A Review of Proctological Disorders

Total Page:16

File Type:pdf, Size:1020Kb

A Review of Proctological Disorders 327-335/Art. 1.1462 6-12-2006 9:18 Pagina 327 European Review for Medical and Pharmacological Sciences 2006; 10: 327-335 A review of proctological disorders P.J. GUPTA Gupta Nursing Home, Laxminagar, NAGPUR – (India) Abstract. – Ano-perianal lesions are es- anatomy are occupied by disorders like hemor- sential part of the family practice setup. Patients rhoids, fissures, and pruritus ani3. usually present with symptoms like pain, bleed- This brief treatise discusses various ano-peri- ing, pruritus, and constipation. In the modern era, the patients prefer a con- anal lesions and an approach to their diagnosis servative therapy or else they opt for a quick of- and treatment. fice procedure to get rid of the symptoms. New- er pharmacological therapies and a handful of The Anal Canal simple and safe office procedures have emerged The anus is the outlet to the gastrointestinal in the last decade for treatment of ano-perianal tract, and the rectum is the lower 10 to 15 cm of lesions. A judicious application of these tech- niques has been found successful in tackling the large intestine. The anal canal starts at the most of the proctological ailments. ano-rectal junction and ends at the anal verge. Complicated or advanced pathologies, how- The average length of the anal canal is 4 cm. The ever, require an expert opinion and it is desir- midpoint of the anal canal is called the dentate able that such patients are referred to the care line. This dentate or pectinate line divides the of colorectal clinics. squamous epithelium from the mucosal or This paper describes presentation symptoms, columnar epithelium. Four to eight anal glands approach towards diagnosis, and various thera- peutic modalities of common anal disorders drain into the crypts of Morgagni at the level of commonly seen in a developing country. the dentate line. Most rectal abscesses and fistu- lae originate in these glands. The dentate line al- Key Words: so delineates the area where sensory fibers end. Proctology, Family practice, Office treatment, Ano-pe- Above the dentate line, the rectum is supplied by rianal disorders. stretch nerve fibers and not the pain nerve fibers. This allows many surgical procedures to be per- formed without anesthesia above the dentate line4. Conversely, below the dentate line, there is extreme sensitivity, and the perianal area is one of the most sensitive areas of the body. The evac- Introduction uation of bowel contents depends on action by the muscles of both the involuntary internal The prevalence of anal pathologies in general sphincter and the voluntary external sphincter. population is probably much higher than what is seen in clinical practice, since most patients with Symptomatology of the symptoms confined to the anorectum tend to shy Ano-Perianal Lesions away and do not seek medical attention1. While in most of the time, patients with ano- A primary care physician frequently faces perianal pathologies presents with typical symp- difficult questions concerning the optimum toms, at times these may be misleading due to management of ano-perianal symptoms. While the patient’s inability to explain or his under- the examination and diagnosis of certain ano- statement or underplaying of symptoms5. perianal disorders is challenging, most of the The common symptoms denoting ano-perianal common disorders of the ano-rectum can be pathology are listed (in order of frequency) in easily recognized with a careful local examina- Table I. tion and proctoscopy2. A systematic approach to the patient with On a rough estimate, more than 81% of the anorectal complaints allows for an accurate and complaints centering on this part of human efficient diagnosis of the underlying problem. Corresponding Author: Pravin J. Gupta, MD; e-mail: [email protected] 327 327-335/Art. 1.1462 6-12-2006 9:18 Pagina 328 P.J. Gupta Table I. Symptomatology of ano-perianal pathologies. Table III. Causes of anal pain. • Anal Pain • Anal fissure (acute or chronic) • Bleeding per rectum • Perianal hematoma • Pus discharge from and around anus • Anal sepsis •Prolapse •Prolapsed and thrombosed hemorrhoids • Anal pruritus • Anal fistula •Presence of swelling or lump in or around anus • Anal malignancy • Constipation or fecal obstruction • Thrombosis in internal hemorrhoids (acute • Difficulty in passing stool attack of piles) • Incontinence to flatus or feces • Functional disorders (proctalgia