Clinical decision support that reasons like a coloproctologist: grade the disease, weigh conservative-versus-surgery, protect the sphincter — with the decision rule and exactly what would change it. Built for verified coloproctologists.
Two real coloproctology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
CT-confirmed acute left-sided diverticulitis, no abscess or free air, tolerating oral intake — inpatient or outpatient?
This is uncomplicated acute diverticulitis (roughly Hinchey 0–Ia). A stable, immunocompetent patient who tolerates oral intake can be managed as an outpatient, and antibiotics are now selective rather than automatic in truly uncomplicated disease. Safety-net the patient, arrange interval colonoscopy after recovery to exclude cancer, and escalate for an abscess, perforation or failure to improve.
Decision ruleUncomplicated (Hinchey 0–Ia) + tolerating orals → outpatient, selective antibiotics; abscess/perforation (Hinchey II–IV) or sepsis → admit ± drainage/surgery.
Not established from this alone — immune status, abscess on CT, comorbidity and oral tolerance change the disposition.
Grade III internal hemorrhoids with bleeding and prolapse, failed fiber and topical therapy — next step?
Grade III internal hemorrhoids prolapse and need manual reduction. After failed conservative therapy, an office procedure is next — rubber-band ligation is first-line and effective for grades I–III. Reserve surgical hemorrhoidectomy for grade IV, large mixed or refractory disease. First confirm the bleeding is hemorrhoidal and not a proximal cancer.
Decision ruleGrades I–III failing conservative care → rubber-band ligation; grade IV / mixed / refractory → hemorrhoidectomy; always exclude a proximal source of bleeding.
Not established from this alone — the grade, external component, coagulopathy and any alarm features change the plan.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Grade internal hemorrhoids by prolapse: I bleed without prolapse; II prolapse and reduce spontaneously; III prolapse and need manual reduction; IV are irreducible. Start with fiber, fluids and topical care for all; escalate grades I–III that fail to rubber-band ligation (or sclerotherapy/coagulation); reserve hemorrhoidectomy for grade IV, a large external component or refractory disease. Exclude a proximal cause of bleeding first.guideline synthesis
Decision ruleConservative for all → rubber-band ligation for I–III that fail → hemorrhoidectomy for IV/mixed/refractory; rule out a proximal source.
Missing data: the grade, external disease, symptoms and coagulation status change the ladder.
The Hinchey classification stages complicated diverticulitis: I a pericolic phlegmon/abscess, II a distant abscess, III purulent peritonitis, IV feculent peritonitis. Uncomplicated disease (Hinchey 0–Ia) is managed medically — increasingly with selective rather than routine antibiotics — and often as an outpatient. An abscess is drained percutaneously with antibiotics; generalized peritonitis (III–IV) needs surgery. Colonoscopy after recovery excludes cancer.Hinchey classification
Decision ruleUncomplicated → medical/outpatient, selective antibiotics; abscess → antibiotics ± percutaneous drainage; Hinchey III–IV → surgery; interval colonoscopy.
Missing data: the CT findings, immune status and clinical trajectory drive the level of care.
An anorectal abscess is drained promptly — incision and drainage, not antibiotics alone (add antibiotics for cellulitis, immunosuppression or valvular disease). A resulting fistula is mapped with the Goodsall rule; a low, simple fistula can have a fistulotomy, while a high or complex fistula that crosses much sphincter is managed with a draining seton, a LIFT or an advancement flap to protect continence.guideline synthesis
Decision ruleAbscess → prompt incision and drainage; simple low fistula → fistulotomy; high/complex fistula → seton / LIFT / advancement flap to spare the sphincter.
Missing data: the fistula track, sphincter involvement, Crohn disease and continence change the operation.
Screen average-risk adults from age 45 — colonoscopy every ten years, or a stool-based test — earlier and more often with a family history or a genetic syndrome. Any alarm feature — rectal bleeding, a change in bowel habit, iron-deficiency anemia or weight loss — warrants prompt colonoscopy regardless of age. Confirmed cancer is staged by TNM and planned in a multidisciplinary team.USPSTF · ACS
Decision ruleAverage risk → screen from 45; alarm features (bleeding, habit change, iron-deficiency anemia, weight loss) → prompt colonoscopy; stage by TNM in an MDT.
Missing data: family history, the alarm features and the colonoscopy/pathology drive screening and staging.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist coloproctology colleague across hemorrhoids, abscess and fistula, diverticular disease, colorectal cancer and IBD — cited, non-directive, always with the decision rule.
Deep specialist agents for colorectal oncology, IBD surgery, pelvic floor and anorectal disease — each its own soul and knowledge base — plus your own uploaded materials.
In the pelvis the margin is thin. Only one of these reasons like a coloproctology colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the coloproctology build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment coloproctology opens — with your Founding Coloproctologist offer.
One email at launch. No spam, ever.
It reasons in the tools you use — the Hinchey classification, hemorrhoid grading and the Goodsall rule — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and before the operating room. Access is gated to verified physicians.
Colorectal oncology, IBD surgery, pelvic floor and anorectal disease each have their own deep specialist agent on the Pro plan, on top of the full coloproctology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited coloproctology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
HeyHippocrates