🩺 Section 392.4: Hemorrhoids

Nelson Textbook of Pediatrics 22nd Edition — Hemorrhoids are rare in children. Internal hemorrhoids: painless rectal bleeding (bright red blood on toilet paper or coating stool). External hemorrhoids: acute pain, palpable lump, may thrombose (bluish-purple nodule). Treatment: conservative (stool softeners, sitz baths, fiber). Thrombosed external hemorrhoid within 48 hours: incision and thrombectomy. Portal hypertension can cause anorectal varices (not true hemorrhoids).

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📋 30 Clinical Scenarios — Hemorrhoids

📇 High‑Yield Review Cards (Hemorrhoids)

🩺 Clinical Presentations: Hemorrhoids

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of Hemorrhoids

🔑 Key Principles — Hemorrhoids (Nelson 392.4)
• Internal hemorrhoids: Above dentate line (insensate). Present with painless bright red bleeding, prolapse.
• External hemorrhoids: Below dentate line (painful). Acute thrombosis → bluish-purple tender nodule.
• Conservative treatment: Stool softeners (PEG), increased fiber/fluids, sitz baths, topical anesthetics.
• Thrombosed external hemorrhoid: If <48 hours → incision and thrombectomy (clot evacuation). If >48 hours → conservative.
• Anorectal varices: Associated with portal hypertension (not true hemorrhoids). Do not excise.

    ⚡ Reflex Prompts — Hemorrhoids

    📖 Hemorrhoids — Core Summary (Nelson 392.4)