fugax and Levator ani syndrome) •Presence of foreign bodies in the anus The process can be divided into the interview, the examination, and conveyance of information6. Throughout this process, the patient must be reas- Pain during bowel movements that is de- sured and made as comfortable as possible. scribed as “similar to one caused by a cut with The key to diagnosis lies in the patient history, sharp glass” usually indicates a fissure. The acute with confirmation by visual inspection and onset of pain with a palpable mass is usually due anoscopy. Expensive workups are usually not re- to a thrombosed external hemorrhoid (perianal quired. Based on the symptoms and possible dif- hematoma). Anorectal pain that begins gradually ferential diagnosis, further investigation may be and becomes excruciating over a few days may necessary7. The common ano-perianal lesions en- indicate infection. Anal pain accompanied by countered in the family practice are listed (in or- fever and inability to pass urine signals perineal der of frequency) in Table II. sepsis9. Anal Pain (Table III) Bleeding per Rectum This is the commonest complaint among the There is no overemphasis when it is said that patients attending a proctology clinic8. all cases of rectal bleeding ought to be evaluated and the cause identified. Causes of bright red rectal bleeding are listed in Table IV. Table II. Common ano-perianal lesions. Pus Discharge Commonest Discharge of pus from or around the anus is •Hemorrhoids (internal or external) another disturbing symptom. The commonest • Anal fissures (acute or chronic) • Anal fistula (low or high) cause of pus formation (Table V) is anal and pe- • Abscesses (perianal, ischio-rectal, submucus) rianal suppuration, presenting as a fistula or burst • Polyps (adenomatous, fibrous anal) abscess10. • Anal skin tags or sentinel pile A thorough evaluation of the patient is neces- • Ano-perianal sepsis (hydradenitis suppuritiva, sary to establish the actual cause of pus dis- AIDS, syphilis) charge. While abscesses and fistulae are obvious Less Common • Sacro-coccygeal pilonidal sinus disease • Neoplasms (benign or malignant) Table IV. Causes of bleeding per rectum. • Condylomas • Connective tissues masses like papilloma, fibroma, •Hemorrhoids and lipoma • Anal fissures • Antibioma (organized abscess) • Polyps • Inflammatory conditions (anal cryptitis and • Malignancy papillitis) • Inflammatory bowel disease (IBD) • Hypertrophied anal papillae. • Rectal prolapse Uncommon • Anal fistula • Strictures of anal canal • Solitary rectal ulcer • Incontinence (flatus or feces) •Arterio-venous malformations 328 327-335/Art. 1.1462 6-12-2006 9:18 Pagina 329 A review of proctological disorders Table V. Causes of pus discharge. Table VII. Causes of prolapse from the anus. • Anal fistula •Hemorrhoids • Anal fissure with suppuration or fistula formation • Rectal prolapse (mucosal or complete) • Submucus or perianal antibioma [aseptic abscess] • Polyps (rectal, fibrous anal polyp) •Proctitis • Neoplasms (melanoma, angioma, papilloma) • Inflammatory bowel disease (IBD) • Intussusception • Anal malignancy • Solitary rectal ulcer • Suppuration in thrombosed hemorrhoids Prolapse from the Anus Protrusion of “something” from the anus is a symptom, which denotes various pathological on inspection and palpation, other lesions may conditions of the ano-rectum. The prolapse may need a careful search to reach to the source of occur during defecation getting reduced sponta- suppuration. Sigmoidoscopy, examination of the neously or manually. In other situations, there discharge, biopsy, and endoanal ultrasonography could be found a permanently prolapsed mass may be required in such attempt11. outside the anus13. Few common lesions presenting with prolapse Pruritus Ani (Anal Itch) are listed (in order of frequency) in Table VII. Pruritus ani is an extremely common and an- noying symptom, associated with a wide range of Swelling or Lump Around Anus (Table VIII) mechanical, dermatological, infectious, systemic, Anal or perineal “lumps” are indicative of le- or certain unidentifiable conditions12. Regardless sions that may or may not be related to the of the etiology, the itch/scratch cycle becomes pathology of the ano-rectum. Lumps or masses self-propagating and results in chronic patholog- of a recent origin or those that are painful have ic changes that persist even if the initiating factor an infective or hemorrhagic etiology like an ab- is removed. scess, a perianal hematoma, or thrombosis and In a belief that pruritus ani is caused by poor should call for a thorough examination14. hygiene, patients become overzealous in keeping the perianal area clean (Table VI). Excessive Constipation cleaning, particularly using brushes and caustic The term constipation can have a variety of soaps, irritates the sensitive anal and perianal re- meanings. Patients may use the term to indicate gion to exacerbate the symptoms further. The pe- the lack of an urge to defecate, a decreased fre- rianal area may be highly sensitive to perfumes, quency of bowel movements, difficulty in pass- soaps, clothes, fabrics, dietary intake, and super-
