Hemorrhoids Flashcards
What is one of the essential questions to ask when we have a person with hemorrhoids?
Have you seen a doctor about this?
What type of hemorrhoids is the most painful?
External hemorrhoids
What type of hemorrhoids is asymptomatic?
Internal hemorroids
Where is the area of infection for internal hemorrhoids?
Both inside and outside
What’s venous plexus?
The structures come off as years pass by
True or false.
Venous plexus is only internal.
False.
Its both internal and external
What are some symptoms of hemorrhoids?
Bleeding
Itching
Swelling
Feeling of fullness in colon
seepage
pain
Whats the difference between prolapse and thrombosed?
Prolapsed is not as painful and it can eventually turn into thrombosed.
Are hemorrhoids very common among people?
No they are not it is only in 4% of the population
Do most people have symptomatic or asymptomatic hemorrhoids?
Asymptomatic
What is the percentage of people who walked into the MD office and did not have actual hemorrhoids?
hemorrhoids
Whats the second choice of diagnosis after hemorrhoids?
anal fissure
What are two very bold symptoms of colon cancer?
Bleeding + pain
Case study:
We have a 20-year-old walk into our pharmacy and he explains that he has had some blood spotting on his underwear what is our next step in the context of colon cancer and hemorrhoids
First we always ask if they have seen a pharmacist before
second based on what JT says we never really think of colon cancer because of the age so we jump to hemorrhoids.
What is one distinctive feature of colon cancer?
Unintended weight loss
What are the symptoms of colon cancer?
Change in bowel habits
You need to have a bowel movement but its not relieved while doing so
Rectal bleeding
Dark stools
Cramping
Weakness
Unintended weight loss
Whats the difference in characteristics of blood between colon cancer and hemorrhoids?
hemorrhoids: bright red
Colon cancer: Very dark
Where does colon cancer rank among different types of cancer?
2nd
What is the odds of having colon cancer after the presentation of new onset rectal bleeding with hemorrhoids?
2.4% to 11%
What are some characteristics of someone with colon cancer?
over 50
Change in bowel habits
Blood very dark in stool
stools narrower than usual
GI discomfort
unexplained weight loss
very tired
Where is polyp found and how can we detect it?
after the intestinal folds and only with colonoscopy
What is an anal fissure?
small tears on the anal canal
How often do we see anal fissures in people with hemorrhoids?
20%
What is the most common reason we have anal fissure in young kids?
Because they hold in their stool
How can you get anal itch?
Seepage and poor hygiene (tenderness in the area) -> commonly via hemorrhoids
What’s the second most common anal symptom?
Anal itch
What is another common way to get anal itch other than hemorrhoids
some skin conditions
irritation via diarrhea
What is proctitis and how can we distinguish it from hemorrhoids?
Inflammation of the rectal region
Very severe cramps
THEY ARE MUCH MORE PAINFUL
How do you get proctitis?
From infections and trauma
What are the symptoms of proctitis?
Urge
high pain and cramps
loads of blood
mucous / discharge
True or false.
Proctitis is very unlikely to be confused with hemorrhoids
True
When do hemorrhoids peak in people?
Age 45-65
hemorrhoids affect what percentage of people?
75%
What are some causes of hemorrhoids?
Low fibers/straining
pregnancy
prolonged standing
chronic diarrhea or constipation
heredity
True or false.
A good way to treat hemorrhoids is by sitting on cold benches.
False
Would the patient notice the size of hemorrhoids in their body?
No
When would you get relief from hemorrhoids?
if the hemorrhoids breaks
When do hemorrhoids become MD care?
somewhere along the way we always want them to see them especially if they are bleeding
What should a pharmacist do if the patient sees blood in their stool?
Take 5 seconds then tell them to go see the doctor
How common is bleeding with people in their rectal area?
1 in 7 patients has experienced these but it might not even be pathalogical.
True or false.
MD is needed in 90% of times you see blood.
False.
100% of time
True or false.
