jean robert
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Itching with burning pain in the perianal region in 22 y.o. female has been present for several months.PE reveals dilated and thrombosed external hemorrhoids. What underlying process most likely led to her present condition?
a.-Rectal adenocarcinoma
b.-Pregnancy
c.-Polyarteritis nodosa
d.-Filariasis
e.-Micronodular cirrhosis
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| acintya
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Pregnancy
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| new_n_lost
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e.-Micronodular cirrhosis ??
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| paheli
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can't be A or E, clinical picture doesn't fit.
has to be B or D.
i'll vote for D, due to the itching and burning pain.
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| Aashi
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Increased progestrone during pregnancy------>relaxes the wall of the veins + delays intestinal transit time------> constipation-----> straining during a bowel movement------> Hemorrhoids-------->B
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| doc_clotaire
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B) pregnancy 
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| jean robert
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Good job, guys
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| jean robert
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B is the correct ans.
Hemorrhoidal veins can become dilated from venous congestion. This is the most commen with chronic constipation but pregnant uterus presses on pelvic veins to produce similar congestion that promotes hemorrhoidal vein dilation.
Portal hypertension with cirrhosis is most likely to dilate submucosal esofageal veins, but hemorrhoidal veins occasionally may be affected.However ,cirrhosis will be rare at her age.
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