Hemorrhoids
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Evaluation
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General—submucosal pads of tissue composed of arterial and venous plexuses
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Epidemiology—Approximately 4.4% of the general population
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Classification
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Internal hemorrhoids—originate above the dentate line
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Clinical—typically painless; called to patient’s attention if bleeding or prolapsed
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Bleeding described as red spotting, usually at the end of defecation.
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Prolapse can create a feeling of pressure or mass.
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Grades
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Grade I—bulge with defecation; do not prolapse.
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Grade II—prolapse with defecation, but reduces spontaneously.
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Grade III—prolapse with defecation and require manual reduction.
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Grade IV—prolapse with defecation and cannot be reduced.
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External hemorrhoids—originate below the dentate line and covered by anoderm
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Clinical—associated with discomfort; can be acutely painful if thrombosed.
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