Showing posts with label Pathophysiology. Show all posts
Showing posts with label Pathophysiology. Show all posts

27 June 2012

Acute Phase Reactants



Acute phase reactants
http://www.uic.edu/

Clinical Chemistry
Keri Brophy-Martinez
http://www.austincc.edu/

Nature of the Immune System
http://www.austincc.edu/

Rheumatoid Arthritis
Praharsha R. Menon
http://www.fpm.emory.edu/

C-Reactive Proteins
Amy Alread
http://www.milligan.edu/

Evaluation of Laboratory Data in Nutrition Assessment
Cinda S. Chima, MS, RD
http://www3.uakron.edu/

General or Nonspecific Host Immune Defense Mechanisms
http://pages.cabrini.edu/

The Immune System
http://navigator.medschool.pitt.edu/

Mechanisms of Immunity
http://webmedia.unmc.edu/

Approach to the Patient with ANEMIA
Lisa Mohr, MD, Mike Tuggy, MD
http://www.fammed.washington.edu/

Overview of Rheumatoid Arthritis
Naureen Mirza, MD
https://cbase.som.sunysb.edu/

Iron Repletion in ESRD
Saleem Bharmal
http://medicine.med.nyu.edu

Nutrition Support of the Hospitalized Patient Therapeutic Priorities
http://www.med.unc.edu/

First Foundations in Pathology
Paul G. Koles, MD
http://www.med.wright.edu/

Effect of procalcitonin-based guidelines vs standard guidelines
Ria Dancel, MD
https://medicine.med.unc.edu/


249 Published articles on Acute Phase Reactants

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12 May 2009

Reproductive Pathophysiology



Reproductive Pathophysiology
Presentation by:W. Rose

1. Alterations of Maturation
2. Female system disorders
3. Male system disorders
4. Breast disorders


Reproductive Pathophysiology

1. Alterations of Maturation

Delayed puberty
High LH, FSH: Lack of gonads often due to
genetic defect – 45X, 47XXY etc
Low LH, FSH: disrupted hypothal-pit-gonadal axis.
Anorexia, severe obesity, marijuana, Cushing syn, GnRH deficiency, etc

Precocious puberty
Reproductive Pathophysiology

2. Female system disorders
Hormonal & menstrual
Infection & inflammation
Pelvic relaxation disorders
Benign growths & proliferative disorders
Cancer
Sexual dysfunction
Impaired fertility

Hormonal & menstrual
Primary dysmenorrhea
Primary amenorrhea
Secondary amenorrhea
Dysfunctional uterine bleeding
Polycystic ovary syndrome
Premenstrual syndrome

Polycystic ovary syndrome
Can cause oligoovulation or anovulation
Most common cause of anovulation in infertile women
Androgen excess typically also seen
Polycystic ovaries
Associated with insulin resistance, metabolic syndrome, hyperinsulinemia, & overweight
Weight loss helps
Drug therapy:
P.I.D. inflamm due to infection. Any or all pelvic organs.
Various bacteria; go from cervix > uterus > pelvic cavity. Salpingitis=fallopian tubes; oophoritis=ovaries. Can cause infertility, ectopic pregn, chronic pelvic pain, etc; complication rate up with repeat infections.

Vaginitis inflamm due to infection
Cervicitis inflamm due to infection
Vulvitis dermatitis
Bartholinitis
infection causes inflamm, closure of of duct from B.g.; cyst forms
Pelvic relaxation disorders
Uterine prolapse
Vaginal prolapse
Benign growths & proliferative disorders
Benign ovarian cysts
Endometrial polyps
Leiomyomas
Adenomyosis
Endometriosis
Vaginal cancer
Vulvar cancer
Endometrial cancer and uterine sarcoma
3. Male system disorders
Urethra
Penis
Scrotum, testis, epididymis
Prostate
Sexual dysfunction
Impaired fertility: low sperm quantity/quality

4. Breast disorders
Female
Galactorrhea
Benign breast conditions
(fibrocystic changes)
Cancer

Male
Gynecomastia
Cancer

Breast Cancer
Most common female ca, 2nd most deadly
Risk factors

Family history. Early menarche, late menopause, late or no 1st pregnancy. Oral contraceptives; estrogen replace w/o progesterone or estrogen replace w/ cyclic progesterone.
Reproductive Pathophysiology.ppt

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02 May 2009

Male and Female Genitalia



Male and Female Genitalia
Presentation Lecture by Jennifer Coleman, Assistant Professor of Nursing
Arkansas Tech University.

