A 48 yrs old male pt suffering some ulcerative type prolapse hemorrhoids since 20 yrs.... pt complains when he try to slight tight pressing during stool piles mass comes out side automatically... then after toielet he press in anal region through d help of fingers. symptom ...in past history massive bleeding and pain but still ocassionaly bleeding and pain during only hard stool... some time blood stain arrives on inner wears or outer wears when piles mass comes out automatically.......sometime hard motion sometime loose motion. habits...past history..smoking,ocassinaly alcohal intake,hot desire of food..,but still stopped all habits excepts smoking. reports..all normal but HB level 6.5gm....ESR..88........respected drs..plz dx..and share ur valuable opinion in dis case.

Spot diagnosis and management of the case. Patient is having this anal problem since last 6 months.

27yr/f second gravida,EDD 6/8/16 C/O : fever c chills,burning micturation,productive cough,coryza,nausea since 2days.BG: B+ve Father's BG :N/A 1st was FTND TPC was 11k 14 units of BT at the time of her 1st delivery Following examination are attached.. Valueble opinions plz...

A female aged 28 yrs presented with complaints of Polymenorrhoea with pain abdomen since 8 months, low grade fever since 2 months and generalised body swelling since 1.5 months....She is married and has no children...On examination, severe pallor alongwith anasacrca was presentAll reports are enclosed..Comment on the differentials and treatment approach to this patient

34 yrs M h/o bleeding piles weakness swelling on face hands & legs reports attached Plz Dx n Rx