Задача 12
Больная Р., 39 лет, жалуется на острую боль в прямой кишке, усиливающуюся при акте дефекации, недомогание, повышение температуры тела до 38,60С. Из анамнеза: болеет на протяжении 3-х суток, заболевание связывает с переохлаждением.
При обследовании: общее состояние больной средней тяжести, температура тела 38,60С, пульс 108 уд/мин. При осмотре периананьной области патологии не выявлено. При пальцевом ректальном исследовании на правой боковой стенке прямой кишки на глубине 8 см определяется выпячивание стенки кишки, пальпируется край инфильтрата, резко болезненного.
Syndrome of acute pain in the rectum and perianal
Case #1
Patient K. , 28 years old , complains of severe burning pain in the anal canal , which occurs during defecation and continues afterwards , pain irradiating to the perineum, accompanied with disuria. From anamnesis : acute onset , the pain came after constipation and difficult defecation .
The examination ( in the knee- elbow position the patient ) when viewed - pathology in the anal canal have not been identified, with a slight straining edge defect of the anal canal mucosa of the linear form appears at 6 o'clock. When you try to digital examination of the rectum pain increased sharply , expressed spasm of the sphincter , on the glove - crimson blood .
Case #2
Patient B.,37 years old, complains of constant throbbing pain in the anal canal and perianal area , increasing with defecation , malaise, fever up to 38.0 C. Anamnesis : the third day of illness , acute onset after hypothermia . The disease began with the appearance of pain in the anal canal and perianal area , the pain gradually intensified, took pulsating character , increased body temperature .
On examination : when inspecting the perianal area to the right of the anal canal has redness and swelling of the skin , local increase in temperature . On palpation determined sharply painful infiltration 5x6 cm, with a softening in the center . A digital rectal examination painful , there is an overhang on the right wall of the rectum with fluctuation .
Case #3
Patient T., 38 years old, complains of constant pain in the anal canal and perianal area , increasing with defecation . From anamnesis : get sick three days ago , the disease is associated with heavy physical activity . In the past year noticed periodic appearance of red blood in the feces.
On examination : in the anal canal visible external hemorrhoids , cyanotic , which are located at 4 , 7 and 11- hours , palpation - nodes tense , painful . When you try digital rectal examination the patient experiences sharp pain, on the glove - crimson blood .
Case #4
Patient R., 40 years old , complaining of severe pain in the anal canal , foreign body sensation . From anamnesis : get sick three hours ago , after lifting weights. In the past, these phenomena were not, however, for several months, noted the periodic allocation of a minor amount of red blood after a defecation , the presence of blood on the toilet paper .
On examination : in the anal canal can be seen several hemorrhoid of bluish- purple color , palpation - nodes tense , painful . Perianal skin is of normal color .
Case #5
Patient F. , 24 years old, complains of severe pain in the interbuttocks fold and perianal region , increased body temperature ; pain radiating into the rectum. From anamnesis : over the years periodically discharge in interbuttocks fold . Two days ago , after hypothermia , there was pain , which gradually intensified, increased body temperature to 37,8 º C.
On examination : in the field of skin in the interbuttocks fold became hyperemic, edematous , palpable infiltration, size 5x4 cm, sharply painful , immobile, with fluctuation in the center. On digital rectal examination revealed no pathological changes .
Case #6
Patient N. , 25 years old , complains of severe pain in the anal canal , which occurs during defecation and continues afterwards ; pain radiating to the perineum and vulva . From history : alcohol abuse ; acute pain occurred after prolonged severe constipation and defecation . In the past, similar phenomena were observed.
On examination : the examination of the perianal and anal region revealed no pathology , palpation - defined moderate pain in the coccyx . When you try to perform a digital examination of the rectum the patient experienced a sharp pain and spasm of the sphincter; on the glove -crimson blood .
Case #7
Patient B. , 52 years old, complains of severe throbbing pain in the perianal region , aggravated by defecation, to increase body temperature to 38.80 C. . Anamnesis : is sick for two days , the disease is associated with hypothermia and constipation . Initially, the pain was constant , nagging , but then increased rapidly adopted pulsating character , increased body temperature . Sick for more than 10 years with diabetes.
On examination : general condition is moderate, body temperature 38.80 C. In the perianal area to the left of the anus there is congestion and swelling of the skin , local increase in temperature . Palpation in this area is defined sharply painful infiltration , size 6x7 cm, with indistinct contours , in the center of which a fluctuation is determined .
TASK 8
Patient Yu , aged 42, complains of severe pain in the anal canal , foreign body sensation . From history : such phenomena not previously observed , but occasionally noted the appearance of red blood after a bowel movement . Two days ago , after heavy physical work and alcohol abuse there was a pain in the anal canal , which is gradually increased.
On examination : in the anal canal at 4 , 7 or 11- hours are external hemorrhoids , cyanotic , moderately painful . When digital examination of the rectum at a depth of 4 cm defined internal hemorrhoids are located at 4 , 7 or 11- hour , dense knots , sharply painful on palpation.
TASK 9
Patient D. , aged 45, complains of severe pain in the anal canal , which appears during defecation and continues for some time after , pain radiating to the perineum and genitals. From history : acute ill two days ago , the disease is associated with long-term constipation and severe act of defecation .
On examination : in the perianal area are external hemorrhoids are located at 4 , 7 or 11- hour , knots Slept painless . Upon careful breeding buttocks in the anal canal at the rear edge of the defect has mucosa , slit-like . When you try to make digital examination of the rectum there was a sharp pain and spasm of the sphincter , on the glove - crimson blood .
TASK 10
Patient Z. , 25 years old , complains of a constant sharp pain in mezhyagodichnoy area , fever , malaise . From history : previously had no such phenomena , but occasionally noticed stains on the linen, soak in mezhyagodichnoy crease. Three days ago , after hypothermia , there was a pain in mezhyagodichnoy area which gradually intensified, increased body temperature .
On examination : general condition is relatively satisfactory , body temperature 37,9 ° C. When viewed in the perianal region mezhyagodichnoy crease determined hyperemia and edema of skin with scar retractions in the center. On palpation determined dense, sharply painful infiltration , size 5x4 cm in digital examination of the rectum revealed no pathology .
TASK 11
Patient S. , 35 years old , complains of severe pain in the anal canal , which may radiate to the perineum and genitals. From history : such phenomena not previously observed . Night ago , after a long in severe constipation defecation there was a sharp pain in the anal canal , said red blood on the toilet paper . Abusing alcohol .
On examination : the examination of the perianal area revealed no pathology . Straining the patient and breeding napkins anal canal at 6 hours determined linear defect region mucosa. When you try to digital examination of the rectum pain increased sharply , there was a spasm of the sphincter muscle on the glove appeared crimson blood .
Case# 12
Patient R. , 39 years old , complains of severe pain in the rectum, increasing with defecation , malaise, fever up to 38.60 C. From history : sick for 3 days , the disease is associated with hypothermia .
On examination : general condition of the patient of average weight , body temperature 38.60 C, the pulse 108 bpm. When viewed perianal area revealed no pathology . Digital rectal examination on the right side wall of the rectum at a depth of 8 cm is defined protrusion of the bowel wall , palpable edge infiltrate sharply painful .