Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bell’s Palsy Benign Disorders of the Rectum and Anus 225

management

■General measures: tape eyelid closed at night & use Lacrilube to

avoid corneal drying

specific therapy

■Indications: symptom onset within 72 hrs

➣Prednisone

➣Treatment w/ both prednisone & acyclovir may improve the

degree of recovery

follow-up

■Not always necessary; depends on severity of symptoms

complications and prognosis

■Most pts show recovery within 1–3 months

➣Some are left w/ mild to severe facial weakness

➣Aberrant reinnervation: jaw-winking, hemifacial spasm,

crocodile tears

■85% of pts recover completely; 95% recover satisfactorily within

weeks to months

Benign Disorders of the Rectum and Anus..................

MARK A. VIERRA, MD

history & physical

History

■Hemorrhoids:

➣More common w/ age, during pregnancy, associated w/ consti-

pation

➣Grade 1: internal hemorrhoids, physiologic & universally present

to some degree

➣Grade 2: spontaneously prolapse w/ defecation but self-reduce

➣Grade 3: spontaneously prolapse w/ defection, must be manually

reduced

➣Grade 4: prolapsed, unable to be reduced

■Fissure: associated w/ constipation; all ages

■Prolapse: occasionally present in children; more common in elderly

(women > men) & institutionalized pts