GASTROINTESTINAL SYSTEM BLOCK

CASE 5A

Ronald Chrisbianto Gani 405090223 Faculty of Medicine 2009 Tarumanagara University

HEMORRHOID

DEFINITION
Dilatation and inflammation of veins in anal area from plexus hemorrhoidalis

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RISK FACTORS
Straining Bad defecation habbits Tumor Pregnancy Age Chronic constipation Diarrhea Anal sex Lack of water drinking Lack of fiber intake Immobilization

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 According to the location, hemorrhoid divided into:

External Hemorrhoid
Inside or lower side of anorectal line / linea dentate

CLASSIFICATION

Internal Hemorrhoid
Outside or upper side of anorectal line / linea dentate Has 4 stages :
Stage I : no prolapse to outsie of anal canal, only can be seen by anerectoscopy Stage II : prolapse hemorrhoid with spontaneous reduction Stage III : prolapse hemorrhoid which needs manual resuction Stage IV : permanent prolapse hemorrhoid
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CLASSIFICATION

Harrisons Principle of Medicine 17th ed Vol I

DIAGNOSIS
Anamnesis and PE Classification Anoscopy or colonoscopy Small intestine rontgen & enteroscopy ensure no small intestine abnormalities Barium enema Rontgen

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MANAGEMENT
Non Pharmacologic

Pharmacologic

Minimal Invasive Treatment

Surgical Treatment
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NON PHARMACOLOGIC TREATMENT

Bowel Management Program (BMP)
Diet Fluid Fiber Lubricant Defecation habit Local hygiene sitz bath More activity
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PHARMACOLOGIC TREATMENT
Facilitating defecation
Fiber suplement (psyllium or isphagula husk) to increase the stool volume, an increase peristaltic. SE : flatus, constipation, allergy, etc Laxatives : Natrium Dioctyl Sulfosuccinat, stimulates small intestine mucosa secretion and increase the penetration of fluid into stools

Simptomatic drugs
Local Anasthesia Corticosteroid to reduce inflammation Suppositoria internal hemorrhoid Ointment external hemorrhoid
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PHARMACOLOGIC TREATMENT
Stopping bleeding
Psyllium Citrus bioflavid (90% diosamin + 10% hesperidin)

Hemorrhoid cure and preventing reccurence

Diosminthesperidin Micronized flavonoid

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MINIMAL INVASIVE TREATMENT

Sclerotherapy hemorrhoid injection of aethoxysclerol 1,5% Ligation hemorrhoid Laser Therapy

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PREVENTION
Maintaining the consistency of stool by
Consuming enough fiber and fluid Routine Exercise

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