Never assume rectal bleed to be hemorrhoids without a visual exam.
true
I did not make a note for slide 29 boys since JT said on OSCE’s always say MD referal when you see blood
:)
Rank hemorrhoids - colorectal - fissures - others based on how common they are.
hemorrhoids
Fissures
Colorectal
Others
When to refer the patient with hemorrhoids?
Blood in stool
With abdominal pain or vomiting
Weight loss
Persistent change in bowel habit
Longer than 3 weeks
What type of hemorrhoids need OTC products?
Mild hemorrhoids
How many days does it take for thrombosed hemorrhoids to get better?
2-3 days
True or false.
Most hemorrhoids heal on their own.
True
What is the regimen for post-BM cleanliness?
Timing of shower (after you poop)
Dry skin lotion prn
commercial preps
When do we use hamamelis water?
hemorrhoids
acne
When should people use sitz baths?
Post surgery hemorrhoids not normal ones
Would we want warm or cold water with hemorrhoids?
Warm
True or false.
Treating hemorrhoids for a short time is a myth.
False.
Takes pressure off from the area
Can you attempt to push back on hemorrhoids in both internal and external cases?
Just internal ones
True or false.
prolapsed hemorrhoids might go back inside your rectum by themselves.
True
What’s the treatment of choice in a pharmacy for hemorrhoids?
Anusol
What is the base in Anusol
zinc sulfate
True or false.
Pramoxine is used in hemorrhoid treatment with zinc sulfate and it is highly sensitizing.
False.
Its very little sensitizing
How often do you dose Anusol?
Q4H esp post BM
Does preparation H do any wound healing?
Absolutely not
JT hates it!
True or false.
Phenylephrine is used on the rectum to relieve itching burning and swelling
False.
It is useful for all of those except swelling
Hows hemoclin beneficial for hemorrhoids?
It is just a good ointment and just have ointment properties.
how does witch hazel cream help for hemorrhoids?
It is a good astringent but the ointment is doing 95% of the job
Is HC 0.5% beneficial for hemorrhoids?
And is it RX after added to oinment for hemorrhoids or OTC
It is Rx and no it does not do anything
If someone has had hemorrhoids previously what’s the first step you would take to help them?
Suggest non-pharmacological treatments for 2 days
If non-pharmacological treatment is not effective what would you do after?
Continue non-pharmacological plus OTC product or prescribe combo product with HC
What should we do after recommending an OTC product or combo product with HC?
After 7 days follow up if no improvements refer to MD if symptoms are relieved then stop pharmacologic treatment but still continue non-pharmacologic measures to prevent reccurance
What are some Rx options for hemorrhoids?
Proctofoam
Proctosedyl
What does proctosedyl contain in its ingredients?
Hc 0.5%
Framycetin = a/biotic
cinchocaine = anesthetic
esculin 1%
What is an oral agent for hemorrhoids and is it effective?
Hemovel
No
While a patient with hemorrhoids is going under surgery what other conditions are the doctors looking for to detect?
Polyps
Are ice packs a good option for hemorrhoids?
No, it can be very uncomfortable
What is the issue with using topical analgesics for more than 3-4 days to use?
The issue is not the drug because they are super safe but the reason that the patient might still need them
True or false.
Topical A535 is a good option to treat hemorrhoids
False.
What’s our thought on using laxatives for hemorrhoids?
Deal with hemorrhoids with anusol first then if the patient is still uncomfortable and has constipation then recommend a laxative.
Is pramoxine safe to use on hemorrhoids for more than 2-3 days?
The product is safe, but the real concern is what is causing pain in the anus
Are hemorrhoidal topical ointments safe in pregnant women?
About 50% of pregnant women develop hemorrhoids. Use for 2-3 days is totally safe due to low absorption
What do we have to worry about for older adults with anal bleeding?
Older adults have increased chance of colorectal cancer.
We need to ask a few more questions to rule out more serious conditions
Treat for hemorrhoids only after more severe conditions have been ruled out
