Haemmorhoids (piles) Flashcards
What are anal cushions?
Discontinuous masses of spongy vascular tissue at the 3, 7 and 11 o clock positions and contribute to anal tone
What attaches the anal cushions to the wall of the anus?
Smooth muscle and elastin fibres
What factors might contribute to displacement/disruption of the anal cushions?
Gravity when standing, straining while defacting, increased anal tone
When haemmorhoids form, they are prone to damage from what?
Bulky/hard stool and can be a cause of blood per rectum (fresh red blood)
Why do piles which originate above the dentate line not hurt?
As there are no sensory pain fibres above the dentate line
What differentials should you consider?
Perianal haematoma, anal fissure, abscess, tumour
What examination is key before you assign the cause of bleeding to piles?
Rectal examination
What are the key reasons for piles?
Constipation and prolonged straining
Pathogenesis?
Protrusion makes cushions even more susceptible to damage and protrude even more until they strangulate
What is a first degree haemmorhoid?
Where it remains in the rectum
What is a second degree haemorrhoid?
Upon defecation haemmorhoid prolapsed through anus but spontaneously reduces back to its original position
What is a third degree haemorrhoid?
Haemorrhoid prolapsed out of a is upon defecation but requires digitation to push it back inside of the anus
What is a 4th degree haemorrhoid?
Haemorrhoid remains permanently prolapsed
What is the management for 1st degree haemorrhoids?
Increased fluid and fibre intake is key! Also topical analgesics and stool softeners may be useful
What treatment options are available if 1st degree treatment fails or there is a 2nd/3rd degree haemorrhoid?
Band ligation or
Sclerosants or
Infrared coagulation
