Hemorrhoids

HEMORRHOIDS 1. CHIEF COMPLAINT •Hemorrhoids 2. HPI 3. ROS 4. SYMPTOMS •Bright red blood covering the stool •Pain •Painful swelling or a hard lump around the anus 5. HISTORY •FAMILY HISTORY o Obesity o Diabetes o Hypertension •SOCIAL HISTORY •PASTMEDICAL HISTORY o Constipation o Diarrhea o Premenstrual syndrome o Menstruation o Hypertension o Portal hypertension o Obesity o Pregnancy o Excessive consumption of alcohol or caffeine •SURGICAL HISTORY •CHRONIC CONDITIONS 6. ALLERGIES 7. PHYSICAL EXAMINATION 8. SPECIFIC DATA LIKE GRADING ETC •External hemorrhoids •Internal hemorrhoids •Prolapsed hemorrhoids

By degree of prolapse •Grade I: The hemorrhoids do not prolapse. •Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce. •Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced. •Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced. 9. TESTS TO BE ORDERED •Anoscopy •Sigmoidoscopy •Colonoscopy 10.ASSESSMENT /PLAN •Rubber band ligation •Hemorrhoidolysis/Galvanic Electrotherapy •Sclerotherapy •Cryosurgery •Laser, infrared or BICAP coagulation •Hemorrhoidectomy •Stapled Hemorrhoidectomy •Enema •Doppler Guided Hemorrhoidal Artery Ligation •HAL-RAR •Transanal hemorrhoidal dearterialization (THD) •Radiofrequency Coagulation 11.EDUCATION •Drink more fluids •Eat more dietary fiber (such as fruits, vegetables and cereals high in fiber) •Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. •Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid. •Do Kegel exercises for the pelvic floor •Avoid alcohol •Avoid caffeine

12.MEDICATION •Nupercainal •Proctosedyl •Benzocaine •Benzyl alcohol 5% to 20% •Dibucaine 0.25% to 1.0% •Dyclonine 0.5% to 1.0% •Lidocaine 2% to 5% •Pramoxine 1.0% •Tetracaine 0.5% to 5.0% •Ephedrine sulfate 0.1% to 1.25% •Epinephrine 0.005% to 0.01% •Phenylephrine 0.25% •Aluminum hydroxide gel •Cocoa butter •Glycerin •Kaolin •Lanolin •Mineral oil •White petrolatum •Starch •Zinc oxide or calamine •Calamine 5% to 25% •Zinc oxide 5% to 25% •Witch hazel 10% to 50% •Boric acid •Hydrastis •Phenol •Benzalkonium chloride •Cetylpyridinium chloride •Benzethonium chloride •Resorcinol •Aluminum chlorhydroxy •Allantoinate 0.2% to 2.0% •Resorcinol 1% to 3% •Menthol 0.1% to 1.0% •Camphor 0.1% to 3% •Juniper tar 1% to 5% 13.FOLLOW-UP