rectal crisis
Introduction
Introduction The spinal cord fistula includes a rectal crisis with severe pain in the rectum and a major symptom in the urgency. Syphilis is a classic sexually transmitted disease. According to medical historians, syphilis originated in the Americas. After the discovery of the New World in Columbus in the 15th century, syphilis was rapidly spread in Europe and Asia through seafarers and soldiers. Before the 16th century, there was no record of syphilis in China. About 1505 years, syphilis was introduced from India to the Lingnan area of Guangdong Province. At that time, it was called Guangdong Sore and Yangmei Sore. After that, syphilis spread to the mainland. The ancient man Chen Sicheng's "Muscle Soul Secret Record" is the most perfect monograph on syphilis in China. In the Ming Dynasty, Li Shizhen wrote the "Compendium of Materia Medica" to record the epidemic situation of syphilis. Syphilis was first brought to China by the Portuguese in the 16th century. In ancient times, it was called Hualiu disease, Yangmei sore, mold sore, and hemorrhoids. After the founding of the People's Republic of China, syphilis was once wiped out in China. In recent years, with the increasing frequency of foreign exchanges, the incidence of syphilis has also shown an upward trend.
Cause
Cause
Syphilis is caused by Treponema pallidum (P. pallidum). It has a long course of illness, early invasion of the genitals and skin, late invasion of various organs of the body, and a variety of symptoms and signs. The lesions can almost affect the organs of the body. Syphilis can spread among people through sexual behavior and can be transmitted from the mother to the fetus, endangering the next generation. Very few patients are infected by kissing, breastfeeding, and daily necessities for patients with contagious damage. In sexually transmitted diseases, the number of patients with syphilis is low, but due to its long course and great harm, it should be taken seriously.
Examine
an examination
Related inspection
Rectal examination of syphilis serum test
Primary syphilis: 9 to 90 days after infection, usually 2 to 4 weeks, with an average of 3 gi, and a syphilis damage in the spirochetic invasion site - hard chancre. Hard chancre is more common in the genital tract, but it is not uncommon to have a hard chancre in the anus, anal canal, or even the rectum.
The hard chin begins as a pimples and quickly ruptures. The typical hard chin, about 1 ~ 2cm in diameter, round, clear boundary, sore surface slightly higher than the skin or mucous membrane, a red meat smashed surface, a small amount of exudate. Hard chancre has the following characteristics: palpation has cartilage hardness; no secondary infection without pain and tenderness; the number of damage is usually only one; damage surface clean; without any treatment can disappear naturally within 3 to 8 weeks, leaving no trace Or leave only a slight scar. The hard chancre in the anal folds is mostly rhomboid, and the bottom is gray; due to frequent secondary infections, there may be purulent secretions, which are different from those of other parts of the lower jaw, and thus often have itching, tingling, etc. symptom. In the hard chancre of the perianal area, multiple squat lesions are less common than other parts, but common anal skin has several ruptures. Hard sputum in the anal canal, such as involving the anal sphincter, and some patients have anal pain caused by sphincter spasm. The typical squat is only about 50% of the hard squat. It occurs in the lower jaw of the rectum and anal canal and is sometimes neglected due to lack of self-consciousness. Anal, especially in the anus, is most common in male homosexuals and other anal sex actors.
Lymph node enlargement (syphilis sputum) caused by primary syphilis occurred 1 to 2 weeks after the occurrence of chin, and bilateral inguinal lymph nodes appeared successively. One or more swollen lymph nodes, from peas to large fingers, hard, non-adhesive, no purulent, no ulceration, no pain and tenderness, no inflammation of the surface skin. The swollen lymph nodes disappeared after several months. The enlargement of the lymph nodes caused by the ankle of the anus usually occurs in the groin, but the proportion of the diaphragm is less than that of the lower part of the genital area.
In the early stage of hard chancre, the serum reaction was negative, and the positive rate gradually increased. After 7-8 weeks of sputum, the serum reaction of all patients was positive.
Secondary syphilis usually occurs 6 to 8 weeks after the occurrence of hard chancre. At this time, the hard sputum of a few patients has not subsided. In this case, the first and second phases of syphilis are difficult to divide.
The main clinical manifestations of secondary syphilis are:
1. Whole body surface: common general malaise, fever, sore throat, headache, hoarseness, loss of appetite, joint pain; laboratory tests can occur anemia, increased white blood cells, rapid blood sedimentation and other performance. 2. Skin and mucous membrane skin: 80% to 95% of patients have such damage. The symptoms are light, destructive and infectious. This type of damage to secondary syphilis often affects the anus, anal canal, and rectum.
