Ver el código de «External hemorrhoid»

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==Background==

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{{Hemorrhoid background}}
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==Clinical Features==

[[File:M 44 anus 22.jpg|thumb|[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]]]
[[File:Perianal thrombosis 01.jpg|thumb|Thrombosed [[Special:MyLanguage/external hemorrhoid|external hemorrhoid]]]]
*Occur distal to dentate line
*Can be seen at external inspection
**More prominent with Valsalva
*Thrombosed hemorrhoids (bluish-purple discoloration) cause painful defecation
**Non-thrombosed hemorrhoids are usually painless
***If patient complains of pain but hemorrhoids are not thrombosed suspect:
****[[Special:MyLanguage/perianal Abscess|Perianal/perirectal abscesses]]
****[[Special:MyLanguage/Anal fissure|Anal fissure]]s
*Prolapse
**Requires periodic reduction by the patient


==Differential Diagnosis==

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{{Anorectal DDX}}
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{{Lower GI bleeding DDX}}
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==Management==


===Not Thrombosed===

*Usually self-limiting with resolution in 1 week


===Thrombosed===

*Consider conservative treatment (sitz baths and bulk laxatives) if:
**Thrombosis has been present >72 hrs
**Swelling has started to shrink
**Pain is tolerable
*Conservative treatment may also include topical 0.3% nifedipine and 1.5% viscous lidocaine<ref>Perrotti P. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum. 2001 Mar;44(3):405-9.</ref>
*Consider [[Special:MyLanguage/Perianal block|Perianal block]] for pain relief
*Consider excision if:
**Patient is not immunocompromised, child, pregnant woman, has portal hypertension, coagulopathic
**Thrombosis is acute (<72 hrs)
**Extremely painful
**See [[Special:MyLanguage/External Hemorrhoid Excision|External Hemorrhoid Excision]]


==Disposition==

*Discharge home if uncomplicated
*Colorectal surgery follow up


==See Also==

*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]
*[[Special:MyLanguage/Internal hemorrhoid|Internal hemorrhoid]]
*[[Special:MyLanguage/Hemorrhoids|Hemorrhoids]]


==External Links==


==References==

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[[Category:GI]]
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