* Health Assessment

Common Chief Complaints
* Urethral discharge
* Palpable mass
* Erectile dysfunction
* Penile lesion
* Scrotal pain

Inspection

* Hair distribution
* Urethral meatus
o Location, discharge
* Inguinal area
o Bulges, masses
* Penis
o Size, shape, lesions, swelling, inflammation
* Scrotum
o Size, shape, lesions, inflammation, swelling, nodules
Inspect the Glans and Urethral Meatus
* Compress meatus
o Check for proper positioning of urethral opening
o Check for drainage – urethral culture
* Skin pink and smooth
Transillumination

* Light from behind scrotum
* Normal - Does not transilluminate
* Hernia – Pink or red glow
* Hydrospadias - Translucent

Palpation

* Penis
o Assess for tenderness, pulsations, masses
* Urethral meatus
o Assess for discharge
* Scrotum
o Assess for masses, tenderness, spermatic cord
* Inguinal area
o Assess for hernias

Inspect and palpate the scrotum

* Patient holds penis out of the way
* Note skin, lumps, nodes
* Testes: slide easily, oval, firm, movable
* Epididymis: feels discrete, softer than testis, smooth

Auscultation

* Not routinely done, but can add to assessment findings
* Scrotum
* Abnormal findings
o Presence of bowel sounds may indicate indirect inguinal hernia

Abnormal Finding Examples

* Hypospadias and Epispadias
* Penile lesions and Urethral discharge
* Hydrocele, Spermatocele, Empty scrotal half, Acute Orchitis, Scrotal Edema, Torsion of the cord, Acute epidymitis, Testis Tumor
* Hernias
* Alopecia, Lice or nits present

Hypospadias

* Urethral meatus open on ventral (under) side of glans, shaft or penoscrotal junction
* Do not circumcise until surgically corrected

Epispadias

* Meatus opens on dorsal (upper) side of glans or shaft
* Less common than hypospadias

Syphilitic Chancre

* Silver, small papule - erodes to red ulcer with yellow, serous discharge
* Nontender base
* Lymph nodes enlarged & nontender

Genital Herpes

* Clusters of small vesicles, surrounding erythema
* Often painful, erupt to superficial ulcers
* 1st infection lasts 7-10 days
* Virus remains dormant indefinitely
* Recurrent infection lasts 3-10 days

Genital Warts

* Warts
* Painless, grapelike clusters
* May look like skin tags
* One of the most common STD’s

Carcinoma of Penis

* Red, raised warty growth or an ulcer with watery discharge
* Necrose and slough
* Usually painless
* Usually on glans
* Lymph nodes commonly enlarged

Hydrocele

* Painless swelling
* Enlarged mass, transilluminates translucent
* Communicating vs. noncommunicating (intermittent or constant bulge)
* Common <2 y.o. - often disappears spontaneously

Spermatocele

* Cyst in epididymis (generally small)
* Painless
* Does transilluminate
* round, freely moveable (may feel like a third testis)

Empty scrotal half

* True cryptorchidism – testes never descended
* Physiologic cryptorchidism - absence of testis in scrotum, but can be milked down
* 3-4% at birth, most will descend in 1st mo. (much higher percentage with prematurity)
* Decrease spermatogenesis to infertile by 6 yrs.