(1) rash: The most common type of rash-type rash, dermatological type of skin diagnosis, you can also see mossy (small papules) rash, yaw rash, pustular rash, crustacean rash and ulcer rash. These rashes, such as those that occur around the anus, are called perianal syphilis. Spotted rash: varies in size. Diameter 1 ~ 2cm mostly; often elliptical or round; the boundary is not neat, the number is more, no infiltration; the beginning is light red, turned into rose after a few days; generally no debris; no symptoms; lasting 2 ~ 3 Around the week, there is no trace after disappearing. The papular rash can occur directly or from the rash; round or oval, peas are large to the nails; infiltrate is obvious, it is reddish-brown, the boundary is clear; the surface is smooth, slightly raised, and some have lesions Desquamation; lasts longer than a rash. Moss-type rash, also known as syphilitic moss, most of the hair follicle papules, the size of the miliary, smooth surface, rapid development, no symptoms. Various rashes can occur individually or simultaneously.
(2) Mucosal rash: About one-half of patients develop a mucosal rash. Mucosal rash can occur in mucous membranes of the mouth, nose, throat, vagina, and rectum. The surface is erythema, papules and erosive ulcers on the damaged part of the mucous membrane. It is generally elliptical, with clear boundary and infiltration. The color is dark red or grayish white, and the number is uncertain. It can develop rapidly with rash, and disappears in 2 to 3 weeks. Conscious symptoms.
(3) syphilitic leukoplakia: more common in women, occurs in the neck, it can also occur in the trunk, limbs and vulva, perianal (called perianal leukoplakia). It is round or oval, with a large number, clear boundary, and the local pigment disappears completely, but the surrounding pigment is more obvious; the white spot disappears slowly and can last for several months.
(4) Flat wet warts: belong to the wet and ruby type syphilis. It is better than the skin rubbing and moist parts, such as perianal (perianal flat wet sputum), external genitalia, armpits, etc., also occurs in the anal canal, which can be formed on the basis of erythema papules. It grows rapidly, often at the same time, and merges into pieces to form a thick and thick piece, which can also occur separately. The surface is smooth and moist, or has a papillary hyperplasia and is a Lai pattern. The surface is accompanied by inflammatory exudate, and the sputum formed by the secretion is removed. It can be seen that the floating white base or papillary proliferates, and there is pus between the nipples, which has a foul odor. The base of the touch is broad, hard, often painful and tender. There are a large number of spirals in the flat wet warts, which are highly contagious. A flat condyloma that occurs in the perianal, generally congenital anal side, then spread to the opposite side, gradually spreading or surrounding the anus for the entire week, and even affecting the scrotum or labia. Patients with perianal flat wet warts often feel anal turbidity, itching, and sometimes itching and stinging.
3. Other damage: secondary syphilis damage to the bone, may occur periostitis, arthritis; secondary syphilis eye damage, the surface may be iritis, iridocyclitis, choroiditis, optic neuritis and retinitis; Phase II neurosyphilis is asymptomatic, but cerebrospinal fluid laboratory tests are often abnormal.
Phase III syphilis: occurs 2 years after infection. About 40% of untreated patients have an active (significant) late syphilis after 2 years of infection.
1. Phase III skin and mucous membrane syphilis: the most common in the late stage of syphilis, accounting for about 48% of various late-stage syphilis. It occurs earlier than other manifested syphilis. Most of the damage is isolated, and it is extremely difficult to find the spirochete in the lesion, which is not contagious. Destructive damage can cause dysfunction, disability, and disfigurement.
(1) nodular syphilis: the most common in the skin and mucous membrane damage of the third stage syphilis, occurs in the head, forehead, shoulder and shoulder blades, the back, the extremities of the extremities, rarely occur in the mucosa, including the rectal mucosa. The nodular syphilis that occurs in the rectal mucosa often causes the surface of proctitis, so it is especially called syphilitic proctitis.
When the rash is first developed, it may be one or several subcutaneous nodules of up to 20 to 30 diameters of about 0.5 cm; red or purple, hard, infiltrating, higher than the surface of the skin and mucous membrane; It is in the shape of a ring, a multi-ring or other shape, and has a clear boundary with the surrounding skin. Progress is slow and can last for months to 2 to 3 years. There is a tendency for the middle to heal to develop around. After the nodule is formed, some patients can heal themselves, the nodules disappear, and the surface is covered with scales or pigmentation. In other patients, the damage continues to develop; the central part of the dense nodules is necrotic, the surface is scarred, and the underarm is a deep ulcer; the ulcer develops to the periphery, the edge is a ridge-like bulge, and the ulcer side forms a cliff-like appearance, ulcer There is a brown-red infiltration around it. When healed, it progresses from the periphery to the center to form atrophic scar.
The nodular syphilis that occurs in the rectal mucosa. When the ulcer is formed, the bowel movement is not clean. The feces are mixed with pus and blood, and even the colitis is followed by rectal inflammation. When syphilitic proctitis heals, it forms atrophic scar, which makes the rectum thicker, harder, and elastic, and scar contraction can also cause rectal stenosis. (2) syphilis gum: also known as syphilis. The occurrence time is later than the nodular syphilis. Occurs in the forehead, scalp, extremities and genitals. It is also common in soft palate, uvula and tongue, nasal septum and other mucosa, and can involve cartilage, rarely occurs in the rectal mucosa. A syphilis gum that occurs in the rectal radiant membrane and is often referred to as a rectal syphilis.
