Hemorrhoids
WASH (warm sitz, analgesics, stool softeners, high fiber)
Anusol HC suppositories or cream
Colace 100 tid
Senna 2 tabs po QHS and/or Metamucil 1 tbl TID-QID
Pontocaine/Rupercaine ointments
Thrombosed hemorrhoid
only drain if within 48 horus or at most 72 hours
cut out an ellipse of skin with iris scissors
Fissures
should be at 6 or 12 o’clock outside of crohns
8 cups of water per day
Citrucel Powder
Magnesium tablets (calcium is constipating, magnesium is a laxitive)
Diltiazem 2% cream
Must treat for 4-6 weeks even after the patient feels better
Fistulas
any connection between two epithelialized surfaces
Pilonidal disease
infection of butt hairs
Proctalgia Fugax
psychogenic pain amongst the anal retentive
Gay bowel syndrome
gc, chl, HSV, syph, chancroid
Difference between prolapsed rectum and prolapsed hemorrhoid
Rectum(Circular) Hemorrhoid (Stellate)
Foreign Bodies
Perianal Abscesses
cruciate incision is not necessary, but it must be big enough to admit a finger to break up adhesions and define the boundaries of the cavity
check for anorectal fistula
half of these patients will develop a fistula
necrotizing infections: cut out everything dead and smelly, no matter how large the resultant wound
can use sugar on strangulated hernias and rectal prolapse
acute perianal hematoma
often erroneously labelled as a thrombosed hemorrhoid
from a clotted perineal vein
non-op management is best
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