Acute Orchitis

* Acute inflammation of testis – most commonly from the mumps
* Pain – sudden onset, swollen testis, fever
* Potential for infertility

Scrotal Edema

* Usually occurs with systemic edema (CHF, renal failure)
* Also with local inflammation
* Tenderness, reddened, taut with pitting

Torsion of the cord

* Sudden twisting of the spermatic cord
* Rare after 20 y.o.
* Usually on left side
* Blood supply is cut off – ischemia and engorgement - very painful
* Emergency – requires surgery
* Cremasteric reflex absent

Acute epidymitis

* Acute infection of epidiymis
* Severe pain of sudden onset, rapid swelling and fever
* Reddened scrotum
* WBCs and bacteria in urine

Testis Tumor

* Usually painless lump
* Increase in local nodes common

Hernia

* Internal anatomy of inguinal hernia
* Loop of bowel protruding through weak muscle
* Possible pain
* Swelling
* May be congenital or acquired

Palpate for hernia

* Inguinal canal
* Ask patient to “bear down”
* Nl: feel no change
* Abnl: feel mass bump into/push against side of your finger

Newborn

* Scrotum pink with rugae (preterm will have smooth scrotum)
* Cremastric reflex strong
* Check for undescended testes, hydrocele, inguinal bulge

Pediatric Considerations

* Circumcision is considered a personal/cultural/religious decision by parents (~70-80% in US)
* Start TSE at ~13-14 years of age
* Undescended testicles increase risk of cancer
* Do not retract foreskin 1st 3 months d/t risk of tearing membrane

Developmental Considerations

* Infants
o Prenatally – testis develop in abdomen then migrate down into scrotum beginning at week 30
* Adolescents
o Puberty ~ 9 ½ yrs- 13 ½ yrs.
o 1st sign of puberty are enlargement of testes, next is pubic hair then penis inc. in size
o Sexual Maturity Ratings – p. 717

Gerontological Variations

* Thinner, gray pubic hair
* Decreased testosterone levels
* Penile and testicular atrophy
* Scrotal rugae decreases
* Slightly decreased spermatogenesis
* Increased time to obtain erection
* Increased risk for impotence
* Benign prostatic hypertrophy - 1 in 10 the prostate gland will increase in size ~ 40 y.o.

Testicular Self Exam (TSE)

* Exam every month
* Exam with warm shower will relax scrotal sac
* Testicular cancer is rare but occurs most commonly in young men (15-35 y.o.)
* Caucasians 4 times more likely to develop testicular cancer
* ~100% cure rate with early detection

Anus

* Anal canal is outlet of GI tract
* Canal is surrounded by 2 layers of muscle
o internal sphincter - involuntary control
o external sphincter - voluntary control
* External inspection looks moist and hairless (check for skin breakdown with valsalva maneuver)
* “ Anal Wink test”

Rectum

* 12 cm long
* distal portion of large intestine

Pediatric Considerations

* 1st stool passed by newborn is dark green (meconium) - indicates anal patency - usually at 24-48 hours
* Infants pass stool by reflex (gastrocolic reflex) with each fdg. - nerves fully myelinated by 1.5 - 2 years old for voluntary control

Prostate

* Gland which surrounds the bladder neck and urethra
* Secretes milky fluid which helps sperm remain viable

Prostate Gland

* Puberty - rapid increase to > double size then stabilizes through adulthood
* Common to increase in size with older adults - gradually impede urine output - BPH
* Most common non-skin cancer in America, affecting 1 in 6 men
* African American men are 61% more likely to develop prostate cancer
* http://www.cancer.gov/cancertopics
* Prostatitis –
o infection in the prostate, most common cause of UTIs in men
o fever, chills, burning during urination, or difficulty urinating

Palpate Prostate Gland

* Size
* Shape
* Surface
* Consistency
* Mobility
* Sensitivity

Palpation of Anus & Rectum

* Gloves with water soluble lubrication
* Approach at an angle with finger
* Palpate muscular ring by rotating finger
* Use thumb to help check bulbourethral glands
* Inspect stool (brown and soft)

Abnormal Findings

* Pilonidal Cyst or Sinus
o Midline over coccyx
o Dimple opening with visible tuft of hair
o May be a palpable cyst – sinus develops when advanced
o Congenital – but often not diagnosed until 15-30 years old

