Hemorrhoids

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍hemorrhoidsanal lumps

Onset was ‍gradualsuddentraumatic

Pattern ‍persistentintermittent

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍lump

‍itching

‍swelling

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍discharge

‍difficulty passing stools

‍constipation

‍straining with bowel movements

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Contributing factors:

‍anal sex

‍use of irritants such as soaps

‍poor hygiene

‍obesity

‍pregnancy

no history of: ‍anal fissure, ‍hemorrhoids, ‍anal abscess, ‍inflammatory bowel disease

no use of: ‍topical anesthetics, ‍laxatives, ‍stool softeners, ‍opioids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Hemorrhoids ‍likelysuspectedpossible

DDx: hemorrhoids, anal fissure, colorectal cancer, perianal abscess, inflammatory bowel disease, proctitis, anal warts, rectal prolapse, portal hypertension, rectal trauma, constipation, prolonged sitting or straining, pregnancy-related hemorrhoids, obesity, heavy lifting





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍ESR, ‍coagulation profile

- Colonoscopy

Treatments:

- ‍Analgesics

- ‍Topical treatments

- ‍Stool softeners

- Incision and drainage for thrombosed external hemorrhoids

- Sitz baths

- Increase fluid intake

- Increase dietary fiber

Further care:

- Referral to gastroenterologist

- Referral to surgeon

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen, if new symptoms develop such as weight loss or blood in stools, or if symptoms do not improve with treatment