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Sy , Jamelle ; Sydiongco , Paula Marie; Tacata , Patricia; Tady , Clarissa Marie

Surgery Case 5. Sy , Jamelle ; Sydiongco , Paula Marie; Tacata , Patricia; Tady , Clarissa Marie. CHIEF COMPLAINT. PERIANAL PAIN. HISTORY. PHYSICAL EXAMINATION. VS: BP= 120/80; PR= 85/min; RR= 18/min; T- 37.8 0 C HEENT: anicteric sclera, pink palpebral conjunctivae

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Sy , Jamelle ; Sydiongco , Paula Marie; Tacata , Patricia; Tady , Clarissa Marie

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  1. Surgery Case 5 Sy, Jamelle; Sydiongco, Paula Marie; Tacata, Patricia; Tady, Clarissa Marie

  2. CHIEF COMPLAINT PERIANAL PAIN

  3. HISTORY

  4. PHYSICAL EXAMINATION • 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

  5. SALIENT FEATURES • 59 y/o male • Diabetic • T- 37.8 0 C • Erythematous, warm and tender 5x4 cm mass on the R perianal region • DRE cannot be tolerated by the patient

  6. DIFFERENTIAL DIAGNOSIS

  7. CLINICAL FEATURES

  8. DIAGNOSIS: PERI-ANAL ABSCESS

  9. PERI-ANAL ABSCESS

  10. INCIDENCE AND EPIDEMIOLOGY • 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.

  11. PATHOPHYSIOLOGY

  12. PATHOPHYSIOLOGY

  13. PATHOPHYSIOLOGY

  14. CLINICAL PRESENTATION • 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.

  15. CLINICAL PRESENTATION • 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.

  16. MANAGEMENT • 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.

  17. Drainage of perianal or superficial abscesses

  18. Drainage of perianal or superficial abscesses

  19. 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.

  20. ANTIBIOTIC THERAPY • Antibiotic therapy when indicated– to cover aerobes and anaerobes e.g. ciprofloxacin 500 mg PO 2x daily for 5 days

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