Abnormal Findings

* Check for anorectal fistula (abnormal passage from GI tract, normally caused by an abcess)
* Rectal prolapse - rectal mucous membrane protrudes through anus
* Hemorrhoids (external & internal, thrombosed)
* Pruritus Ani - intense perianal itching
o children - pinworms
o adults - fungus

Abnormal Findings

* Polyps of rectum
o Relatively common growth
o Not easily palpated
o Proctoscopy and biopsy needed to screen for malignancy
* Carcinoma of the rectum
o Malignant neoplasm
o Asymptomatic

Female Genitalia

* Common chief complaints
o Uterine bleeding
o Vaginal discharge
o Urinary symptoms
o Pelvic pain

External Inspection

* Pubic hair distribution
* Skin color and condition
o Mons pubis and vulva
o Urethral meatus
o Vaginal introitus
o Perineum and anus

Palpation of External Genitalia

* Labia
* Urethral meatus
* Skene’s glands (normally unable to visualize)
* Bartholin’s glands (normally unable to visualize)
* Vaginal introitus
* Perineum

Bartholin’s Gland Infection

* Local pain (may be severe)
* Skin over abscess red and hot
* Can express purulent discharge
* Often complication of gonococcal infection

Internal Inspection

* Order of internal examination
o Speculum examination - obtain specimens
o Bimanual examination – water soluble lubrication
o Rectovaginal examination

Lithotomy Positioning

* Elevate head and shoulders slightly to improve comfort - also provides opportunity for patient to maintain eye contact
* Slide patient to very end of table
* Proper draping very important

Speculum Examination of the Cervix

* Use of speculum
* Characteristics of assessment
o Color
o Position
o Size
o Surface characteristics
o Discharge
o Shape of cervical os

Cervix

* Mucosa is pink and even
* 2nd mo. pregnancy is blue (Chadwick’s sign)
* After menopause is pale
* Note Os

Cervical Cancer and Nabothian Cysts
* HPV – main risk factor for cervical cancer
* Lack of regular Pap tests
* Weakened immune system
* Over the age of 40
* BC pills for 5 or more years with HPV
* http://www.cancer.gov/cancertopics

Cervix Specimen Collection
Collecting Specimens

* Pap smear/ Thin-layer preparation (liquid-based)
o Endocervical
o Cervical
o Vaginal
* Gonococcal/Chlamydia culture
* Saline mount (Wet Prep)
* Acetic Acid Wash (HPV – human papilloma virus – genital warts)
* Anal culture

Vaginal Discharge

* Normal – small amount, clear or cloudy, nonirritating
* Profuse, watery, gray-green & frothy - trichomoniasis
* Thick, white & curd-like - candidiasis

Uterine Positions

* Anteverted - usual position
* Anteflexed - usual position
* Midposition
* Retroflexed
* Retroverted
* See page 777.

Rectocele

* Rectum (under vaginal mucosa) is prolapsed into vagina
* Pressure felt in vagina
* Constipation possible

Cystocele

* Prolapse of bladder (under vaginal mucosa) into vagina
* Pressure felt in vagina
* Stress incontinence

Pediatric Considerations

* Newborn - engorged external genitalia d/t maternal estrogen
* Puberty - estrogen stimulate secondary sex characteristics
* 1st signs are breast and pubic hair development
* Begins 8.5 to 13 years
* Sexual Maturity rating – p. 411 & 760

Pregnancy

* Primagravida - pregnant for the 1st time
* Primipara - first delivery
* Multigravida - pregnant for >1 time
* Multipara - > 1 delivery
* Gravida - pregnancy
* Para - delivery
* AB - abortion (spontaneous/elective)

Pregnancy

* Chadwick’s sign – blue cervix
* Goodell’s sign – cervix softens
* Mucus plug – cervical canal
* Cervical & vaginal secretions – increase, thick, more acidic
* May increase risk of candidiasis (yeast) infection

Gerontological Variations

* Menopause - cells in the reproductive tract are estrogen dependent
o Low estrogen levels
o Cessation of menses
o Generalized atrophy of external and internal female organs
o Thinning of vaginal epithelium
+ Decrease in lubrication
+ Wall becomes drier and itchy
+ Increase risk for bleeding & vaginitis

Copyright 2002, Delmar, A division of Thomson Learning
Male and Female Genitalia.ppt

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The Rectum and You



The Rectum and You
Presentation lecture by:Robert Theobald III, D.O.
Vein Associates P.A.