Most of the gums are single (or multiple) subcutaneous nodules, 0.5 to 3 cm in diameter, non-adhesive to the skin and mucous membranes, movable, no change in skin and mucous membrane color, and no self-study symptoms. After 2 to 6 months, the nodules become larger and adhere to the skin, forming a purple-red or cyan-red induration higher than the leather surface, which can be larger or larger. The center gradually softens, the epidermis ruptures, and a small amount of gelatinous secretions flow out to form a round, oval or horseshoe-shaped break. The ulcer is deep, the edges are purple, the shape is steep, and the touch is hard. The base of the base is not flat and has yellow necrotic tissue. The end is often healed and his end is still spreading. If there is no suppurative infection, the lymph nodes in the drainage area are not swollen and there is no obvious symptom. If the gum is not treated, new damage can occur continuously.
Regardless of ulceration or not, the gums will form atrophic scars when they heal, and the tinge is pale, the surface is smooth like paper, and there is obvious pigmentation around. Patients with rectal syphilis often feel heavy rectum and poor feces. After the gums are swollen and ruptured, there will be pus and blood, and diarrhea, urgency and weight will occur. The continuous appearance of gums, which form scars during healing, can lead to scarring of the rectum and affect the function of the rectum.
2. Nervous system syphilis: Advanced neurosyphilis can be divided into asymptomatic neurosyphilis and symptomatic neurosyphilis. Asymptomatic neurosyphilis has no clinical signs and symptoms, but abnormal findings have been detected in cerebrospinal fluid examination. Symptomatic neurosyphilis usually occurs 3 to 20 years after infection. Symptomatic neurosyphilis is divided into meningeal vascular type (mainly in the meninges and blood vessels) and brain parenchyma (mainly in the parenchyma of the brain and spinal cord). The former includes syphilitic meningitis, meningitis, dural meningitis and syphilitic cerebral arteritis, intracranial gums, etc.; the latter includes paralytic dementia, spinal cord spasm, optic atrophy and the like.
Spinal cord spasm usually occurs 20 to 25 years after infection. The main lesions are degeneration and atrophy of the posterior spinal cord and posterior cord, which causes the posterior horn of the spinal cord to become flat and even sag. Due to the lesions in the posterior root of the spinal cord, the sensory impulses of the peripheral nerves cannot be transmitted to the central nervous system, leading to symptoms such as dysfunctional dysmenorrhea, sensory disturbances, and neurotrophic disorders. Exercise ataxia can cause anal incontinence, which is called anal sphincter ataxia. The typical performance is: after the anus is pulled to the sides during the examination, the anus can not be closed as quickly as a normal person, and the closure is slow. This situation is called driving to the anus. Spinal cord hernia also causes a variety of visceral crises, which are common in gastric crisis. It also includes rectal crisis with severe pain in the rectum, urgency and weight, and intestinal crisis with abdominal pain, diarrhea and constipation.
3. Other advanced syphilis damage: late syphilis causes bone pain, periostitis or osteomyelitis, joint pain, synovitis, joint edema, etc. in the skeletal system; syphilitic epididymitis caused by genitourinary system, orchitis, testicular gum Wait. The above two system damage together with the skin mucosal damage of the third stage syphilis is called benign syphilis. Late syphilis can also cause simple aortitis, aortic regurgitation, aortic aneurysm, coronary stenosis and obstruction, myocardial gelatin and other damage in the cardiovascular system. Liver syphilis can cause generalized cirrhosis, liver gum and so on.
Diagnosis
Differential diagnosis
Need to be identified with the following symptoms:
Recurrent duplication of the rectum: the diagnosis of rectal repeat deformity has signs of intestinal obstruction, and the rectal examination can touch the mass. A double-chamber rectum can be found by colonoscopy and X-ray examination. The treatment procedure closes the proximal end of the excess rectum.
Rectal pain: Anorectal pain is the most common symptom of anorectal disease. Due to anatomical and physiological relationships, pain in anorectal diseases occurs in the lower abdomen, perineum, anal and rectum.
Rectal prolapse: rectal prolapse is common in children and old age. In children, rectal prolapse is a self-limiting disease that can heal itself before the age of 5, so it is mainly based on non-surgical treatment. Adult complete rectal prolapse is more serious, long-term prolapse will cause genital nerve injury to produce anal incontinence, ulcer, perianal infection, rectal bleeding, prolapse of intestinal edema, stenosis and necrosis, should be based on surgical treatment.
Rectal prolapse refers to a chronic disease in which the rectal mucosa, anal canal, rectum, and part of the sigmoid colon are displaced downwards and removed from the anus. In the stool, the rectal mucosa is prolapsed, the lower abdomen is painful, and it is not clean; in severe cases, rectal mucosal congestion, edema, ulcer, bleeding, etc. may occur as the main clinical manifestations. The degree of prolapse can be divided into three degrees.
