Sy , Jamelle ; Sydiongco , Paula Marie; Tacata , Patricia; Tady , Clarissa Marie
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Transcript of Sy , Jamelle ; Sydiongco , Paula Marie; Tacata , Patricia; Tady , Clarissa Marie
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Surgery Case 5
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CHIEF COMPLAINT
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VS: BP= 120/80; PR= 85/min; RR= 18/min; T- 37.8 0 C HEENT: anicteric sclera, pink palpebral
conjunctivae HEART & LUNGS: unremarkable ABDOMEN: flat, soft, non-tender w/
normoactive bowel sounds
DRE: erhythematous, warm and tender 5x4 cm mass at the perianal region; DRE cannot be tolerated by the patient
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59 y/o maleDiabetic T- 37.8 0 CErythematous, warm and tender 5x4 cm mass on the R perianal region
DRE cannot be tolerated by the patient
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RECTAL CA LYMPHOGRANULOMAVENEREUM
HSV
PERIANAL ABSCESS
Perianal Pain * Aggravated by sitting done
* Prior to bowel movement
(-)
(-) (-) ✔
Palpable mass
Present
(-) Genital ulcers
(-) Genital ulcer
✔
Fever and Chills
(-)
Present
(-)
✔
Rectal Discharge
(-)
Present (-) ✔
Constipation Present
(-)
(-) ✔
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Perianal abscess Patient’s Symptoms
Perianal Pain * Aggravated by sitting done
* Prior to bowel movement
✔
Palpable mass ✔
Fever and Chills ✔
Rectal Discharge ✖
Constipation
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DIAGNOSIS:
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M > F (3:1) peak incidence: 3rd
to 5th decade of life. The disease is more
prevalent in immunocompromised patients such Diabetics hematologic disorders inflammatory bowel
disease (IBD) HIV positive These disorders should
be considered in patients with recurrent perianal infections.
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HALLMARK: Perianal pain and fever
dull perianal discomfort and pruritus
perianal pain often is exacerbated by movement and increased perineal pressure from sitting or defecation.
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PE: demonstrates a small, erythematous, well-defined, fluctuant, subcutaneous mass near the anal orifice.
LABORATORY EVALUATION: elevated WBC count
DIAGNOSTIC PROCEDURES are rarely necessary unless evaluating a recurrent abscess.
A CT scan or MRI has an accuracy of 80% in determining incomplete drainage.
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Early surgical drainage of the purulent collection.
Primary antibiotic therapy alone is ineffective in resolving the underlying infection and simply postpones surgical intervention.
Any delay in surgical drainage of anorectal abscesses prolongs infection, augments tissue damage, and may impair sphincter continence function, as well as promote stricture and/or fistula formation.
The ability to drain an anorectal abscess depends on patient comfort and on the location and accessibility of the abscess.
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Postoperative analgesics and stool softeners are prescribed to relieve pain and prevent constipation.
The patient typically will follow up with his/her physician in 2-3 weeks for wound evaluation and inspection for possible fistula-in-ano.
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Antibiotic therapy when indicated– to cover aerobes and anaerobes e.g. ciprofloxacin 500 mg PO 2x daily for 5 days