2020年12月17日星期四

hemorrhoids zinc oxide,Differential diagnosis of rectal cancer

    The main complaint of the patients is that they show different clinical symptoms during different periods and different pathological changes of the disease, which can be misdiagnosed as multiple diseases. Common ones are the following: hemorrhoids, bacillary dysentery, amoebic dysentery, schistosomiasis, chronic colitis, etc.

    1. hemorrhoid

    Hemorrhoids and rectal cancer are not difficult to distinguish, and all of them will be misdiagnosed. The main reason is that the medical staff underestimated the condition and failed to conduct serious examinations.

    Internal hemorrhoids are usually painless blood in the stool. The blood color is bright red and does not mix with the stool. Depending on the amount of bleeding, there will be blood, dripping, linear bleeding, or jet-like bleeding on the surface of the stool. The blood in the stool of rectal cancer is often accompanied by mucus and mucus blood in the stool and rectal irritation.

    Although some patients with early rectal cancer seen clinically only have blood in the stool and no other accompanying symptoms, it is very necessary to perform digital rectal examination for patients with blood in the stool.

    If it is a dilated venous mass, it is not easy to detect on the digital rectal examination. Anoscopy or sigmoidoscopy can reveal dark purple hemorrhoids near the dentate line. When the hemorrhoids gradually increase, they can protrude out of the anus during defecation, and they can often return on their own at the beginning. If the course of the disease is long, the perianal tissues and anal sphincter muscles may relax due to repeated prolapse, causing the hemorrhoids to prolapse, even if the abdominal pressure is increased. Spontaneous rebirth, need to be pushed by hand, due to repeated prolapse and rebirth, the mucosa often rubs and thickens and secretions increase, and the anus often suffers from itching and pain due to moist and uncleanness. According to these medical history and digital rectal examination, It is not difficult to identify patients.

    2. Anal fistula

    Anal fistulas are often caused by anal sinusitis and paraanal abscesses are caused by incomplete treatment; the outer mouth of high anal fistulas is more than 5 cm from the anus, and low anal fistulas are close to the anus. These patients often have a history of paraanal abscess, local redness and pain. It is very different from the symptoms of rectal and anal cancer, and it is easy to distinguish. However, when the anal fistula does not heal for a long time, especially when the anal fistula is enlarged and the ectropion presents a butterfly ulcer, it is necessary to pay attention to the possibility of malignant transformation. Biopsy is feasible to identify.

    3. Amoebic Enteritis

    Amoebic enteritis is characterized by abdominal pain and diarrhea, 7 to 8 times a day or even more than 10 times a day. If the disease involves the rectum, it is often accompanied by tenesmus. The stool has dark red or purple-red blood and mucus, and the volume is large, and the stool is typically "jam-colored" with a fishy smell.

    In the acute infection stage, amoebic enteritis has a typical sigmoidoscopy with a small mouth and a large "flask-like", the ulcer is relatively superficial, and the base has brown necrotic tissue, so the diagnosis is not difficult.

    However, the ulcer becomes a chronic stage for a long time. The ulcer can penetrate into the muscle layer, even penetrate the serosal layer, and adhere to adjacent tissues, and there is intestinal mucosal epithelial hyperplasia, ulcer basal granulation tissue hyperplasia and surrounding fibrous tissue hyperplasia, making the intestinal wall Thickening and narrowing of the intestinal lumen. If the connective tissue hyperplasia is obvious and the tumor-like hyperplasia is easy to be misdiagnosed as cancer, a detailed understanding of the condition will help distinguish.

    4. Schistosomiasis

    Intestinal lesions of schistosomiasis occur in the rectum, sigmoid colon, descending colon, and the deposition of eggs on the intestinal mucosa causes local congestion, edema, and necrosis. If the necrotic mucosa falls off, it will form superficial ulcers, causing symptoms such as abdominal pain, diarrhea, blood in the stool, and acute inflammation. After the changes subsided, connective tissue proliferation followed, thickening the intestinal wall and even narrowing the intestinal lumen. Schistosomiasis granulomas with repeated severe infections and obvious mucosal proliferation were easily confused with cancer. Pathology can be diagnosed or differentiated. Shanghai Medical University Pathology The teaching and research group analyzed the slices of intestinal cancer with schistosomiasis and found that some patients had more schistosomiasis egg deposits in the adenomas, and glandular epithelial hyperplasia and even cancerous changes were seen elsewhere in the egg deposit area.

    For this reason, those who are pathologically diagnosed as schistosomiasis granuloma should pay close attention to changes in the condition and review them regularly.

    5. Rectal polyps

    Rectal polyps are common benign tumors, which mostly occur clinically in the rectum and sigmoid colon. The main symptoms are blood in the stool, and blood is fresh blood, which is not confused with stool. Some patients may also have pus and blood in the stool; X-ray examination showed filling defects. If no fiber colonoscopy biopsy is performed, the polypoid rectal cancer can be misdiagnosed as rectal polyps.

    Rectal polyps are one of the common diseases of the anorectum. When polyps have ulcers and infections, or polyps have rectal inflammatory lesions at the same time, not only bleeding after going to the toilet, but also pus blood and mucous secretions often flow out.

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