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Mass per rectum.pptx

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Mass per rectum.pptx

  1. 1. Growth per Rectum Ashutosh Carpenter
  2. 2.  Name : Ravikumar  Age / sex: 35y/m  Residence:katni  Occupation:farmer
  3. 3. Chief complains  c/o bleed per rectum -1 year  Altered bowel habits- 6 months  Pain- 4 months back.
  4. 4. HOPI  Patient initially had c/o streak of blood on stools, 1 year back which not associated with pain. And around 10 months back he has c/o passage of blood (bright red in colour) around (10-20 ml)along with stools, and last 2 months c/o passage of blood per rectum mixed with mucus whose frequency was initially 1 episode in 15 days but has now increased to 2-3 episodes /week.  He has complaints of increased frequency of motion(2/day to 6-7 episodes /day) with frequent c/o constipation for which the patient takes laxative.  He had episode of pain per rectum, since 4 months back which was , insidious in onset, non colicky ,constant and dull aching in nature, mild to moderate in intensity, non radiating sometimes aggravated by defecation and was relieved on taking medications.  Sleep disturbances as the patient has to wake up in early morning to evacuate bowel in which there is usually passage of blood along with mucus last 2 months.
  5. 5.  c/o loss of weight (52 to 45kg ) last 6 months and loss of appetite due to decreased hunger no c/o abdominal distension or vomiting or pain(8 chapati to 3 chapati per day).  n/o c/o mass coming out per rectum or pruritus.  n/o c/o abdominal distension/ jaundice/fever.  No c/o cough/hemoptysis.  n/o c/o difficulty in micturation, sexual dysfunction or passage of mucus or blood in urine.  n/o c/o tenesmus or incontinence.  No h/o radiation in past.
  6. 6. Past history He was treated 4 months back for bleed per rectum(? haemorrhoids) at local quack but his symptoms persisted. No p/h/o PTB/BA/HTN/DM/COPD or any other chronic medical or surgical illness
  7. 7. Personal history:  Patient take non vegetarian diet  Bladder function are normal.  No history of addiction to alcohol or tobacco.
  8. 8. Family history  No c/o similar complains in any family member or relatives.
  9. 9. O/E  The patient was examined with proper consent in adequate light ,  The patient is conscious /oriented to time / place and person.  The patient is average in built.  Ht -150cm wt -46kg
  10. 10.  P- 80/min taken in right radial artery which is regular/ normovolumic and there is radio radial or radiofemoral delay.  BP- 116/76 mmHg taken in left brachial artery in supine position.  e/o pallor(+)  No e/o icterus /cynosis/clubbing/ generalised or cervical lymphadenopathy .
  11. 11. Per abdominal examination  Inspection:  The abdomen is exposed from nipple to knee which is normal in contour, not distended , no e/o any lump present.  All quadrants moves proportionately with respiration .The umbilicus is central and inverted.  No e/o any dilated veins /scars/or lymphadenopathy present  No cough impulse seen on hernial orifices.
  12. 12. palpation  The findings of inspection are confirmed on palpation.  On superficial palpation there in increase in temperature or tenderness.  Abdomen is soft and no guarding /rigidity or any palpable lump present.  No inguinal or cervical LN pathy present.  There is no organomegaly , no cough impulse over the hernial orifices.
  13. 13. ascultation  Ascultation BS+  Percussion: Puddle sign negative . Liver span is normal. Tympanic note present over the abdomen.
  14. 14.  CNS- cons/oriented  CVS-S1S2 +  R/S –AEBE
  15. 15. Per rectal examination  Per rectal examination is done in Sims position after taking consent and explaining the procedure.  on inspection: No e/o any fistula / growth /sentinel pile /any infection present in peri anal area
  16. 16. on digital examination  Normal anal tone and squeeze present.  Growth An ulceroproliferative hard growth felt at 5 cm from anal verge with well defined margins, irregular in shape no induration of base , which has involved whole circumference of rectum, around 1 cm longitudinal width, mobility over rectal wall not possible, mucosa over growth is non mobile, getting above the growth is possible, and finger can be insinuated between prostate and growth, similarly finger can be insinuated b/w sacral curve and growth posteriorly and presence of blood over finger present. No perianal or rectal wall tenderness present. Rest of mucosa is normal/ no prostatomegaly.
  17. 17. proctoscopy  On proctoscopy: ulceroproliferative growth seen at 5 cm from anal verge, well defined margins, irregular in shape no surrounding inflammation , which has involved whole circumference of rectum, around 1 cm longitudinal width, more growth on anterior aspect than posterior No e/o any polyp/ ulcer or haemorrhoid and rest of the anal canal and rectum is normal.
  18. 18. summary  Patient initially had c/o streak of blood on stools, 1 year c/o passage of blood per rectum mixed with mucus last 2 months  Altered bowel habits- 6 months  He also has e/o pain -4 months back An ulceroproliferative hard growth felt at 5 cm from anal verge with well defined margins, irregular in shape no induration of base , which has involved whole circumference of rectum, around 1 cm longitudinal width, mobility over rectal wall not possible, mucosa over growth is non mobile, getting above the growth is possible, and finger can be insinuated between prostate and growth, similarly finger can be insinuated b/w sacral curve and growth posteriorly and presence of blood over finger present.
  19. 19.  CARCINOMA of rectum with Dukes stage B without involvement of clinically detectable LN with no spread to the viscera or adjacent structures .

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