Recommended publications
  • Anorectal Disorders Satish S
    Gastroenterology 2016;150:1430–1442 Anorectal Disorders Satish S. C. Rao,1 Adil E. Bharucha,2 Giuseppe Chiarioni,3,4 Richelle Felt-Bersma,5 Charles Knowles,6 Allison Malcolm,7 and Arnold Wald8 1Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia; 2Department of Gastroenterology and Hepatology, Mayo College of Medicine, Rochester, Minnesota; 3Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; 4Division of Gastroenterology and Hepatology and UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 5Department of Gastroenterology/Hepatology, VU Medical Center, Amsterdam, The Netherlands; 6National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, United Kingdom; 7Division of Gastroenterology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia; 8Division of Gastroenterology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin This report defines criteria and reviews the epidemiology, questionnaires and bowel diaries are correlated,5 some pathophysiology, and management of the following com- patients may not accurately recall bowel symptoms6; hence, mon anorectal disorders: fecal incontinence (FI), func- symptom diaries may be more reliable. tional anorectal pain, and functional defecation disorders. In this report, we examine the prevalence and patho- FI is defined as the recurrent uncontrolled passage of fecal physiology of anorectal disorders, listed in Table 1,and material for at least 3 months. The clinical features of FI provide recommendations for diagnostic evaluation and are useful for guiding diagnostic testing and therapy. management. These supplement practice guidelines rec- ANORECTAL Anorectal manometry and imaging are useful for evalu- ommended by the American Gastroenterological Associa- fl ating anal and pelvic oor structure and function.
    [Show full text]
  • Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain
    Acta Interna The Journal of Internal Medicine Vol. 6 No. 2 December 2016 Website Journal : http://jurnal.ugm.ac.id/jain Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain Suharjo Broto Cahyono,1 Putut Bayupurnama,2 Neneng Ratnasari,2 Siti Nurdjanah2 1Department of Internal Medicine, Charitas Hospital, Palembang 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Gadjah Mada University-Sardjito General Hospital, Yogyakarta ABSTRAK Gangguan gastrointestinal fungsional (GGIF) mewakili gangguan yang sering dijumpai dan perlu mendapatkan perhatian dalam bidang gastroenterologi. Gangguan ini menyebabkan kecemasan, distress dan morbiditas. Pasien dengan gangguan ini sering memperlihatkan manifestasi klinis secara tumpang tindih. Pasien dispepsia fungsional seringkali tumang tindih dengan gangguan gastrointestinal lain, termasuk nyeri anorektal fungsional. Keadaan tumpang tindih ini dapat menimbulkan keluhan yang makin berat, kualitas hidup yang lebih buruk dan skor somatisasi yang lebih tinggi, dan pasien mengalami kecemasan, depresi atau insomnia lebih sering dibandingkan pasien yang tanpa problem tumpah tindih. GGIF ditegakkan berdasarkan kriteria Rome III dan eksklusi penyakit organik. Pendekatan multimodalitas dibutuhkan dalam mengatasi pasien yang menderita gangguan gastrointestinal fungsional. Pada tinjaun kasus ini, dilaporkan seorang pasien laki laki menderita gangguan dispepsia fungsional dan nyeri anorektal fungsional tidak spesifik. Kata kunci : gangguan
    [Show full text]
  • Avian Crop Function–A Review
