Haemorrhoid

Clinical Features:

• 1)Itching or irritation in your anal region.
• 2)Pain or discomfort.
• 3)Swelling around your anus.
• 4)Bleeding.

O/E:

• Digital Rectal examination (DRE)
  

Investigation:

• 1)CBC
• 2)RBS
• DRE

Rx:

• Diet: fiber rich 

1.  Tab. Normanal/Hemorif(Diosmin+hesperidin)

• 3+0+3………….4 days
• 2+0+2………….3 days
• 1+0+1……....….2 days

2. Tab.pantonix(pantoprazol)(20mg)

• 1+0+1…...10 days

3. Tab.Anadol(50mg)(Tamadol)

• 1+0+1 (ভরাপেটে ব্যাথা হলে)

4. Syp. Avolac(lactolose)

• 3-6 TSF daily 3 times ....15 days (পায়খানা পাতলা বন্ধ হলে)

5.Hip Bath:...২ চামচ Povisep ১ গামলা কুসুম গরম পানিতে মিশিয়ে বসবেন দিনে ৩ বার......-১৫ দিন

Note: 3rd degree haemorrhoid  হলে advice for surgery.

 Advice:

• Eat high-fiber foods. Eat more fruits, vegetables and whole grains. 
  
• Drink plenty of fluids. 
  
• Consider fiber supplements.
  
• Don't strain. 
  
• Go as soon as you feel the urge.
  
• Exercise. 
  
• Avoid long periods of sitting. 
  

Pre-Operative Order:

1.Diet: NPO ,TFO

2. Inf. Hartman solution ([post id="506" title="Hartmann"])(1000ml)

• ……10-20 drop/min

3.Inj.Ceftron([post id="398" title="Ceftriaxone"]) (1gm)

• … 1 vial I/V ….stat

4. Inj.Sergel ([post id="392" title="Esomeprazole"])(40mg)

• …1 vial I/V stat

5.Inj.Rolac([post id="450" title="Ketorolac"]) (30mg)

• ….1 ample I/M OR I/V stat & SOS

6.Clean the operative area .

7.send the patient OT table 30 min before operation .

8. Counsel the patient party & written consent must be taken.

Post Operative Order:
1.Diet: NPO, TFO(Till further order)
2.Inf.Hartman ([post id="506" title="Hartmann"])(1L) +
Inf.5%DNS([post id="510" title="DNS"])(1L) +
Inf.5%DA ([post id="511" title="Dextrose "])(1L)

• ….I/V 30 drop/min.

3. Inj.Ceftron([post id="398" title="Ceftriaxone"])  (1gm)

• … 1 vial I/V ….BD 

4. Inj.Sergel ([post id="392" title="Esomeprazole"])((40mg)

• …1 vial I/V ….BD

5.Inj.Filmet([post id="406" title="Metronidazole"])(500mg/100ml)

• …1 bottle I/V….stat.& TDS

6.Inj.Rolac([post id="450" title="Ketorolac"]) (30mg)

• ….1 ample I/M OR I/V stat & TDS 

OR 
Inj.Anadol([post id="453" title="Tramadol"]) (100mg/2ml)

• ….1 ample I/M OR I/V stat & TDS

7.Nalbun-2( Nabuphine  )

• …1 ample I/M stat 

OR 
Inj.G-Pethidine([post id="456" title="Pethidine"](100mg/2ml)

• …..1 ample I/M stat

With 
Inj.Vergon( Vergon) (12.5mg/ml)

• …1 ample …I/M stat 

9.Monitor all Vitals…any abnormality then call doctor

Fresh Order of VH:

1. Diet: Sips of water → Liquid to soft Then Normal.

2.  Inj. Ceftron 2gm/Ceftriaxone

• 1 vial I/V ....Daily
  

3.  Tab. Filemet 400mg/Metronidazole 

• 1+1+1

4.Tab. Torax 10mg/Ketorolac

• 1+1+1..... (A/M)

5. Cap. Nexcap 20mg/esomprazole

• 1+0+1 (B/M)
  

6.Tab. Ceevit 250 mg/vit-C

• 1+0+1

7. Continious Catheterization 3 days.

8. Keep Drain Tube untill collection is nill.

9.  Syp. Avolac/Lactulose

• 4 চামচ..... ৩ বার 

10. Hip Bath