Hemorrhoids differential diagnosis: Difference between revisions
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|Anal fissure | |Anal fissure | ||
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* Anal fissure usually presents with tearing pain with every bowel movement. | * Anal fissure usually presents with tearing pain with every bowel movement.<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref> | ||
* Pain usually lasts for minutes to hours after every bowel movements. | * Pain usually lasts for minutes to hours after every bowel movements. | ||
* Patient is typically afraid of going to the bathroom to avoid the pain, which leads to a viscious cycle. The fissure worsens the constipation and the constipation (hard stool) aggravates the fissure. | * Patient is typically afraid of going to the bathroom to avoid the pain, which leads to a viscious cycle. The fissure worsens the constipation and the constipation (hard stool) aggravates the fissure. | ||
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* May be accompanied by pruritis and discharge. | * May be accompanied by pruritis and discharge. | ||
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* Most fissures occur in the posterior midline of the anal canal. | * Most fissures occur in the posterior midline of the anal canal.<ref name="pmid26929749">{{cite journal |vauthors=Beaty JS, Shashidharan M |title=Anal Fissure |journal=Clin Colon Rectal Surg |volume=29 |issue=1 |pages=30–7 |year=2016 |pmid=26929749 |pmc=4755763 |doi=10.1055/s-0035-1570390 |url=}}</ref> | ||
* Skin tags in the perianal area may accompany chronic anal fissures. | * Skin tags in the perianal area may accompany chronic anal fissures. | ||
|[[Image:Anal fissure 1 - By Bernardo Gui - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750.jpg|center|300px|thumb|Anal fissure - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750]] | |[[Image:Anal fissure 1 - By Bernardo Gui - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750.jpg|center|300px|thumb|Anal fissure - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750]] | ||
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|Rectal [[prolapse]] | |Rectal [[prolapse]] | ||
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* Rectal prolapse most commonly occurs in multiparous females over 40 years old. | * Rectal prolapse most commonly occurs in multiparous females over 40 years old.<ref name="pmid28144208">{{cite journal |vauthors=Cannon JA |title=Evaluation, Diagnosis, and Medical Management of Rectal Prolapse |journal=Clin Colon Rectal Surg |volume=30 |issue=1 |pages=16–21 |year=2017 |pmid=28144208 |doi=10.1055/s-0036-1593431 |url=}}</ref> | ||
* Progressive mass protrusion from the anus. Protrusion at first with straining and defecation then progresses to the degree that it is no longer be replaced. | * Progressive mass protrusion from the anus. Protrusion at first with straining and defecation then progresses to the degree that it is no longer be replaced. | ||
* It presents with abdominal discomfort and incomplete defecation. | * It presents with abdominal discomfort and incomplete defecation. | ||
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* Pain is not usually present. | * Pain is not usually present. | ||
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* Mass protruding from the anus. | * Mass protruding from the anus.<ref name="pmid28144206">{{cite journal |vauthors=Blaker K, Anandam JL |title=Functional Disorders: Rectoanal Intussusception |journal=Clin Colon Rectal Surg |volume=30 |issue=1 |pages=5–11 |year=2017 |pmid=28144206 |doi=10.1055/s-0036-1593433 |url=}}</ref> | ||
* Concentric mucosal rings are characteristic for rectal prolapse. | * Concentric mucosal rings are characteristic for rectal prolapse. | ||
|[[Image:Prolapse of rectum 01- By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968.jpg|center|300px|thumb|Rectal prolapse - By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968]] | |[[Image:Prolapse of rectum 01- By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968.jpg|center|300px|thumb|Rectal prolapse - By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968]] | ||
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|Perianal [[abscess]] | |Perianal [[abscess]] | ||
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* Perianal abscess presents with severe continuous dull aching pain in the perianal area. | * Perianal abscess presents with severe continuous dull aching pain in the perianal area.<ref name="pmid28223268">{{cite journal |vauthors=Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK |title=Perianal abscess |journal=BMJ |volume=356 |issue= |pages=j475 |year=2017 |pmid=28223268 |doi= |url=}}</ref> | ||
* Pain is exacerbated with bowel movements but is not exclusive with it. | * Pain is exacerbated with bowel movements but is not exclusive with it. | ||
* Constipation due to fear of bowel movements. | * Constipation due to fear of bowel movements. | ||
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|[[anal cancer]] | |[[anal cancer]] | ||