    Ann. Anim. Sci., Vol. 16, No. 3 (2016) 653–678 DOI: 10.1515/aoas-2016-0032 AVIAN CROP function – A REVIEW* * Bartosz Kierończyk1, Mateusz Rawski1, Jakub Długosz1, Sylwester Świątkiewicz2, Damian Józefiak1♦ 1Department of Animal Nutrition and Feed Management, Poznań University of Life Sciences, Wołyńska 33, 60-637 Poznań, Poland 2Department of Animal Nutrition and Feed Science, National Research Institute of Animal Production, 32-083 Balice n. Kraków, Poland ♦Corresponding author: [email protected] Abstract The aim of this review is to present and discuss the anatomy and physiology of crop in different avian species. The avian crop (ingluvies) present in most omnivorous and herbivorous bird spe- cies, plays a major role in feed storage and moistening, as well as functional barrier for pathogens through decreasing pH value by microbial fermentation. Moreover, recent data suggest that this gastrointestinal tract segment may play an important role in the regulation of the innate immune system of birds. In some avian species ingluvies secretes “crop milk” which provides high nutri- ents and energy content for nestlings growth. The crop has a crucial role in enhancing exogenous enzymes efficiency (for instance phytase and microbial amylase,β -glucanase), as well as the activ- ity of bacteriocins. Thus, ingluvies may have a significant impact on bird performance and health status during all stages of rearing. Efficient use of the crop in case of digesta retention time is es- sential for birds’ growth performance. Thus, a functionality of the crop is dependent on a number of factors, including age, dietary factors, infections as well as flock management.
    [Show full text]
  • Raptor Digestion Facts
    Raptor Digestion Facts For birds that have a crop, food passes to the crop to soften or to just be stored temporarily. From there food goes to the stomachs. Owls do not have crops, all other raptors do. Food is stored in the crop on the way down, but not on the way up. Birds have two stomachs (in this order): A glandular stomach (the proventriculus) which digests food chemically A muscular stomach or gizzard (the ventriculus) that grinds food with the aid or grit. In many carnivorous species – hawks, for example, their glandular stomach is so highly acidic, it dissolves bones. The bearded vulture of Europe and China is said to have a stomach so acidic it can dissolve the whole of a cow’s vertebra in one or two days. Pellets are formed in the gizzard. A given bird’s pellet will be the size and shape of their gizzard. The gizzard of birds serves the same function as the teeth and strong jaws of mammals. The gizzard is most developed in birds that eat plant parts. Birds intentionally ingest grit to be kept in their gizzard to help grind food. They can prevent this grit from passing through the digestive system with the food, and remain in the gizzard. Birds prefer brightly colored grit. Such examples of grit found in birds include: quartz, granite, ruby, gold, fruit pits, coal, ground oyster shells, black lava, and lead shot form shotguns (this of course causes lead poisoning, which we do see a lot of at Willowbrook). Many other birds cough-up pellets, especially those which feed much on insects.
    [Show full text]
  • Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-In-Ano, and Rectovaginal Fistula Jon D
    PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Jon D. Vogel, M.D. • Eric K. Johnson, M.D. • Arden M. Morris, M.D. • Ian M. Paquette, M.D. Theodore J. Saclarides, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Sur- and submucosal locations.7–11 Anorectal abscess occurs geons is dedicated to ensuring high-quality pa- more often in males than females, and may occur at any Ttient care by advancing the science, prevention, age, with peak incidence among 20 to 40 year olds.4,8–12 and management of disorders and diseases of the co- In general, the abscess is treated with prompt incision lon, rectum, and anus. The Clinical Practice Guide- and drainage.4,6,10,13 lines Committee is charged with leading international Fistula-in-ano is a tract that connects the perine- efforts in defining quality care for conditions related al skin to the anal canal. In patients with an anorec- to the colon, rectum, and anus by developing clinical tal abscess, 30% to 70% present with a concomitant practice guidelines based on the best available evidence. fistula-in-ano, and, in those who do not, one-third will These guidelines are inclusive, not prescriptive, and are be diagnosed with a fistula in the months to years after intended for the use of all practitioners, health care abscess drainage.2,5,8–10,13–16 Although a perianal abscess workers, and patients who desire information about the is defined by the anatomic space in which it forms, a management of the conditions addressed by the topics fistula-in-ano is classified in terms of its relationship to covered in these guidelines.
