2021年2月18日星期四

what does a hemorrhoids look like,Lesions that can be palpable during digital anorectal examination

    (1) Anorectal diseases

    1. Rectal cancer Uneven lumps can be palpable on the intestinal wall, ulcers can be found on the surface, the intestinal cavity is often narrow and circular, and the finger cuffs are often stained with pus, blood and mucus. Some people think that digital examination is the same as looking directly. Touching is equal to seeing, so it is called "diagnosing eye" (Figure 3-3).

    2. Rectal polyps can be palpated as soft and pushable round masses, often with a pedicle, and often stained with blood on the finger cots. Sometimes low rectal polyps can be hooked out of the anus by fingers.

    3. Internal hemorrhoids Simple internal hemorrhoids are soft and cannot be palpable, but if there is thrombosis or injection therapy, smooth induration can be palpable.

    4. Anal fistula can be paved at the perianal cord and connected with the external opening, and sometimes at the anal recess, the internal opening of the anal fistula can be palpated like a small hard knot.

    5. Perirectal abscess, pelvic rectal abscess and posterior rectal abscess, a tender mass can be palpable in the rectum. For other interstitial abscesses, two-finger palpation can be performed with thumb and index finger, that is, the index finger is in the rectum, the thumb is placed on the perianal skin, and the thumb and index fingers are palpated. Deep anterior and deep posterior interstitial abscesses or sciatic rectum can be found Interstitial abscess or perianal abscess. Two-finger examination is also easy to pick up the fibrous fistula.

    6. Rectal prolapse The sphincter muscles are often loose or the pelvic floor muscles are weak on the digital examination.

    7. Rectal carcinoids account for about 17% of gastrointestinal carcinoids. The typical appearance is a single, sliding submucosal induration, the mucosa is smooth and complete, the size is 1-1.5cm, and the color is yellowish gray or brownish yellow. Only 2%-4% are issued frequently. Symptoms are blood in the stool and constipation, but most of them are asymptomatic. They are often found inadvertently due to physical examination or other diseases. Can be malignant. Bates proposed that tumor size is related to malignant transformation: <1cm malignant transformation rate is 1.7%, 1-2cm is 10%, >2cm is 82%. In addition, if the tumor reaches deep into the muscle layer, it is often malignant.

    8. Postrectal tumors Although these tumors are rare, there are many types, such as teratomas, bone tumors, neuromas and others. Small asymptomatic retrorectal tumors are often found on digital examination. When referring to the posterior rectal mass, the rectal wall can be pushed forward or to one side, and the rectal mucosa is smooth. If it is a small sacrococcygeal teratoma, the mass is smooth and lobed, some moving, some fixed. If the sacral chordoma protrudes forward, it is hard and fixed to the sacrum without tenderness.

    9. Ulcerative colitis refers to a granular sensation in the rectal mucosa, sometimes with pseudopolyps on the rectal wall. Pus, blood and mucus are stained on the finger cot.

    10. Prolapse of the rectal mucosa The digital rectal examination can palpate the mucosa of the rectal ampulla that is folded and stacked, soft and smooth, and moved up and down. There may be an annular groove between the prolapsed part and the intestinal wall. Some authors have also reported that digital rectal examination can only find sphincter relaxation and rectal mucosal accumulation, and some patients can feel the intussusception ring.

    11. Rectal protrusion: A round or oval recessed weak area will be touched on the tooth line of the anterior wall of the rectum during digital examination, and the capsular bag will protrude into the vagina. The depression is more pronounced when the patient is forced to defecate, and even the back wall of the vagina can be pressed outside the vaginal opening.

    12. Pelvic floor muscle spasm syndrome and puborectalis syndrome. Digital rectal examination found that the anal canal tension is increased. Sometimes it is difficult to insert the fingers into the anus and it takes force to pass through the anal canal. The anorectal ring is hypertrophy and the anal canal is longer, reaching more than 6cm in the elderly. The back of the rectal ampulla deepens into a pouch. When doing the levator anus, the posterior edge of the puborectalis muscle contracts forward and upward, and its edge is sharp. When simulating a bowel movement, the posterior edge of the puborectalis muscle does not relax but contracts forward and upward, and the anal canal pressure also increases. In some patients, even basin muscles and hip muscles can also produce spastic contractions. The anal canal may relax after stopping the bowel movement.

