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Office Diagnosis and Treatment, Part 1

机译：办公室诊断和治疗，第1部分

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摘要

When a patient presents with an anorectal complaint, it is important to get a detailed history, asking about bleeding, any protrusion of tissue or the presence of a mass, and the quality and timing of any pain and whether it is associated with bowel movements. Thrombosed external hemorrhoids usually cause severe, throbbing pain of sudden onset. They typically resolve on their own within 3 weeks; however, if the pain is severe or an ulceration has developed, surgical excision can relieve symptoms more quickly. Symptoms commonly associated with internal hemorrhoids include bleeding, protrusion, fecal soiling, and pruritus—but not pain. Initial treatment consists of conservative measures. Prolapsing internal hemorrhoids that are reducible can often be treated in the office with rubber band ligation. Hemorrhoids that fail conservative treatment may require surgery. Anal fissures can cause burning or aching pain that occurs during and especially after bowel movements; bleeding; spasm; and fecal soiling. Fissures often resolve within 6 weeks of initiation of medical therapy; options include topical anesthetics/analgesics, chemical sphincterotomy (with nitroglycerin 0.2% ointment or diltiazem 2% gel), and injection with botulinum toxin. Recalcitrant fissures may require operative treatment.
机译：当患者出现肛门直肠主诉时，重要的是要获得详细的病史，询问出血，组织是否突出或肿块的存在，疼痛的质量和时机以及是否与排便有关。血栓形成的外部痔疮通常会引起突然发作的剧烈的抽动性疼痛。他们通常在3周内自行解决;但是，如果疼痛严重或出现溃疡，手术切除可以更快地缓解症状。通常与内部痔疮相关的症状包括出血，突出，粪便弄脏和瘙痒，但不包括疼痛。初始治疗包括保守措施。可以在办公室使用橡皮筋结扎术治疗可消散的内部痔疮。保守治疗失败的痔疮可能需要手术。肛裂会引起排便期间或之后发生灼痛或疼痛。流血的;痉挛;和粪便弄脏。裂痕通常在药物治疗开始后的6周内消退;选项包括局部麻醉/镇痛药，化学括约肌切开术（使用0.2％硝酸甘油软膏或2％地尔硫卓凝胶）和注射肉毒杆菌毒素。顽固性裂痕可能需要手术治疗。

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