potentially be a colon that moves slow.
Open
Quotation
So 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.
Open
Statement
For 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.
Open
Quotation
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.
Open
Quotation
So in this one, the colon is decompressed and you see a lot of prostration. So potentially the colon is moving too fast.
Open
Quotation
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.
Open
Statement
For hypermotile patients (7-8 stools daily), treatment involves constipating them and then ensuring timed emptying—either spontaneous if sphincters intact or mechanical if deficient.
Open
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient...
Quotation
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.
Open
Statement
In 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.
Open
Quotation
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.
Open
Quotation
So if you guys had to pick a soiling or an obstructive problem, which one would you pick?
Open
Hira's statements about Hirschsprung's-associated Enterocolitis 8 statements
Open the Hirschsprung's-associated Enterocolitis collection →
Colorectal Quiz Episode 19: Hirschsprung Disease - The Obstructed Patient Part 1
Statement
Post-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).
Open
The Colorectal Quiz Episode 20: Hirschsprung Disease Obstruction Part 2
Statement
For exam under anesthesia in Hirschsprung's patients, digital exam should assess for circumferential stricture at the anastomosis
Open
Quotation
I usually do a digital exam and then feel for the anastomosis and if there's any circumferential stricture.
Open
Quotation
Sometimes 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.
Open
Statement
Swabe cuff presents as a 1-2 centimeter circumferential narrowing that is not the anastomosis itself
Open
Statement
For patients with previous Duhamel procedure, full-thickness rectal biopsy should be performed posteriorly because that segment should be ganglionic
Open
Hira's statements about Hydrocolpos 2 statements
Summaries Hira gave as host · 6 summaries
Recaps of other experts' statements, not Hira's own clinical position.
Summaries Hira gave as host · Cloaca 2 summaries
Colorectal Quiz Episode 17: Cloaca Part 1
Host summary
Hira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.
Open
Host summary
Hira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.
Open
Summaries Hira gave as host · Colorectal / ARM & Hirschsprung 2 summaries
Open the Colorectal / ARM & Hirschsprung collection →
Colorectal Quiz Episode 17: Cloaca Part 1
Host summary
Hira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.
Open
Host summary
Hira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.
Open
Summaries Hira gave as host · Hydrocolpos 2 summaries
Open the Hydrocolpos collection →
Colorectal Quiz Episode 17: Cloaca Part 1
Host summary
Hira Ahmad summarizing the discussion: In the large majority of cloaca patients, diagnosis is made at birth rather than prenatally.
Open
Host summary
Hira Ahmad summarizing the discussion: Definitive imaging and reconstructive planning should wait until the patient is growing and thriving.
Open