Hemorrhoids

* Cushions of tissue and varicose veins located in and around the rectal area
* Usually swollen and inflamed due to precipitating factors
* Factors include constipation, diarrhea, pregnancy, straining, aging, and anal intercourse
* Approximately 89% of all Americans at some time in their lives
* Over 2/3 of healthy people report having hemorrhoids
* Hemorrhoids tend to become worse over the years, never better, unless intervention ensues
* They are located both inside and above the anus (internal) or under the skin around the anus (external)
* Hemorrhoids arise from congestion of internal and/or external venous plexuses around the anal canal

Hemorrhoids-Classifications

* 1st Degree: Bleeding occurs, but do not prolapse outside the anal canal
* 2nd Degree: Prolapse outside the anal canal upon defecation, but retract spontaneously
* 3rd Degree: Require manual reduction after prolapse
* 4th Degree: Can not be reduced, because of strangulation

* The major drainage of the hemorrhoidal plexus is through the superior hemorrhoidal vein, which drains into the inferior mesenteric vein and the portal system
* Hemorrhoidal veins have no valves
* Valveless veins exert maximal pressure at the lowest point
* Any process that impairs venous return will promote stasis
* Can be produced by either systemic or by portal venous hypertension (CHF or cirrhosis)
* Intra-abdominal pressure also impairs venous return (ascites, exercise, pregnancy, straining, and tumors)

* The most significant symptom is rectal bleeding!
* Usually bright red
* Internal hemorrhoids are NOT painful
* Bleeding can be significant because of an arteriovenous fistula formation in plexus
* Other symptoms are prolapse, pruritis, and perianal edema

Perianal Edema
Hemorrhoid Treatment

* Treatment starts conservatively
* Hydrocortisone Cream 2.5%
* Anusol HC Suppositories
* Rubber-Band Ligation
* Sclerotherapy (5% phenol)
* Infra-Red Coagulation
* Surgery

Hemorrhoidectomy
Thrombosed External Hemorrhoids

* Thrombosed hemorrhoids are an acute and very painful problem that develops rapidly
* Typically a perianal mass develops which is painful to palpate (and look at)
* The lesion is due to sudden clot formation in one of the subcutaneous or submucosal veins
* The diagnosis is easy to make by the violet discoloration of the lesion
* The overlying tissue is tense and shiney
* Treatment is with excision of the clot
* The body will eventually reabsorb the clot, but might takes weeks
* Easier to excise after a few days
* Adherence may occur if not excised within a few days

Abscesses

* A perianal abscess is a collection of pus in one of the anatomic spaces of the anal region
* The perianal anatomy is defined by the sphincter and the levator ani muscles
* The Iliococcygeus, Pubococcygeus, and Puborectalis
* Abscesses can be classified according to location
* Perianal, Supralevator, Intersphincteric
* The most common location is perianal
* It results from a blockage of the anal glands located just outside the anus
* According to the crypto-glandular theory, they often develop from cryptitis which may be associated with an enlarged papillae in the anal canal
* It starts as a cellulitis with only swelling and erythema
* Finally, the infecting organisms burrow in the anal glands producing the abscess
* The microorganisms are not specific or unique
* They are usually polymicrobial
* More than 90% will include E. coli
* Other organisms include streptococci, staphylococci, and a variety of anaerobic bacteria

Abscesses-Symptoms

* The patient will present with fever, local inflammation, and pain
* The initial manifestation is fever followed by pain
* In 24-48 hours a fluctuant mass will appear
* An abscess in the intramuscular space may be difficult to diagnose and treat
* Clinical assumption is needed to treat appropriately
* Treatment consists of surgically draining the infected cavity
* A cruciate incision is made to allow pus to drain for a few days
* Sometimes a catheter is left in the incision to assure adequate drainage
* A fistulous tract can arise if the abscess is not treated properly

