RECTAL DISCHARGE

RECTAL DISCHARGE: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is it mucopurulent or feculent? A mucopurulent discharge suggests an anal fistula, perirectal abscess, proctitis, anal ulcer, or rectal prolapse. A feculent discharge suggests anal incontinence, internal hemorrhoids, chronic anal fissure, or ulcer.
2. Is it painful? Painful discharge suggests a perirectal abscess, proctitis, anal ulcer, or rectal prolapse.
3. Is there an abnormal neurologic examination? An abnormal neurologic examination suggests that there is anal incontinence from an upper or lower motor neuron lesion. This may be due to spinal cord trauma, multiple sclerosis, spinal cord tumor, transverse myelitis, and many other disorders.

DIAGNOSTIC WORKUP

Routine laboratory tests include a CBC, sedimentation rate, urinalysis, chemistry panel, and smear and culture of the discharge. A Frei test may be necessary to rule out lymphogranuloma venereum. Sigmoidoscopy, colonoscopy, and a barium enema may be needed in selected cases. A proctologist or gastroenterologist should be consulted in difficult diagnostic problems. If there are abnormalities on the neurologic examination, a neurologist should be consulted.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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