SFGH 10.16 pearls – malabsorption and perirectal abscess!

  • Dr. Cello pearls – an episode of heavy alcohol use should not cause acute pancreatitis unless someone has a history of chronic alcohol use
    • True melena does not develop until a patient loses at least 1u per 24 hours, and you should question whether stool is melenic if it doesn’t have a metallic smell, no matter how dark it is!
  • For malabsoroption work up, start with qualitative fecal fat testing. If this is negative and suspicion is high, then proceed to quantitative (harder to perform). If positive, then send testing for celiac and fecal elastase
  • Men are twice as likely as women to develop perirectal abscesses as women, and the abscesses are more likely to progress to Fournier’s gangrene in diabetics
  • If the abscess is above the levator muscles (as suspected in this patient) there may be no external exam findings, though fluctuance may be noted on digital rectal exam
  • Wound cultures and antibiotics are not needed for most patients after drainage of the abscess, but should be done for patients with DM, valvular heart disease, and immunosuppression

Evernote link here: https://www.evernote.com/shard/s300/sh/1e805b2e-69b5-427b-b121-60f29e35f488/95cd45adbb9b90df8fd7edd0db99b659

Nelson RL, Abcarian H, Davis FG, Persky V. Prevalence of benign anorectal disease in a randomly selected population. Dis Colon Rectum 1995; 38:341.

Rizzo JA, Naig AL, Johnson EK. Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am 2010; 90:45.

World organization of gastroenterology guidelines: www.omge.org/globalguidelines/guide03/guideline3.htm

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