Fistula

* Most fistulas begin as an anorectal abscess
* Anal fistulas is an abnormal passage or communication between the interior of the anal canal or rectum and the skin surface
* Rarer forms may communicate with the vagina, large bowel, and bladder

Fistula-Symptoms

* Are usually a purulent discharge and drainage of pus or stool near the anus
* Can irritate the outer tissues causing itching and discomfort
* Pain occurs when fistulas become blocked and abscesses recur
* Flatus may also escape from the tract
* Fistulas can be difficult to diagnosis
* A probe must be passed between the opening of the skin’s surface and the interior opening
* Goodsall’s Rule can be helpful
* Other causes include tuberculosis, inflammatory bowel disease, and cancer

Crohn’s Fistula
Fistula-Treatment

* Fistulas last until surgically removed
* Excision of the complete tract is called a fistulectomy
* Sometimes a seton is placed in the tract to elicit an inflammatory reaction in the tissue resulting in closure
* 80% success rate with surgery
* Remicade (infliximab) for persistent disease
Fissures

* An anal fissure is a tear causing a painful linear ulcer at the margin of the anus
* Can cause itching, pain, or bleeding
* 80% of fissures occur in the posterior midline
* 15% of fissures occur in the anterior midline
* 5% of fissures occur either right or left lateral
o Fissures that occur laterally think of Crohn’s, tuberculosis, lymphoma, leukemia, anal cancer, syphilis, and trauma
* When an anal fissure is suspected, physical examination is diagnostic
* The exam may be difficult due to pain and sphincter spasm
* The triad consists of a sentinel skin tag, a fissure and a hypertrophied papilla

Fissures-Treatment

* Treatment for superficial fissures includes Anusol HC or Canasa (mesalamine) suppositories
* If suppositories don’t heal fissure, then nitroglycerin cream 0.2% is used (headaches are major side-effect)
* If not responding to pharmacotherapy or chronic fissure, then surgery is recommended
* Surgery consists of a fissurectomy and sphincterotomy
* Helps the fissure to heal by preventing pain and spasm which interferes with healing
* 90% of patients will improve with the surgery
* Very small chance of anal incontinence

Auto-colonoscopy
Pilonidal Cysts

* The term pilonidal was derived from the Latin pilus meaning hair and nidus meaning nest
* The pathogenesis is unknown, but the most common theory is that they are a result of an embryonic malformation and results in a remnant of a neurocanal
* Men are more likely than women to have the cysts at a ratio of 4 to 1
* Infection of a pilonidal cyst is most commonly seen between puberty and age 30
* Hair growth and secretion of sebaceous glands reach their peak
* Some suggest that trauma to the gluteal area to be an important predisposing factor
* In WWI it was known as Jeep Rider’s Disease
* Unless they become infected or inflamed, they are asymptomatic
* When a cyst becomes infected, an abscess can develop, usually lateral or superior to the gluteal cleft and over the coccyx
* As the process becomes chronic, a fistula develops and creates a sinus tract
* Diagnosis can be made with pilonidal pores which are 2 or more openings located between the gluteal cleft

Pilonidal Cysts-Treatment

* The only way to cure pilonidal cysts is surgery
* The first episode can be treated with antibiotics (Keflex or Augmentin)
* If recurrent, then surgery is performed
* Open-technique is most successful
* Other techniques include closed, marsupialization, and Z-plasty
Condylomata Acuminata

* Condylomata Acuminata (anal or perianal warts) are the most common sexually transmitted disease of the anus and rectum
* Human papillomavirus (HPV) is responsible
* Over 40 subtypes of HPV
* Most common 6 and 11
* 16, 18, 31, and 32 are associated with squamous cell carcinoma

