Perianal Abscess

A. The anal glands, located in the base of the anal crypts at the level of the dentate line, are the most common source of perianal infection. Acute infection presents as an abscess, and chronic infection results in a fistula.

B. The most common symptoms of perianal abscess are swelling and pain. Fevers and chills may occur. Perianal abscess is common in diabetic and immunosuppressed patients, and there is often a history of chronic constipation. A tender mass with fluctuant characteristics or induration is apparent on rectal exam.

C. Management of perianal abscess. Perianal abscesses are treated with incision and drainage. If the abscess is small, incision and drainage using a local anesthetic is usually possible. Large abscesses require regional or general anesthesia. A cruciate incision is made close to the anal verge and the corners are excised to create an elliptical opening which promotes drainage. An antibiotic, such as Zosyn, Timentin, or Cefotetan, is administered.

D. About half of patients with anorectal abscesses will develop a fistula tract between the anal glands and the perianal mucosa, known as a fistula-in-ano. This complication manifests as either incomplete healing of the drainage site or recurrence. Healing of a fistula-in-ano requires a surgical fistulotomy.

References: See page 195.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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