    [Show full text]
  • Digestion of CHO, Fats, and Proteins
    Handout 5 Carbohydrate, Fat, and Protein Digestion ANSC 619 PHYSIOLOGICAL CHEMISTRY OF LIVESTOCK SPECIES Digestion and Absorption of Carbohydrates, Fats, and Proteins I. Variations in stomach architecture A. Poultry (avian species in general) 1. The crop, proventriculus, and gizzard replace the simple stomach of other monogastrics. 2. The esophagus extends to the cardiac region of the proventriculus. 3. The proventriculus is similar to the stomach, in that typical gastric secretions (mucin, HCl, and pepsinogen) are produced. B. Omnivores 1. Nonglandular region – no digestive secretions or absorption occurs. 2. Cardiac region – lined with epithelial cells that secrete mucin (prevents lining of the stomach from being digested). 3. Fundic region – contains parietal cells (secrete HCl), neck chief cells (secrete mucin), and body chief cells (secrete pepsinogen, and lipase). 1 Handout 5 Carbohydrate, Fat, and Protein Digestion II. Architecture of gastrointestinal tracts in monogastrics, herbivores, and ruminants A. Monogastrics – pigs 1. Oral region – Saliva is secreted from the parotid, mandibular, and sublingual glands. α-Amylase in saliva initiates carbohydrate digestion. 2. Esophageal region – Extends from the pharynx to the esophageal portion of the stomach. 3. Gastric region – Dvided into the esophageal region, the cardiac region, and the fundic (proper gastric) region. The cardiac region elaborates mucus, proteases, and lipase. The action of α-amylase stops in the fundus, when the pH drops below 3.6. 4. Pancreatic region – The endocrine portion secretes insulin and glucagon (and other peptide whereas the jejunum (88-91%) and ileum (4-5%) form hormones) from the islets of the lower intestine. Pancreatic α-amylase, lipase, and Langerhans. The exocrine portion proteases are mixed with chyme from the stomach.
    [Show full text]
  • Crop Problems
    Text and photos: Monique de Vrijer Translation: Diana Hedrick CROP PROBLEMS The crop serves as a temporary ‘storage bin’ for the feed the chicken eats. It is often full during and at the end of the day and should normally be empty when the bird starts its day in the morning. Unfortunately ‘crop prob- lems’ are not an uncommon occurrence and presents as symptomatic with many dif- ferent illnesses and condi- tions. The Crop The crop is part of the digestive system and is an enlarged part of the esophagus at the foot of the neck where feed is (temporarily) stored and "moistened" with mucous and saliva from the mouth until the contents are moved into the stomach. A chicken has two stomachs, the proventriculus (the glandular stomach) and the gizzard or ventriculus (also called the muscular stomach). The feed is transported from the crop into the the glandular stomach which, as the name implies, is where secretory enzymes are added to the feed mass to aid in digestion; one of which is pepsin which in turn activates the stomach to produce hydrochloric (stomach) acid lowering the PH to aid in digestion and absorption of nutrients and also helps to dissolve the calcium grit (usually oyster shell) releasing the calcium in it. These enzyme-filled gastric juices infuse the feed as it moves onwards towards the gizzard (ventriculus or muscular stomach). The gizzard is a small organ and not able to deal with large quantities of feed. It is composed of two oval shaped and thick walled powerful muscles with a tough horny lining.
