Gen Surg: haemorrhoids and meckels Flashcards
How may Meckel’s diverticulum present?
Bright red blood in stools. Child with rectal bleeding ++.. Malena. Obstruction.
How is Meckel’s managed?
Resection of diverticulum.
What are the three classes of lower GI bleeding
Occult, Moderate and Massive
What do we mean by occult lower GI bleed?
Presents with anaemia
What do we mean by moderate lower GI bleed?
Rectal bleeding - fresh, dark or Malena BUT pt is haemodynamically stable.
What is a massive lower GI bleed?
Large amounts of fresh blood loss. Shock - systolic BP below 90mmHg. Bleeding for over 3 days, or rebleed in a week. Need a transfusion of 2+ units of blood. Hb is less than 6g/dl, initial drop in haematocrit.
What are two common causes of a lower GI bleed?
Diverticular disease, diverticulitis, UC, Chrons, Infective colitis, Haemmorhoids, Colorectal malignancy, Angiodysplasia, Ischaemic colitis.
How can haemorrhoids be classified?
1st degree - remain in rectum. 2nd degree - prolapse through rectum on defecation and spontaneously reduce. 3rd degree - prolapse on defectation and are manually reduced. 4th degree - persistently prolapsed
How are 1st and 2nd degree haemorrhoids managed?
Rubber band ligation
How can 2nd and 3rd degree haemorrhoids be managed?
Haemorrodial artery ligation (id the main vessel of the haemorrhoid through Doppler and tie it off —> haemorrhoid infarcts and falls off).
In which classifications of haemorrhoids would haemorrhoidectomy be considered?
3rd and 4th degree
Name two differentials for haemorrhoids
IBD, malignancy, diverticular disease, anal fissure (in ano), perianal abscess, external piles