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* Rectal bleeding is the most common presentation. | * Rectal bleeding is the most common presentation.<ref name="pmid28610905">{{cite journal |vauthors=Moureau-Zabotto L, Vendrely V, Abramowitz L, Borg C, Francois E, Goere D, Huguet F, Peiffert D, Siproudhis L, Ducreux M, Bouché O |title=Anal cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Dig Liver Dis |volume= |issue= |pages= |year=2017 |pmid=28610905 |doi=10.1016/j.dld.2017.05.011 |url=}}</ref> | ||
* Mass sensation in the anus. | * Mass sensation in the anus. | ||
* Mucoid discharge may occur. | * Mucoid discharge may occur. | ||
* Patient may give a history of anal condyloma (especially homosexual men). | * Patient may give a history of anal condyloma (especially homosexual men).<ref name="pmid28528690">{{cite journal |vauthors=Prigge ES, von Knebel Doeberitz M, Reuschenbach M |title=Clinical relevance and implications of HPV-induced neoplasia in different anatomical locations |journal=Mutat. Res. |volume=772 |issue= |pages=51–66 |year=2017 |pmid=28528690 |doi=10.1016/j.mrrev.2016.06.005 |url=}}</ref> | ||
* Fecal incontinence. | * Fecal incontinence. | ||
* | * | ||
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* Patient may give a history of anal unprotected sex with an infected partner. | * Patient may give a history of anal unprotected sex with an infected partner. | ||
* Multiple sexual partners is a risk factor and should be investigated. | * Multiple sexual partners is a risk factor and should be investigated.<ref name="pmid28160045">{{cite journal |vauthors=Wieland U, Kreuter A |title=[Genital warts in HIV-infected individuals] |language=German |journal=Hautarzt |volume=68 |issue=3 |pages=192–198 |year=2017 |pmid=28160045 |doi=10.1007/s00105-017-3938-z |url=}}</ref> | ||
* Condyloma accuminata presents with a painless warts that varies in size, shape and color. | * Condyloma accuminata presents with a painless warts that varies in size, shape and color. | ||
* Pruritis and discharge might accompany the warts. | * Pruritis and discharge might accompany the warts. | ||
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* Anal condyloma accuminata may be accompanied by cervical, vaginal or even ororpharyngeal warts, so the patient should be examined thoroughly. | * Anal condyloma accuminata may be accompanied by cervical, vaginal or even ororpharyngeal warts, so the patient should be examined thoroughly.<ref name="pmid27364818">{{cite journal |vauthors=Köhn FM, Schultheiss D, Krämer-Schultheiss K |title=[Dermatological diseases of the external male genitalia : Part 2: Infectious and malignant dermatological] |language=German |journal=Urologe A |volume=55 |issue=7 |pages=981–96 |year=2016 |pmid=27364818 |doi=10.1007/s00120-016-0163-9 |url=}}</ref> | ||
|[[Image:SOA-Condylomata-acuminata-female.jpg|center|300px|thumb|Condylomata acuminata]] | |[[Image:SOA-Condylomata-acuminata-female.jpg|center|300px|thumb|Condylomata acuminata]] | ||
|} | |} | ||
Revision as of 15:46, 19 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defaecation such as rectal cancer, anal fissure, anal abscess, anal fistula.
Differentiating Hemorrhoids from other Diseases
Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defaecation.
| Disease | History | Physical exam findings | Sample image |
|---|---|---|---|
| Anal fissure |
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| Rectal prolapse |
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| Perianal abscess |
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| anal cancer |
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| Condylomata acuminata |
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References
- ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
- ↑ Beaty JS, Shashidharan M (2016). "Anal Fissure". Clin Colon Rectal Surg. 29 (1): 30–7. doi:10.1055/s-0035-1570390. PMC 4755763. PMID 26929749.
- ↑ Cannon JA (2017). "Evaluation, Diagnosis, and Medical Management of Rectal Prolapse". Clin Colon Rectal Surg. 30 (1): 16–21. doi:10.1055/s-0036-1593431. PMID 28144208.
- ↑ Blaker K, Anandam JL (2017). "Functional Disorders: Rectoanal Intussusception". Clin Colon Rectal Surg. 30 (1): 5–11. doi:10.1055/s-0036-1593433. PMID 28144206.
- ↑ Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK (2017). "Perianal abscess". BMJ. 356: j475. PMID 28223268.
- ↑ Moureau-Zabotto L, Vendrely V, Abramowitz L, Borg C, Francois E, Goere D, Huguet F, Peiffert D, Siproudhis L, Ducreux M, Bouché O (2017). "Anal cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up". Dig Liver Dis. doi:10.1016/j.dld.2017.05.011. PMID 28610905.
- ↑ Prigge ES, von Knebel Doeberitz M, Reuschenbach M (2017). "Clinical relevance and implications of HPV-induced neoplasia in different anatomical locations". Mutat. Res. 772: 51–66. doi:10.1016/j.mrrev.2016.06.005. PMID 28528690.
- ↑ Wieland U, Kreuter A (2017). "[Genital warts in HIV-infected individuals]". Hautarzt (in German). 68 (3): 192–198. doi:10.1007/s00105-017-3938-z. PMID 28160045.
- ↑ Köhn FM, Schultheiss D, Krämer-Schultheiss K (2016). "[Dermatological diseases of the external male genitalia : Part 2: Infectious and malignant dermatological]". Urologe A (in German). 55 (7): 981–96. doi:10.1007/s00120-016-0163-9. PMID 27364818.