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Hemorrhoid (s/s (1st degree (hemorrhoid descend beyond dentate with…
Hemorrhoid
s/s
protusion of swollen mass after bowel movement
bright red bleeding after defecation
constipation
anal itching
sensation of incomplete fecal evacuation
infection
rectal varices due to portal ypertension
1st degree
hemorrhoid descend beyond dentate with straining
not prolapse
bleeding
2nd
anal cushion protrude below dentate with straining
spontaneous retract
3rd degree
protrude outside anaus
need manaual reduction
4th
prolapse independent of straining
irreducilbe
RX
Asymptomatic no treatment
high fiber diet to :arrow_up: softness and bulk
regular bowel habbit
nonirritatin stool softeners
control of itching improved anal hygiene and moisture control
frequent warm sitz bath for pain and swelling
manual reduction
meds
anusol cream for mild astringent
preparation H
corticosteroid
anusol HC
Ultraproct cream
avoid prolong use topical anesthesia as causing allergic perianal skin rash
surgical
Sclerotherapy
cryosurgical hemorrhoidectomy
infrared photocoagulation
bipolar diathermy
laser therapy
rubber ring ligation
standard excisional hemorrhoidectomy
stapled hemorhoidectomy
pre op
pain management
lactulose
bowel preparation :
ducolax
prophylactic antibiotic
metronidazole
post op
pain relief
frequent positioning
use pillow for support
wwarm sitz bath
anal pad, cream
analgesia
note for drainage and hemorhage
complication
hemorrhage
urinary retention
infection
education
do not remain toliet seat for longer than 1 min
only defecate when have sensation for bowel urgency
diet
gradual progression high fiber diet to avoid bloating
8-10 glassess per day to avoid constipation
discourage regular use of laxative
firm soft stool dialte anal and :arrow_down: stricture formation
regular exercise
avoid strenous exercise
cause
abnormal dilatation of vein internal hemorrhoidal venous plexus
abnormal distension of arteriovenous ansatomoses
prolapse of anal cushion
destruction of anchoring connective tissue
risk factor
pregancy
prolong standing/sitting
straining at defecation
constipation/diarrhea
rectal surgery
vomitting
loss of muscle tone
:arrow_up: intra ab pressure cause engorgement of vascular lining of anal canal
anal intercourse
loosening of vessel that protrue into anal canal
investigation
history taking
DRE Digital rectal examination
direct visualization
proctosocopy
proctosigmoidoscopy
anoscopy
barium enema
colonoscopy
exclusion test
types
vascular massess in lower rectum/ anus
internal hemorrhoid
above dentate line
above internal sphincter
external hemorrhoid
below detate line
outside external sphincter
thrombosed hemorrhoid
blood clotted within hemorrhoid become obstruction
anorectum anatomy
dentate line
upper anal canal
columnar epithelium
lower anal canal anoderm
sensate squamous epithelium
physiology
fecal continence
puborectalis cause the anus 90 degree to the rectum
sitting or squatting straigthen the aligment
anal cushio prevent fecal leaking out