院长查房 PPH,20160712.ppt

Method Results Pooled analysis recurrent prolapse (OR ? 5.529, P ? 0.016) for up to 2 years after surgery SHLH VAS pain scores (OR ? 1.060, P ? 0.149) postoperative bleeding OR ? 1.188, P ? 0.871) Q7: Us?20160712 PPH: 18 case Male: 10 Female: 8 Age: 24-60 Stay days: 3-5 days Jiang Xun 2016.07.12 Defecation Case report Female , 34y Height : 157.6cm Weight : 88.6KG BMI : 35.7 July 3th,2016 Chief complaint: Recurrent anal mass prolapse for 4 years, getting worse with pain for 10 days Present illness Past history Deny: Deny : no fever Allergy (-) no tarry stool Menstrual regularity no pus Personal history (-) no weight loss Family history (-) no stool?changing Q1: Diagnosis? Prolapse -Internal hemorrhoids -External hemorrhoids -Hypertrophy of anal papilla -Rectal polyps -Rectal prolapse -Tumor Physical examination 左侧卧位，肛门口见环状肿物突出，色暗，水肿严重，约3*2cm大小，肛周见三角形皮赘突出，指诊：肛门7、9、11点可触及距肛内齿线附近粘膜隆起，指套退出无染血。肛门镜检查见齿状线上下环状混合痔突出，直肠粘膜突出 CBC/DC ：Hb 96g/L，Hct 30.8%，MCV 74.6fL/L MCH 23.2pg/cell ，MCHC 312.0g/L Preliminary diagnosis Mixed hemorrhoid Prolapse of rectal mucosa TreatmentOP-PPH Anti、Reduce swelling、 pain and stool softening treatmentdischarge Q2:Definition? Q3:Pathophysiology? History Varicose veins theory Anal Cushion Q4: Predisposing factor? Diets lack of exercise nutritional factors (low-fiber diets) increased intra-abdominal pressure genetics Aging Spinal cord injury Colon cance Signs and Symptoms no significant symptoms painful bleeding?------anemia thrombosed swelling itchiness Grade I: No prolapse, Grade II: Prolapse upon bearing down, but spontaneous reduction Grade III: Prolapse upon bearing down requiring manual reduction Grade IV: Prolapse with inabilit