Proctitis

Vivi Anisa Putri

1310211057

Proctitis
inflamasi pada mukosa rectum

Epidemiologi :
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>> dewasa

Classification
Onset after radiation
Acute (6 months)
Chronic (2-4 years)

Gejala (Kottmeier 1964)

Derajat I : keluhan ringan, kelainan mukosa minimal
Derajat II : diare sering disertai mucus dan darah, jaringan
nekrosis, ulkus atau stenosis sedang pada kolonoskopi
Derajat III : stenosis rectum berat hingga memerlukan
kolonostomi
Derajat IV : fistula

Etiology
side effect of medical treatments (radiation therapy
more than 150 rad or antibiotics)
sexually transmitted diseases (STDs)
Common : gonorrhea, chlamydia
Uncommon : lymphogranuloma venereum, Herpes simplex
virus (HSV) type 1 (10%) type 2 (90%), Clostridium difficile,
papillomavirus

Nonsexually transmitted causes

Crohn disease and ulcerative colitis
Trauma of anorectal area
Toxins (eg, hydrogen peroxide enemas)

Symptoms
Nausea & vomiting (acute)
Feeling of rectal fullness
Anal and rectal pain
Diarrhea, usually frequent, small amounts
Tenesmus
Pain in the lower left abdomen
Passing mucus through the rectum
Rectal bleeding
Pruritus (infectious)

Diagnosis
Anamnesis
Px. Fisik
Perbesaran KGB inguinal (HSV)

Px. Penunjang
Endoskopi (rectosigmoidosopy/colonoscopy):

Pallor or erythema
Loss of usual vascularity of mucosa
Prominent telangiectasia
Friability
Bleeding
Ulcerations
Edema
Scattered areas of scarring
Vesicles/pustules
Strictures

 Darah lengkap : leukositosis (infectious), tanda tanda anemia

karena perdarahan
Biopsy for histology / histopatology
Barium enema : bila terjadi strinktur hebat atau fistula
sehingga endoskopi sulit dikerjakan
Stool
culture : untuk identifikasi bakteri penyebab
elevated fecal calprotectin and fecal lactoferrin

Tatalaksana
1. Medikamentosa
Sesuai penyebab
Antiinflamasi : steroid enema, sulfasalazine/mesalamine
oral
Antibiotik : Ceftriaxone and doxycycline for gonorrheal
proctitis, Tetracycline or doxycycline for chlamydial
proctitis, Metronidazole (Flagyl) or oral vancomycin for
C difficile proctitis
Antiviral : Acyclovir for herpetic proctitis

2. Non medikamentosa
Sitz bath : bath in which a person sits in water up to the
hips, used to relieve discomfort and pain in the lower
part of the body.
Edukasi
Diet rendah serat
Pengobatan

Complication
Perforation
Abscess
Treatment failure
Fistula formation

Prognosis
Depends on severity
HBV immunodeficiency prolonged & severe

Reference
emedicine.medscape.com
IPDUI
AACC (American Association for Clinical Chemistry)
Gastroenterologi dan Hepatologi Lecture Notes
Buku Ajar Gastroenterologi Interna