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Old 05-20-2013
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Default gastroenterology q12 hemorrhoids

A 67-year-old man is evaluated in the emergency department for blood in the toilet bowl after moving his bowels. Blood was also present on the toilet paper after wiping. He reports straining and recent constipation. He has a history of systemic hypertension and hyperlipidemia.
Vital signs are normal and he is not orthostatic. Anoscopy shows external hemorrhoids. Hematocrit is normal and bleeding does not recur during his 6-hour emergency department stay. Which of the following is the most appro-priate management?

A. Ciprofloxacin and metronidazole
B. Cortisone suppositories, fiber supplementation
C. Hemorrhoidal banding
D. Operative hemorrhoidectomy
E. Upper endoscopy
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Old 05-20-2013
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Quote:
Originally Posted by cingulate.gyrus View Post
A 67-year-old man is evaluated in the emergency department for blood in the toilet bowl after moving his bowels. Blood was also present on the toilet paper after wiping. He reports straining and recent constipation. He has a history of systemic hypertension and hyperlipidemia.
Vital signs are normal and he is not orthostatic. Anoscopy shows external hemorrhoids. Hematocrit is normal and bleeding does not recur during his 6-hour emergency department stay. Which of the following is the most appro-priate management?

A. Ciprofloxacin and metronidazole
B. Cortisone suppositories, fiber supplementation
C. Hemorrhoidal banding
D. Operative hemorrhoidectomy
E. Upper endoscopy
I believe the first step would be conservative measures.. unless the hemorrhoid is thrombosed or the bleeding doesnt stop.. im not good regarding the anus hahaha
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Old 05-21-2013
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Originally Posted by XpaezX View Post
I believe the first step would be conservative measures.. unless the hemorrhoid is thrombosed or the bleeding doesnt stop.. im not good regarding the anus hahaha

But to have good score u have good knowledge in that area too

answer is B.

Hemorrhoids can be internal or external; however, they are normally internal and may prolapse to the external position. Hemorrhoids are staged in the following manner:
stage I, enlargement with bleeding;
Stage II, protrusion with spontaneous reduction;
Stage III, protrusion requiring manual reduction;
Stage IV, irre-ducible protrusion.

Stage I, which this patient has, is treated with fiber supplementation, cortisone suppositories, and/or sclerotherapy.
Stage II is treated with fiber and cortisone suppositories.
Stage III patients are offered the prior three therapies and banding or opera-tive hemorrhoidectomy. Stage IV patients benefit from fiber and cortisone therapy as well as operative hemorrhoidectomy.

While substantial upper GI bleeding may result in hematochezia, the absence of suggestive signs/symptoms and the consistent findings of hemorrhoids do not indicate the need for upper endoscopy.


Last edited by cingulate.gyrus; 05-21-2013 at 09:51 AM. Reason: correction
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