Practice Management
14 results
1 - 14
Miscellaneous- Pelvic Floor
- Anorectal Disease
- A 28-year-old man presents for follow-up of a painful posterior midline anal fissure that has not improved after fiber supplementation and a 6-week course of topical diltiazem 2%. On examination, he has a chronic posterior midline fissure and a hypertonic sphincter. What is the best next course of action?
- A 24-year-old man presents to your office with tailbone pain of 2 days’ duration. He has a temperature of 100.7°F (38.1°C) and the examination findings shown in the Figure. What is the best next step in management?
- A 25-year-old HIV positive MSM was referred to you for a 1-month history of tenesmus, blood per rectum, pain, and fevers. On physical examination, small ulcerations of the perianal skin are noted. Flexible sigmoidoscopy reveals moderate proctitis but the descending colon mucosa is normal. Rectal biopsies reveal crypt abscesses and granulomas. He denies a family history of inflammatory bowel disease and of recent travel. What is the best next step in management?
- Benign Disease
- A 65-year-old woman with coronary artery disease and a history of abdominoperineal resection for a low rectal cancer 3 years ago presents with a painless peristomal bulge and an occasional appliance leak. She denies pain and reports normal colostomy output. Examination reveals a pink healthy colostomy and soft bulge medial to the stoma on application of the Valsalva maneuver. Result of recent surveillance computed tomography is available for review (Figure). What is the best management option?
- A 62-year-old man presents to the emergency department with acute-onset left lower quadrant abdominal pain. He is mildly tachycardic but is otherwise hemodynamically stable. On abdominal examination, he has diffuse peritonitis. Laparoscopy reveals sigmoid diverticulitis with purulent fluid throughout the abdomen without fecal contamination. What is the best next step in management?
- A 53-year-old male renal transplant recipient receiving tacrolimus and prednisone presents with acute sigmoid diverticulitis with specks of free air and a 5-cm pelvic abscess which is not amenable to percutaneous drainage. His vital signs are a temperature of 102.0°F (38.9°C), heart rate 105 beats/min, blood pressure 110/80 mm Hg, and white blood cell count 18,000/µL (18109/L). The best next step in management is:
- A 56-year-old woman with a history of recurrent urinary tract infections presents to the emergency department with tachycardia (heart rate 124 beats/min), hypotension (blood pressure 85/38 mm Hg), diffuse abdominal pain, and frequent watery diarrhea following a course of oral antibiotics. Her abdomen is distended and diffusely tender. Her white blood cell count is 25,000/L (25109/L) and her hemoglobin is 15.0 g/dL (150 g/L). The patient is positive for Clostridioides difficile and is not responding to treatment with 125 mg of oral vancomycin. What is the next best option for this patient?
- A 70-year-old man with history of perianal Crohn’s disease and 15-year history of an anal fistula presents to establish care. On examination, he has a right anterior anal fistula that appears chronic in nature. What is the best next step in management?
- A 68-year-old woman developed crampy abdominal pain with diarrhea after taking antibiotics for a dental procedure. She was treated for Clostridioides difficile infection (CDI) with oral vancomycin. Three weeks later, she developed similar symptoms and is treated for a relapse of CDI with vancomycin for 2 weeks. She now presents with her third episode of CDI 8 weeks after her initial infection. She is hemodynamically stable with minimal abdominal discomfort. She does not want to have surgery and would like to know other alternatives. What is the best next step in management?
- ASCRS Question Bank
- Perioperative
- Malignancy