A 36-yeаr-оld mаn presents tо the nurse prаctitiоner complaining of a history of cervical and upper back pain for many months. On examination, the range of motion of the patient's spine is limited, especially with lateral flexion. The other joints in the patient's body are normal. Only the spine seems to be affected. The patient reports that a laboratory test from a previous doctor showed a positive gene HLA-B27, increased ESR (erythrocyte sedimentation rate), negative antinuclear antigen (ANA), and negative rheumatoid factor. Which of the following is best described?
A 39-yeаr-оld mаle client presents tо yоur clinic, complаining of pain with defecation and profuse bleeding in the toilet after a bowel movement. Two weeks ago, he was in a car accident, where he injured his shoulder and was prescribed prescription narcotics.. Since then, he is constipated with hard and pebble-like stool. He states he has always been "regular" in the past, with easy bowel movements. His diet has not changed but he states that he is exercising less since the accident. His past medical history includes hypertension and he is on a low-dose diuretic. He has had no other chronic illnesses or surgeries. He has a family history of hypertension, coronary heart disease, and diabetes but no cancer. He is divorced and has three children. He smokes two packs of cigarettes per day and quit drinking more than 10 years ago. He has had no recent weight loss, weight gain, fever, or night sweats. On examination he appears muscular and healthy; he is afebrile. His blood pressure is 135/90 with a pulse of 80. His cardiac, lung, and abdominal examinations are unremarkable. He is wearing a sling on his left arm. On observation of his anus, you find a swollen bluish ovoid mass that appears to contain a blood clot. Digital rectal examination is extremely painful for the patient. No other mass is palpated within the anus or rectum. What disorder of the anus is this patient likely to have?