2020年10月19日星期一

what does a hemorrhoids look like,Cases of rectal cancer (Mile’s operation 4 cm from the anus)

    Patient Cai**, female, 49 years old

    He was admitted to the hospital because of "blood in the stool for more than 6 months, worsening for 3 months".

    Since the onset of the disease, the patient has good spirits, appetite, poor sleep, normal physical strength, stools as described above, and normal urination, and weight loss of about 5kg in the past 3 months. .

    Past history: Respiratory system symptoms: 30 years of chronic bronchitis, Circulatory system symptoms: None, Digestive system symptoms: None, Urinary system symptoms: None, Blood system symptoms: None, Endocrine and metabolic symptoms: None, Neuropsychiatric symptoms: None, Reproductive System symptoms: None, motor symptoms: None, history of infectious diseases: denial of history of hepatitis, tuberculosis or other infectious diseases, history of vaccination: vaccination according to the national plan, others: no special, history of allergies: denied history of drug and food allergies, history of trauma : Deny history of trauma, history of operation: Deny history of operation

    Physical examination: T: 36.8℃, P: 78 times/min, R: 20 times/min, BP: 133/90mmHg. Consciousness, cooperative physical examination, normal face, lymph nodes: no swelling of superficial lymph nodes throughout the body. Heart rate {heart rate} beats/min, heart rhythm is uniform, heart sounds are normal, no murmur is heard in each valve area. Inspection: no abnormal pulmonary apex pulsation, no abnormal bulge or depression, auscultation: lungs with clear breath sounds, no dry and wet rales and pleural friction sounds. Abdominal appearance: Abdominal appearance is normal, abdominal palpation: the whole abdomen is soft, tenderness and rebound pain: the whole abdomen has no tenderness, the right lower abdomen has slight rebound pain, mass: the abdomen is not palpable, the liver: the liver is not palpable under the ribs, Spleen: The spleen is not touched under the ribs. There was no edema in both legs. Physiological reflex is present, but pathological reflex is not elicited.

    Specialty conditions: no yellowing of the skin and sclera, no bleeding, purpura and ecchymosis on the skin and mucous membranes of the whole body, no palpable swelling of superficial lymph nodes, no tenderness of the sternum, no obvious abnormalities in cardiopulmonary auscultation, flat and soft abdomen, no tenderness, slight right lower abdomen Rebound pain, untouched liver and spleen ribs, mild edema of both lower limbs. .

    Auxiliary examination: 2014-09-04 Wuhan Union Medical College Hospital electronic colonoscopy: rectal Ca, internal hemorrhoids

    Initial diagnosis: rectal cancer? Internal hemorrhoids

    The patient underwent laparoscopic radical resection of rectal cancer on September 16, 2014, and found the pathology: During the operation, a new ulcer-like organism with a size of about 4*5cm was seen 4cm from the anus, the surrounding mucosa of the lesion was raised, and the central necrosis and bleeding. The quality is tough, and it is easy to bleed when touched. The lesion invades the intestinal cavity about 1/2 circle. The serosal layer of the intestinal wall is intact. Several lymph node hyperplasias can be seen around the rectum. The adhesion between the anterior rectum and the uterus is dense, and the liver does not reach obvious nodules. There was no obvious ascites in the abdominal cavity, no obvious metastatic lesions, and no obvious enlarged lymph nodes in the mesentery.

    Postoperative pathology: (rectal) moderately differentiated adenocarcinoma infiltrated the entire thickness of the intestinal wall and extramural fat tissue, mesenteric lymph nodes (6/9), and ① (inferior mesenteric artery root) lymph nodes (3/6) cancer metastasis (other (See 2 metastatic nodules). No cancer involvement was seen on both sides of the surgical specimen.

    The patient was discharged from the hospital on October 1, 2014. The condition of discharge: the patient’s general condition was fair, the skin and sclera were not yellowish, there were no bleeding spots, purpura and ecchymosis on the skin and mucous membranes of the whole body, no palpable swelling of superficial lymph nodes, no tenderness of the sternum, and cardiopulmonary auscultation No obvious abnormality, flat and soft abdomen, no tenderness, slight rebound pain in the right lower abdomen, untouched under the liver, spleen and ribs, and mild edema of both lower limbs.

    Discharge diagnosis: (rectal) moderately differentiated adenocarcinoma

    Patient's message: "Dear Professor Xiao and Dr. Liu Xin, how are you! You have worked hard. From my admission to the operation to the post-treatment, they are very concerned about the patient. I am very satisfied with the operation and the post-treatment recovery is very good. Well, I am very grateful to Professor Xiao, Dr. Liu Xin and the nurses for caring and working so hard for me to recover so well! I am grateful again, thank you!"

没有评论:

发表评论

hemorrhoids ligation,Irritating anorectal swelling

    Irritating anorectal swelling     Anal bulging is different from anal pain. In the mild cases, local fullness and falling, and severe c...