tailieunhanh - Anal and rectal diseases explained - part 3

Bệnh nhân được đặt ở một vị trí bên trái và nhẹ nhàng kiểm tra trực tràng kỹ thuật số được thực hiện. Điều quan trọng là để thực hiện một kiểm tra tuyến tiền liệt trên bệnh nhân nam ở thời gian này để màn hình cho ung thư tuyến tiền liệt. Sigmoidoscope linh hoạt được đưa vào và nâng cao đến 60 cm, hoặc như xa như là dung nạp của bệnh nhân | Chapter 2 preparation in patients undergoing evaluation for colitis because a preparation may alter the appearance of the mucosa. How the procedure is performed The patient is placed in a left lateral position and a gentle digital rectal examination is performed. It is important to perform a prostate examination on male patients at this time to screen for prostate cancer. The flexible sigmoidoscope is inserted and advanced to 60 cm or as far as is tolerated by the patient. It is not uncommon for patient discomfort due to sigmoid angulation and redundancy to limit advancement of the flexible sigmoidoscope beyond 30 cm. If a large polyp is seen the patient will undergo a colonoscopy for complete evaluation of the colon and removal of the polyp see Figure 1 . If smaller polyps are seen see Figures 2 and 3 biopsies of these lesions are recommended. Colonoscopy is subsequently performed if adenomatous polyps are identified. In patients with diarrhea caused by a suspected infection fecal material may be suctioned and collected for culture and ova parasite and Clostridium difficile toxin evaluation. Retroflexion of the sigmoidoscope in the distal rectum allows visualization of the proximal anal canal and the dentate line. This is particularly useful for looking at internal hemorrhoids and high anal canal lesions. The retroflexed view is also useful for finding polyps in the distal rectum see Figure 4 . If colitis is suspected based on visualization of the mucosa and or clinical history biopsies are obtained and sent for histologic evaluation. Figure 1. A large sessile sigmoid polyp. Removal will be technically challenging. Figure 2. Small sessile rectal polyp a common finding on flexible sigmoidoscopy. This is trial version 38 Flexible sigmoidoscopy Typical abnormal findings Screening of the distal 60 cm of the colon may reveal polyps or colon cancer evaluation of the proximal 60 cm of the colon allows for identification of sources of rectal bleeding .