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Thursday, 5 December 2013

Proctitis -The Diagnosis

Proctitis is defined as a condition of inflammation of the anus and the lining of the rectum (i.e., the distal 10–12 cm) of that can lead to bowl discomfort, bleeding, a discharge of mucus or pus, etc.
B. Diagnosis
1. Stool sample
The aim of the stool examination is to find out types of bacterial causes of infection.
Unfornunately, Non-invasive diagnostic tools to evaluate the severity of acute, radiation-induced proctitis are not readily available, but faecal calprotectin and lactoferrin concentrations could be markers of acute, radiation-induced proctitis(34).
2. Blood test
The aim of the blood test is also to determine the types of infection as well as blood loss
3. Proctoscopy
Proctoscopy procedure in which yuor doctor insert a thin tube containing a camera and a light to visually inspect to look for sign of proctitis. In a prospective study of 130 patients who underwent external radiation therapy (RT) for stage T1 to T4 prostate cancer between 1997 and 2008, to determine the Role of Early Proctoscopy in Predicting Late Symptomatic Proctitis After External Radiation Therapy for Prostate Carcinoma, Proctoscopy showed that In patients with acute endoscopic proctitis (AEP) and Acute clinical proctitis (ACP), the risk of late clinical proctitis (LCP) was more than 5-fold increased compared to those who were asymptomatic, while a much smaller increase in risk occurred in patients with ACP only. Early proctoscopy can provide valuable information regarding the likelihood of late(35).
4. Rectal culture
Rectal culture is the laboratory test of normally involves a swab of patients rectum with an aim to determine types of bacterial causes of proctitis.
5. Rectal microscopy
The Microstructure imaging of human rectal mucosa may be helpful in determination the causes of the disease. According to the study by the Urinary Medicine, Mortimer Market Centre, in all, 134/136 had rectal microscopy of whom, 47/134 (35%) were smear-positive for Rectal gonorrhoea (GC) . Of the 136 cases, 90 received antibiotics for GC at their first presentation. Twenty-four of 90 (27%) would not have been treated until culture results were available, if rectal microscopy had not been performed. The results suggest that rectal microscopy remains an important tool and increases the proportion of men treated for GC at their first attendance(36).
6. Sigmoidoscopy
Sigmoidoscopy is a procedure of using a flexible tube called a sigmoidoscope with a small camera attached to the end placed through the anus and gently moved into your colon for examination of up to the sigmoid. Dr. McMillan A. in the study to to assess the value of sigmoidoscopy in the routine investigation of homosexual men, this procedure was undertaken on 1118 men who attended a sexually transmitted diseases clinic as “new” or “return new” patients, indicated that Serious rectal disease was not identified in any of the 557 men who were symptomless at the initial attendance. Though the extent of the proctitis diagnosed in 166 men would not have been defined, 99% (465) of 470 anorectal lesions would have been identified if proctoscopy alone had been performed. It is concluded that sigmoidoscopy does not have a role in the routine investigation of homosexual men(37).
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Sources
(34) http://www.ncbi.nlm.nih.gov/pubmed/15545170
(35) http://www.ncbi.nlm.nih.gov/pubmed/22975612
(36)_ http://www.ncbi.nlm.nih.gov/pubmed/16595053
(37) http://www.ncbi.nlm.nih.gov/pubmed/3817825