Condylomata Acuminata

* CDC reports a 500% increased in the incidence from 1981; 1/7 Americans
* Are epithelialized, raised wartlike lesions that arise alone or more often in groups
* They can range from a few millimeters to a cauliflower-like lesion
* Can occur in combination with genital lesions
* Mode of transmission is sexual intercourse, auto-inoculation may occur
* Rarely bleed or painful, mostly pruritis
* Although perianal condylomata can be seen in women and heterosexual men, typically the patients are homosexual males
* CDC reports that 60-70% of homosexual men have condylomata
* Women have increased risk of cervical carcinoma with HPV infection
* Successful therapy requires accurate diagnosis and eradication of all warts
* All patients undergo anoscopy and genital examination
* Once identified, there are many different treatments depending on disease progression
* Each treatment has advantages and disadvantages
* The treatment options consist of excisional, destructive, immunotherapy, and chemotherapy
* Condylomata can be excised either in the office with local anesthesia or in the operating room
* Preservation of the anoderm and anal canal mucosa to minimize pain and healing time
* The rate of recurrance is less than 10%
* Podophyllin is a resin that is cytotoxic to condylomas and very irritating to normal skin
* Can not be applied to anal canal lesions
* Local complications include necrosis, fistula, and anal stenosis
* Electrocautery, Cryotherapy, and Lasers are also used with frequency
* Two therapies that are more commonly practiced today are interferon injections and Aldara (imiquimod) cream
* Both therapies are very potent with many side-effects
* LFT’s should be checked routinely with interferon injections
* Aldara should be used every other day, because it can burn normal tissue and make it necrotic

Pruritis Ani

* More common in males than females
* Symptoms include itching, burning, and irritation
* Close examination of the perianal area is required; ulcerations and excoriation
* Can be associated with other diseases
o Infections (fungal, parasitic, bacterial)
o Irritants (soaps, coffee, ETOH, detergents)
o Dermatologic (psoriasis, dermatitis, pemphigus)
o Systemic disease (diabetes, SLE, liver dx)

* Treatment
o Avoiding the offending agents
o Creams (analpram lotion/cream 2.5%)
o Topical Steroids
o Corona ointment (lanolin/bees wax based)

Anal Cancer

* Very uncommon cancer, accounting for only 4% of all cancers of the lower GI tract
* Anal cancer is on the rise due to individuals with HPV
* The majority of patients are women in their seventh decade who present with bright red bleeding and pain







Anal Cancer

* Anal cancer is often curable
* 3 major factors include site, size, and differentiation
* Squamous cell carcinomas make up the majority of all primary cancers of the anus
* The others are adenocarcinoma, verrucous carcinoma, and malignant melanoma
* Colorectal cancers are primarily adenocarcinoma

Squamous Cell Carcinoma

Anal Cancer-Treatment

* Surgery is a common way to diagnose and treat anal cancer
* Local resection takes out only the cancer, it spares the internal anal sphincter muscle
* Abdominoperineal resection (APR) removes the anus and the lower part of the rectum by cutting into the abdomen and the perineum
* With an APR, the patient will have a colostomy
Anal Cancer-Treatment

* Radiation therapy and Chemotherapy are used together to shrink tumors
* All anal cancers respond very well to this combination therapy
* APR is now an unnecessary surgery for anal cancer, but still very common for distal rectal carcinoma
Levator Syndrome

* More commonly called Proctalgia fugax
* It is episodic rectal pain caused by spasm of the levator ani muscles
* A spasm is situated in the rectum approximately 10-15 cm above the anus
* The pain or spasm is related to sitting for long periods of time
* Pain is described as a sharp, knife-like, twisting inside the rectum

Levator Syndrome

* Physical examination is usually normal
* Emotional factors, sexual activity, or fatigue can trigger an attack
* Can also be triggered by an injury to coccyx or lower back
* Structural deviations of the lumbro-sacral area, sacro-iliac, coccyx, and supportive structures are also causes

OSTEOPATHIC TREATMENT

* A fracture or dislocation of the coccyx should be reduced by bi-manual manipulation
* Levator ani tenderness will readily respond to OMT
* Digital stretching of the ischiococcygeus tends to relax the entire structure, usually on the left lateral side
Beach Bum
The Rectum and You.ppt

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