Hemorrhoids
25 results
1 - 25
Anorectal Disease- A 47-year-old man with chronic constipation presents with increasingly painful prolapsed perianal tissue of 3 days’ duration (Figure) Which of the following is the best next step in treatment?
- A 68-year-old man with end-stage liver disease presents with repeated episodes of lower gastrointestinal bleeding resulting in symptomatic anemia with hypotension. Colonoscopy shows prominent veins in the submucosa of the lower rectum. Which of the following is the most durable treatment option?
- You evaluate a patient with a 3-month history of pruritis ani. Examination reveals perianal erythema and excoriation. You treat the patient with dietary modification and calamine-zinc barrier. The patient returns in 3 months reporting no symptomatic improvement. What is the next step in management?
- An 80-year-old woman presents with anal pruritus and prolapsing internal hemorrhoids. She has fecal urgency and occasional fecal accidents. On anoscopy, grade 2 internal hemorrhoids are visualized. What is the best option for treating her internal hemorrhoids?
- A 28-year-old woman with perianal Crohn’s disease is referred for evaluation for perianal itching. On examination, she has large bilateral anal skin tags that are painless to palpation. What is the most appropriate treatment?
- A 37-year-old homosexual man presents for evaluation for anal bleeding and prolapsing internal hemorrhoids. He reports only transient improvement after several rubber band ligations. On examination, grade III internal hemorrhoids are noted with a minimal external hemorrhoidal component. What is the next step in management?
- A 35-year-old man presents to the office for evaluation for anal itching and an episode of painless rectal bleeding. On examination, he has small hemorrhoidal skin tags. Office anoscopy shows grade I internal hemorrhoids. What is the initial treatment of choice?
- A 29-year-old healthy man presents to the emergency department with severe anal pain and urinary retention 72 hours after hemorrhoidal banding. His temperature is 101.6°F (38.7°C), heart rate is 120 beats/min, and blood pressure is 80/50 mm Hg. His abdomen is mildly tender in the suprapubic region. Urinary catheter was placed and 750 mL of urine drained. What is the best next step in management?
- A 67-year-old patient presents with a 2-year history of recurrent hemorrhoid swelling, difficulty cleaning, and bright red blood with bowel movements despite fiber supplementation and avoidance of straining. Examination reveals grade III hemorrhoids with a large external component. Which of the following would be the most effective treatment?
- A patient presents with difficult and painful evacuation 2 months after undergoing Ferguson excisional hemorrhoidectomy for acutely thrombosed grade IV internal and external hemorrhoids. An examination reveals anal stenosis. What is the most likely cause of the anal stenosis?
- A 55-year-old man presents with multiple perianal and anal canal condylomas. The patient undergoes an examination under anesthesia and excision. Which of the following techniques is most appropriate?
- A healthy 41-year-old man presents to your office complaining of blood on the toilet paper after each bowel movement for the past 6 months. On anoscopy, grade II internal hemorrhoids with stigmata of bleeding are found. Which of the following is the most appropriate management?
- A 72-year-old man with obesity underwent an uneventful outpatient 2-quadrant rubber band ligation for bleeding hemorrhoids 4 days ago. He now reports vague perianal pain. Which additional symptom raises the suspicion for procedure-related sepsis?
- A 55-year-old man presents with malaise, fatigue, inability to urinate, temperature of 102°F (38.8°C) and a heart rate of 115 beats/min 4 days after undergoing rubber band ligation for bleeding internal hemorrhoids. What is the next step in management?
- A 78-year-old man with atrial fibrillation seeks inpatient consultation for persistent bright red blood per rectum. He is hemodynamically stable. After holding anticoagulation, colonoscopy demonstrates internal hemorrhoids with stigmata of bleeding. What is the most appropriate next step in management?
- Pelvic Floor
- A 37-year-old woman with a body mass index of 18 kg/m2 has been experiencing rectal pain for 6 months. She has no rectal bleeding, no family history of colon disease, and no chronic change in bowel habits. Findings of digital rectal examination, anoscopy, and flexible sigmoidoscopy are remarkable for grade 2 internal hemorrhoids and tenderness with manipulation of the coccyx. What is the best next step in management?
- An 80-year-old woman with multiple comorbidities has hemorrhoids and fecal incontinence. On examination, you observe full-thickness rectal prolapse and offer a perineal proctectomy. What additional procedure may improve continence?
- Malignancy
- question 25
- Question Number: 22
- ASCRS Question Bank
- Perioperative
- A 57-year-old man undergoes 3-column hemorrhoidectomy under general anesthesia. He is unable to void postoperatively before discharge and requires catheter placement. What intervention would have reduced his risk of urinary retention?
- A 40-year-old man presents to the emergency department with large-volume rectal bleeding and transanal passage of clot 8 days after elective excisional hemorrhoidectomy. He is tachycardic and hypotensive. What is the best next step in management?