    13. Internal anal sphincter dysfunction has obvious tightness on digital rectal examination, but this kind of tightness is different from puborectal muscle spasm and hypertrophy, the latter is that the deeper the anal canal, the higher the tension, and the internal sphincter is the anal canal The lower part of the patient is tight, especially the anal mouth, the pressure of the anal canal increases, and it is even difficult for the fingertips to enter the anal canal. Digital rectal examination can feel thickening of the internal sphincter, and some patients have tenderness. Exploring the groove between the internal and external sphincter of the anal canal often finds that the groove becomes deeper. In severe cases, the internal sphincter can be shown to protrude beyond the anus when performing defecation. There are more dry feces that can be touched above the anal canal.

    14. Isolated rectal ulcer syndrome Most lesions are located at the junction of the anorectal canal, in the front wall of the rectum. The digital examination can touch a single thickened, hard and active rectal mucosa, with tenderness, and sometimes the hardened rectal mucosa has a raised edge with nodules or villi around it. Polyp-like objects can also be touched. It was also misdiagnosed as polyps or cancer. Occasionally, a circular stenosis can be palpated at the lower end of the rectum.

    (2) Urinary system diseases

    1. The central sulcus of prostate hyperplasia becomes shallow or disappears, and the glands can increase in length and width or both. According to the degree of increase, it can be divided into three levels: the first level is the size of an egg, the second level is the size of a duck egg, and the third level It is the size of a goose egg.

    2. Prostate cancer can touch stone-like hard nodules.

    3. Acute prostatitis can touch enlarged, swollen, tender prostate. If there is a fluctuating feeling, it indicates that an abscess has formed. At this time, it is forbidden to perform prostate massage and urethral equipment inspection.

    4. Chronic prostatitis can touch the prostate with irregular surface, increased hardness or uneven hardness. The glands vary in size and are fixed around them.

    During digital rectal examination, due to the high position of the seminal vesicles, it is generally impossible to touch it. It may occasionally be palpated above the prostate during infection. The texture is soft and cystic. You should pay attention to whether there are nodules, lumps or tenderness.

    (3) General surgical diseases

    1. Acute appendicitis If the appendix is ​​in the pelvic cavity, a digital rectal examination can reveal tenderness on the right side of the front wall of the rectum. If the inflammation has spread beyond the appendix, there is tenderness on both sides of the front wall of the rectum. If the appendix is ​​high, the test result is mostly negative.

    2. Intussusception There is often mucus and blood on the finger cuff. Sometimes the intussusception can be felt on the digital rectal examination.

    3. Pelvic abscess is often the result of pelvic inflammation and infection, mostly caused by perforation of the appendix. Digital rectal examination on the right side often reveals that a tender lump bulges into the rectal cavity, the temperature is increased, and there is a sense of fluctuation, while the opposite side is negative.

    4. The posterior peritoneal hematoma often has trauma. Digital examination can reveal tenderness and fullness in the posterior abdominal wall.

    (4) Gynecological diseases

    1. Ovarian follicles or corpus luteum rupture. Because young unmarried women often occur, vaginal examinations cannot be performed. Digital rectal examination can find tenderness on the posterior wall of the uterus, tenderness on one side of the fornix, and pain when moving the uterine body. It is not difficult to diagnose based on menstrual history.

    2. Chronic adnexitis The digital rectal examination can often reveal enlarged, tender appendages and cervical tenderness and cervical movement tenderness.

    3. Endometriosis During the digital rectal examination, a painless mass can be palpated in the recess of the uterus and rectum with smooth mucosa. Combining the history and menstrual cramps with aggravated abdominal pain, tumor enlargement and tenderness, the diagnosis can be confirmed.

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