General surgery - Haemorrhoids Flashcards
Haemorrhoids - what are they
Enlarged anal vascular cushions
Associations in haemorrhoids
Chronic constipation and straining
Pregnancy
Obesity
Increased age
Increased abdominal pressure e.g. weightlifting, chronic cough
How do you describe anal pathology?
Where are haemorrhoids often found?
The location of pathology at the anus is described as a clock face
12 o’clock is towards the genitals and 6 o’clock is towards the back.
The anal cushions are usually located at 3, 7 and 11 o’clock.
Classification of haemorrhoids
1st degree - no prolapse
2nd degree - prolapse when straining, retract when relaxing
3rd degree - prolapse when straining, do not return on relaxing, but can be pushed back
4th degree - permanent prolapse
Presentation of haemorrhoids
Painless bright red rectal bleeding
Typically on wiping
Blood is not mixed with stool
Itching of anus
Feeling lump around or inside the anus
Management of haemorrhoids conservative and non-surgical
Conservative -
- Topical treatments e.g. anusol (contains astringents to shrink the haemorrhoids, germoloids cream (contains lidocaine)
- Prevention of constipation - good fluids/ fibre intake, laxatives PRN
- Avoiding straining
Non-surgical:
- Rubber band ligation
- Injection sclerotherapy - injection of phenol oil into the haemorrhoid to cause sclerosis and atrophy)
- Infra-red coagulation (infra-red light is applied to damage the blood supply)
- Bipolar diathermy (electrical current applied directly to the haemorrhoid to destroy it)
Surgical management of haemorrhoids
Haemorrhoidal artery ligation
Haemorrhoidectomy (or stapled haemorrhoidectomy)
A complication of haemorrhoids can be
Thrombosed haemorrhoids
These are caused by strangulation of the haemorrhoid causing thrombus formation
Present with severe pain - PR often not possible as a result
Resolve with time but can take several weeks