    [Show full text]
  • Clinical Characteristics and Incidence of Perianal Diseases in Patients with Ulcerative Colitis
    Annals of Original Article Coloproctology Ann Coloproctol 2018;34(3):138-143 pISSN 2287-9714 eISSN 2287-9722 https://doi.org/10.3393/ac.2017.06.08 www.coloproctol.org Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis Yong Sung Choi1, Do Sun Kim2, Doo Han Lee2, Jae Bum Lee2, Eun Jung Lee2, Seong Dae Lee2, Kee Ho Song2, Hyung Joong Jung2 Departments of 1Gastroenterology and 2Surgery, Daehang Hospital, Seoul, Korea Purpose: While perianal disease (PAD) is a characteristic of patients with Crohn disease, it has been overlooked in pa- tients with ulcerative colitis (UC). Thus, our study aimed to analyze the incidence and the clinical features of PAD in pa- tients with UC. Methods: We reviewed the data on 944 patients with an initial diagnosis of UC from October 2003 to October 2015. PAD was categorized as hemorrhoids, anal fissures, abscesses, and fistulae after anoscopic examination by experienced proctol- ogists. Data on patients’ demographics, incidence and types of PAD, medications, surgical therapies, and clinical course were analyzed. Results: The median follow-up period was 58 months (range, 12–142 months). Of the 944 UC patients, the cumulative in- cidence rates of PAD were 8.1% and 16.0% at 5 and 10 years, respectively. The incidence rates of bleeding hemorrhoids, anal fissures, abscesses, and fistulae at 10 years were 6.7%, 5.3%, 2.6%, and 3.4%, respectively. The cumulative incidence rates of perianal sepsis (abscess or fistula) were 2.2% and 4.5% at 5 and 10 years, respectively. In the multivariate analyses, male sex (risk ratio [RR], 4.6; 95% confidence interval [CI], 1.7–12.5) and extensive disease (RR, 4.2; 95% CI, 1.6–10.9) were significantly associated with the development of perianal sepsis.
    [Show full text]
  • Prevalence of Functional Disorders of the Bowel, Rectum, and Anus in a Tertiary Urogynecology Population
    200 Jelovsek J E1, Barber M D1, Walters M D1, Paraiso M F1 1. The Cleveland Clinic Foundation PREVALENCE OF FUNCTIONAL DISORDERS OF THE BOWEL, RECTUM, AND ANUS IN A TERTIARY UROGYNECOLOGY POPULATION Hypothesis / aims of study Straining is frequently mentioned as a possible etiologic factor in pelvic floor disorders and pelvic denervation. Constipation is a disease that results in frequent straining often seen in patients with pelvic floor disorders. The overall prevalence of constipation in the U.S. population is 14.7%, with 4.6% being functional constipation, 4.6% outlet subtype, 2.1% IBS- constipation subtype, and 3.4% IBS-outlet[1]. The prevalence and clinical subtypes of constipation and other functional bowel, rectal and anal disorders have not been well characterized in women with urinary incontinence (UI) and pelvic organ prolapse (POP). The specific aims of this study were: (1) to determine the prevalence of functional bowel disorders as defined by the Rome II criteria in a tertiary urogynecology clinic, (2) to determine the prevalence of subtypes of constipation, and (3) to determine whether demographic, clinical, or physical exam factors are associated with different types functional bowel, anal, and rectal disorders in patients with prolapse and incontinence. Study design, materials and methods This was a cross-sectional study design. One hundred and fifty consecutive female subjects presenting to a tertiary referral, urogynecology clinic were identified. Demographic, general medical, and physical exam information were collected. The prevalence of functional bowel disorders and functional disorders of the anus and rectum as defined by the Rome II criteria[2] were collected.
