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A 55-year-old male truck driver presents for
evaluation of bright red rectal bleeding with
bowel movements. He also has the feeling that
something protrudes through his anus while he
strains to move his bowels but that it withdraws
into the bowel when he relaxes. He has
no abdominal pain, weight loss, or other symptoms.
A colonoscopy reveals no polyps or
tumors but does note internal hemorrhoids.
Which of the following is the best initial treatment
for him?
(A) high fiber diet, frequent sitz baths, and
topical steroid ointment
(B) rubber band ligation
© sclerotherapy injection
© infrared coagulation
(E) surgical hemorrhoidectomy
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Mux Q
Only th for internal hemorroides is: rubber band ligation
But they ask best initial treatment :could be High fiber diet
I am confused b/n A and B
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initial treatment is definitely diet, sitz bath, topical steroids....but my confusion is why high fiber diet this will increase constipation more strain and more bleeding ...usually stools softeners are used semisolid stools are expected after treatment.( lactulose)
prolapsed hemorrhoids however treated surgically...
so i will go for surgical hemorrhoidectomy E
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Why not Band Ligation? Would you not do this before surgical resection?
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band ligation is preferred for non prolapsed hemorrhoids before surgery even sclerotherapy also an option for non prolapsed hemorrhoids.
I m not totally confident but thats what i have seen doing in office by attendings.
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Source: Handbook of Gastroenterology
1st degree internal hemorrhoids don't protrude from anus
2nd degree prolapse with defecation but spontaneously reduce
3rd degree prolapse and require digital reduction
4th degree can't be reduced
Tx: high fiber diet, adequate fluid intake, sitz baths for 1st and 2nd degree
Rubber band ligation and injection sclerotherapy used for bleeding or other symptoms caused by 1st or 2nd degree
Surgical hemorrhoidectomy for most 3rd degree and 4th degree.
This guy has 2nd degree--> A
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A..
to answer getthespirits question, high fiber diet actually produces less constipation. Remember, why its good to eat lots of fruits and vegetables? With high fiber diet there is less undigested matter in the colon adding bulk to stools, this makes peristalasis easier, and propulsion of stool along the GI tract is easier and less need to strain.
