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ation usually reveals the characteristic signs of an abscess—a mass that is red, tender, and
warm.Theabscessmaycometoapoint(head)intheskinadjacenttotheanus.Afewrectal
abscesses are located deeper beneath the skin and can only be felt during digital examina-
tion of the rectum.
Rectal abscesses should be treated just like abscesses anywhere else—with incision and
drainage. If the abscess comes to a point in the skin beside the anus, an incision can be
made in the center of the fluctuant area. If a deeper abscess is felt or the surrounding in-
flammation is extensive, the person should be evacuated; only a surgeon should drain such
abscesses,andseriouscomplications canfollowanabscessinthislocationthatisnotprop-
erly treated. If the individual has a fever, amoxicillin/clavulanate (Augmentin®) or cipro-
floxacin (Cipro®) should be administered during evacuation.
PEPTIC ULCER AND RELATED PROBLEMS
A peptic ulcer is an inflammatory destruction of the lining of the stomach or intestine pro-
duced by the digestive action of the enzymes and acids from the stomach ( Fig. 19-2 ). The
cause of peptic ulcers is not completely understood, but although stress is thought to play
a role, familial and host factors affecting mucosal protective mechanisms are most import-
ant.Manyulcersareassociatedwithinfectionby Helicobacter pylori, aubiquitousbacteria
found worldwide that is adapted to living in the acidic environment of the stomach. Ag-
gressive diagnosis and therapy in developed countries have produced a notable decrease
in the prevalence of stomach ulcer this infection. However, in underdeveloped countries,
the organism is widely disseminated and can be contracted from infected food, water, or
persons. Chronic infection with this organism has been associated with two gastric malig-
nancies: adenocarcinomas and lymphomas. However, the manner in which this organism
produces these disorders is as yet unknown. Drugs such as aspirin, ibuprofen, nonsteroidal
anti-inflammatory agents (NSAIDs), and steroids sharply aggravate the ulcerative effects
of the bacteria.
Figure 19-2. Peptic and duodenal ulcers
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