QUOTE(yeelin04 @ Oct 2 2009, 11:38 PM)
yah she said yes...
i think lack of water kot...cos she seldom drink water 1...
dowan to see doctor can 1 ar?? ....
Hemorrhoidsi think lack of water kot...cos she seldom drink water 1...
dowan to see doctor can 1 ar?? ....
BASIC INFORMATION
DEFINITION
A hemorrhoid is a varicose dilation of a vein of the superior or inferior hemorrhoidal plexus, resulting from a persistent increase in venous pressure. External hemorrhoids are below the pectinate line (inferior plexus). Internal hemorrhoids are above the pectinate line (superior plexus)
SYNONYMS
Piles
Hemorrhoids
EPIDEMIOLOGY & DEMOGRAPHICS
Potential for development of symptomatic hemorrhoids in all adults
PREVALENCE:
Estimated 50% of the adult population in the U.S.
PREDOMINANT SEX:
Males and females affected equally
PHYSICAL FINDINGS & CLINICAL PRESENTATION
• Painless bleeding with defecation; bleeding is bright red and staining on toilet paper
• Perianal irritation
• Mucofecal staining of underclothes
• Acute external hemorrhoids: painful, swollen, and often thrombosed
• Pain on sitting, standing, or defecating (thrombosed hemorrhoid)
• Prolapse
• Constipation
ETIOLOGY
• Low-fiber, high-fat diet
• Chronic constipation and straining with defecation
• High resting anal sphincter pressures
• Pregnancy
• Obesity
• Rectal surgery (i.e., episiotomy)
• Prolonged sitting
• Anal intercourse
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Fissure
• Abscess
• Anal fistula
• Condylomata acuminata
• Hypertrophied anal papillae
• Rectal prolapse
• Rectal polyp
• Neoplasm
WORKUP
• Inspection
• Digital rectal examination
• Anoscopy
• Sigmoidoscopy
TREATMENT
NONPHARMACOLOGIC THERAPY
• Avoidance of constipation and straining with defecation
• Avoidance of prolonged sitting on toilet
• High-fiber diet (20 to 30 g/day)
• Increased fluid intake (6 to 8 glasses of water per day)
• Cleaning with mild soap and water after defecation
• Warm soaks or ice to soothe
• Sitz baths
ACUTE GENERAL Rx
• Fiber supplements to provide bulk (psyllium extracts or mucilloids)
• Medicated compresses with witch hazel
• Topical hydrocortisone (1% to 3% cream or ointment)
• Topical anesthetic spray
• Glycerin suppositories
• Stool softeners
• Surgically remove during first 72 hr after onset
CHRONIC Rx
• Rubber-band ligation
• Injection sclerotherapy
• Photocoagulation
• Cryodestruction
• Hemorrhoidectomy
• Anal dilation
• Laser or cautery hemorrhoidectomy
• Observance for complications: thrombosis, bleeding, infection, anal stenosis or weakness
DISPOSITION
Should resolve, but there is a high rate of recurrence
REFERRAL
To colorectal or general surgeon for any hemorrhoid that does not respond to conservative therapy
PEARLS & CONSIDERATIONS
COMMENTS
• Patients need to understand the importance of a healthy diet, regular exercise, and rectal hygiene.
• Stress the importance of avoiding prolonged sitting and straining on the toilet.
• Stress the need not to defer the urge to defecate.
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I copy this from Ferri's Clinical Advisor 2010, 1st ed
You can go to this Link , But I think you have to have priviliges to view them...