Arip Septadi Dika Herza Pratama Wahyu Setiawan Panca Erfah Safitry Ernawati

08310032 08310077 08310319 08310233 08310097

Case
A 62-year-old man presents to your office for a routine

evaluation. His only complaint is of fatigue over the past 2 to 3 months despite no changes in diet or lifestyle. On questioning, the patient reports that he has never smoked and admits to an increase in his consumption of alcohol. Upon retiring, to about two to three beers per day. He has occasional headaches on the day after a night of heavier drinking, which are easily relieved by the use of over-thecounter nonsteroidal anti-inflammatory drug (NSAID) preparations. While talking to the patient and examining his chart you note no distress and procced with your examination. You note a 4 lb weight loss since his last visit 6 months ago and a relative.

 Increase in his pulse with a blood pressure of 129/81 mm

Hg. Remarkable to this visit is the paleness of his conjunctivae, but the rest of his general. Examination is unchanged from the previous examination. You perform a digital rectal examination and find a smooth, normal-size prostate and some soft, reducible protrusions within the internal sphincter, along with guaiac-positive stools. You decide on a more direct approach and delve into his drinking, bowel habits, and NSAID use. His only addition is the occasional production of bloody stools accompanied by some diffuse abdominal discomfort.

Key words
Fatigue over the past 2 to 3 month
Consumption of alcohol Drink about 2 to 3 beers per day When headaches use NSAID Blood pressure of 129/81 mm Hg Paleness of his conjunctivae Guaiac positive stools

Definition
HEMORRHOID is enlargement and inflamtion of

vein in the lower part of the rectum at indigenous of plexus hemorrhoidalis.

Epidemiology
The number of hemorrhoidectomies performed in

hospitals is declining. 117 hemorrhoidectomies per 100,000 people in 1974 37 hemorrhoidectomies per 100,000 people in 1987. Hemorrhoids plague all age groups, although they occur most often in individuals aged 46-65 years.

Cause
Genetic
Pregnancy because change hormonal Chronic obstipation Chronic liver disease cause increased venous pressure Hipertension, obesity, bad life style.

Type
Hemorrhoid can be devide into 2 category: Internal Hemorrhoid Internal hemorrhoids are located in the inside lining of the rectum and cannot be felt.
External Hemorrhoid

External hemorrhoids are located underneath the skin that surrounds the anus.

Internal hemorrhoid can be devide into four grade: Grade 1 Grade 2 Grade 3 Grade 4

Diagnosis
For the diagnosis hemorrhoid can concluded from anamnesis, symptom and hemorrhoid grade. The diagnosis will be perfect if we can endoscopy.

Symptom
Symptom of hemorrhoid: Bledding in the rectum Felt sprags in the rectum Itch

Discussion
What is the most likely diagnosis?
What is your next diagnostic step? What is the next step in therapy?

 Based diagnose and physical examination, the most

likely diagnosis in this patient are hemorrhoids. For hemorrhoids diagnosis can be done by inspection, digital examination, and examination Proctoscopy or colonoscopy examination. Hemorrhoids treatment consists of nonpharmacological management, pharmacological and minimally invasive.

Discussion
Anamnesis
Hemorrhoid Physical examination

Diagnosis

Discussion
Digital Examination Colonoscopi

Hemorrhoid

Next Step

Discussion
non-farmakologis

Therapy

farmakologis

minimal invasif

Conclusion
Hemorrhoid is enlargement and inflamtion of vein in

the lower part of the rectum at indigenous of plexus homorrhoidalis. Hemorrhoids can be caused by tumors, bowel habits are wrong, pregnancy, aging, chronic constipation, chronic diarrhea, excessive acute diarrhea.

 Hemorrhoids diagnosis based on colonoscopy

examination. Management of hemorrhoids consist of pharmacological management, non-pharmacologic, minimally invasive and surgical. The best prevention of hemorrhoids is to keep the stool remains soft and easy exit.