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Hemorrhoids
Published in Charles Theisler, Adjuvant Medical Care, 2023
Internal hemorrhoids are typically painless. In contrast, external hemorrhoids cause pain, itching, bleeding, and possible swelling in the anal region. Hemorrhoids are one of the most common causes of rectal bleeding. Rarely dangerous, hemorrhoids usually clear up in a few weeks. For pregnant individuals, most hemorrhoids regress after childbirth. The most common and serious complications of hemorrhoids include perianal thrombosis and incarcerated prolapsed internal hemorrhoids with subsequent thrombosis. They are characterized by severe pain in the perianal region possibly with bleeding.1
Acquired anorectal disorders: Prolapse, fistula, and hemorrhoids
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Anal fissure is a longitudinal split in the anal margin, often occurring in the anterior or posterior midline position. The peak incidence is in children around 2 years of age. Fissure is usually provoked by passage of a large, hard, painful stool. Symptoms are of acute, severe pain on defecation, often with bright red rectal bleeding. Stool-withholding behavior may result in anal fissure in younger infants. The fissure may be seen in physical examination. An anterior skin tag (“sentinel pile”) may be seen in chronic cases.
Approach To The Patient With Rectal Bleeding
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
A step-by-step schema has been presented for the investigation of patients who present with the symptom of rectal bleeding. The cornerstone of an accurate diagnosis rests on a thorough and complete history obtained from the patient. Although each of the many possibilities must be considered in every patient with rectal bleeding, the differential diagnosis may be markedly narrowed by an accurate history and pinpointed by the appropriate diagnostic procedure. A stepwise approach to every patient who presents with rectal bleeding will enable a prompt and precise diagnosis.
Potential applications of drug delivery technologies against radiation enteritis
Published in Expert Opinion on Drug Delivery, 2023
Dongdong Liu, Meng Wei, Wenrui Yan, Hua Xie, Yingbao Sun, Bochuan Yuan, Yiguang Jin
Formalin can be used to treat RE, especially hemorrhagic enteritis. Formalin acts as a chemical cauterization by damaging blood vessels through protein coagulation to hemostasis [59,60]. Formalin is used in the concentrations of 4% to 10% and can be either directly perfused or endoscopically perfused. However, it is important to note that local treatment with formalin has serious complications, including severe pain, colitis, perforation, stenosis, ulceration, and fecal incontinence [82]. In a 4% formalin clinical study of radiation proctitis involving 20 patients, 10 patients had a complete resolution of their symptoms after the first treatment with formalin and the others experienced a recurrence of bleeding and were offered with another dose of formalin infusion and/or ASA suppository and argon therapy. Finally, the complete resolution of symptoms was achieved in all patients. Formalin therapy may be repeated in the case of recurrent bleeding and in combination with other treatments. Another study involved 29 chronic radiation proctitis patients who were treated with 4% formalin for continuous 5 years. Sixty-two percent of patients had complete freedom from rectal bleeding, while 34.5% of the patients had partial benefits. Only one patient required a diversionary colostomy due to persistent bleeding [61]. Therefore, the treatment of hemorrhagic radiation proctitis with local administration of formalin is an effective, well tolerated and safe procedure. The procedure is inexpensive, technically simple and can be done on an outpatient basis.
End of induction patient reported outcomes predict clinical remission and endoscopic improvement with vedolizumab and adalimumab in ulcerative colitis
Published in Scandinavian Journal of Gastroenterology, 2023
Emily Chu Lee Wong, Badar Hasan, Parambir S. Dulai, John K. Marshall, Walter Reinisch, Neeraj Narula
Compared to traditional categorization for RBS and SF, each with four categories of severity, our analyses demonstrate that a simplified approach can adequately capture the likelihood of achieving long-term outcomes at one year. Our findings suggest that the absence or presence of rectal bleeding may suffice. Similarly, the SF can be simplified into three categories (normal, mild/moderate, and severe). Compared to the modified PMS, the modified PRO-2 score had similar ability to predict outcomes at one year. Simplification of the traditional PRO categories can benefit both patients and clinicians by offering a more direct assessment strategy. This simplified approach may also benefit clinical trials by increasing the frequency of assessments with minimal additional effort by patients and trialists. Further validation in external cohorts of simplified approaches to evaluating PROs should be performed before incorporation into clinical practice or trials.
Prolapsed anorectal malignant melanoma presenting as hemorrhoids
Published in Baylor University Medical Center Proceedings, 2023
Busara Songtanin, Kenneth Nugent, Sameer Islam
A 71-year-old woman with known internal hemorrhoids presented to the hospital with rectal bleeding for 3 months. She felt a “mass” inside her rectum that occasionally protruded and bled. She also complained of right upper quadrant pain and “lumps” for 3 weeks. She denied nausea, vomiting, weight loss, and changes in appetite. Her vital signs were within normal limits. Physical examination showed hepatomegaly, and rectal exam revealed an irregular mass with blood on the glove after palpation. Laboratory tests showed a hemoglobin of 9.6 g/dL; aspartate transaminase, 25 U/L; alanine transaminase, 17 U/L; alkaline phosphatase, 319 U/L (35–104 U/L); and lactate dehydrogenase, 401 U/L (135–214 U/L). Ultrasound of the abdomen showed multiple lesions in the right and left lobes of the liver, with the largest 8.3 cm in diameter. Computed tomography of the abdomen with contrast showed hepatosplenomegaly with numerous solid lesions involving the liver consistent with diffuse metastatic disease and thickening of the rectal wall.