EXTERNAL HEMORRHOID

Question 1

Pertinent Anatomy of a patient with External Hemorrhoids

Answer 1

(a) Arise from the inferior hemorrhoidal veins
(b) Below the dentate line
(c) Covered with squamous epithelium
(d) Possess nervous innervation
1) Painful when thrombosed

Question 2

Pertinent Physiology

Answer 2

arise from the inferior hemorrhoidal veins located below the
dentate line and are covered with squamous epithelium of the anal canal or perianal
region.
(a) Because they possess nervous innervation they are painful when thrombosed.

Question 3

Hemorrhoids may become symptomatic as a result of

Answer 3

activities that increase venous
pressure, resulting in distention and engorgement
Straining at stool, constipation, prolonged sitting, pregnancy, obesity, and low-fiber diets
all may contribute.

Question 4

Thrombosis of the external hemorrhoidal plexus results

Answer 4

in a perianal hematoma.

Question 5

It most commonly occurs in otherwise healthy young adults and may be precipitated
by (perianal hematoma)

Answer 5

coughing, heavy lifting, or straining at stool.

Question 6

The condition is characterized by the relatively acute onset of an (perianal hematoma)

Answer 6

exquisitely painful,
tense and bluish perianal nodule covered with skin that may be up to several
centimeters in size.

Question 7

Pain is most severe within the _____but gradually eases over____ as
edema subsides. (perianal hematoma)

Answer 7

Pain is most severe within the first few hours but gradually eases over 2-3 days as
edema subsides.

Question 8

Physical Findings

Answer 8

Bleeding is manifested by bright red blood that may range from streaks of blood visible
on toilet paper or stool to bright red blood that drips into the toilet bowl after a bowel
movement.

Question 9

Physical Examination of External hemorrhoids:

Answer 9

(a) Are readily visible on perianal inspection.
(b) They appear as a tense bluish perianal nodule covered with skin that may be up to
several centimeters in size.
(c) They are extremely tender to palpation on exam.

Question 10

Differential Diagnosis

Answer 10

(a) anal fissure or fistula,
(b) neoplasms of the distal colon or rectum,
(c) ulcerative colitis or Crohn colitis,
(d) infectious proctitis, or
(e) rectal ulcers

Question 11

Lab

Answer 11

None

Question 12

RAD

Answer 12

Colonoscopy should be performed in all patients with hematochezia to exclude disease in
the rectum or sigmoid colon that could be misinterpreted in the presence of hemorrhoidal
bleeding.

Question 13

Treatment of Thrombosed external hemorrhoids

Answer 13

(a) Warm sitz baths
(b) Analgesics and ointments
(c) If seen in the first 24-48 hrs, removal of the clot may hasten symptomatic relief.

Question 14

Initial Care

Answer 14

In acute onset stay with treatment protocol.