    [Show full text]
  • Perianal Abscess in a 2-Year-Old Presenting with a Febrile Seizure and Swelling of the Perineum Gregory M
    Oxford Medical Case Reports, 2019;01, 26–28 doi: 10.1093/omcr/omy116 Case Report CASE REPORT Perianal abscess in a 2-year-old presenting with a febrile seizure and swelling of the perineum Gregory M. Taylor, DO* and Andrew H. Erlich, DO Emergency Medicine Physician, Beaumont Hospital, Teaching Hospital of Michigan State University, Department of Emergency Medicine, Farmington Hills, MI, USA *Correspondence address. Beaumont Hospital, Teaching Hospital of Michigan State University, Farmington Hills, MI, USA. E-mail: Gregory.Taylor@ Beaumont.org Abstract An anorectal abscess, specifically a perianal abscess, is a relatively uncommon infection in children. It is a purulent fluid collection under the soft tissue outside the anus. Some of these abscesses may spontaneously drain and heal by themselves, while others may result in sepsis and require surgical intervention. The transition to a systemic illness requiring hospital admission is considered rare. We present the case of a 2-year-old male presenting with a febrile seizure and found to be systemically ill secondary to a perianal abscess. To our knowledge, this is the first case reported in the literature of a febrile seizure secondary to a perianal abscess. INTRODUCTION Vitals on arrival to the ED were as follows: 103.1°F, blood pressure of 96/78 mmHg, respiratory rate 27 breaths/min, heart A perianal abscess occurs most often in male children <1 year rate 126 beats/min, weight 12.8 kg and 100% oxygen saturation of age; however, they can occur at any age and in either sex [1]. on room air. As soon as he was brought back to the treatment In one study, an incidence was reported of up to 4.3% [1].
    [Show full text]
  • Evaluating and Treating the Gastrointestinal System
    CHAPTER 14 Evaluating and Treating the Gastrointestinal System STACEY GELIS, BS c, BVS c (Hons), MACVS c ( Avian Health) The avian gastrointestinal tract (GIT) has undergone a multitude of changes during evolution to become a unique anatomical and physiological structure when compared to other animal orders. On the one hand it has evolved to take advantage of the physical and chemi- cal characteristics of a wide variety of food types.1 On the other hand, it has had to do so within the limitations of the requirements for flight.2 To this end, birds have evolved a lightweight beak and muscular ventriculus, which replaces the heavy bone, muscular and dental structure characteristic of reptiles and mammals. The ventriculus and small intestine are the heaviest struc- tures within the gastrointestinal tract and are located near the bird’s centre of gravity within the abdomen. Greg J. Harrison Greg J. The overall length of the GIT is also less than that of a comparable mammal, another weight-saving flight adap- tation. Interestingly, these characteristics are still shared with the flightless species such as ratites and penguins. In addition, the actual digestive process needs to be rapid to support the high metabolic rate typical of flighted birds.3 Gastrointestinal adaptations to the wide range of ecolog- ical niches that birds occupy mean that birds can take advantage of a huge variety of foodstuffs. The GIT hence shows the greatest degree of diversity of all the organ systems between different avian taxa. However, the pres- sures of convergent evolution have also meant that many distantly related species have developed a similar gastrointestinal anatomy to take advantage of particular food niches.3,4 Examples of these will be presented in the discussion of each section of the GIT.
    [Show full text]
  • Anorectal Disorders
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE HHS Public Access provided by Carolina Digital Repository Author manuscript Author ManuscriptAuthor Manuscript Author Gastroenterology Manuscript Author . Author Manuscript Author manuscript; available in PMC 2017 September 25. Anorectal Disorders Satish S. C. Rao1, Adil E. Bharucha2, Giuseppe Chiarioni3,4, Richelle Felt-Bersma5, Charles Knowles6, Allison Malcolm7, and Arnold Wald8 1Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia 2Department of Gastroenterology and Hepatology, Mayo College of Medicine, Rochester, Minnesota 3Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy 4Division of Gastroenterology and Hepatology and UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 5Department of Gastroenterology/Hepatology, VU Medical Center, Amsterdam, The Netherlands 6National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, United Kingdom 7Division of Gastroenterology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia 8Division of Gastroenterology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Abstract This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases.
    [Show full text]