Haemorrhods Flashcards
Veins in internal and external hemorroïdal plexus
Superior and inferior hemorrhoidal veins
Primary hemorrhoid location of veins
Right anterior (11 o’clock)
Right posterior (7 o‘ clock)
Left lateral (3 o’clock)
Where can you find secondary hemorrhoids
Between primary ones
Etiology of hemorrhoids
Varicose dilatation of internal hemorrhoidal plexus
Predisposing factors to hemorrhoids
Genetic (overt or occult connective tissue disease )
Age (rise after 30 yo)
Pregnancy
Precipitating factors
Cathartic abuse
Diarrhea
Enemata
Constipation
Obesity
Abdominal pressure rise
Types of hemorrhoid
Internal
External
Presenting complaints of hemorrhoids
Asymptomatic
Bleeding (painless, bright red, splashes te span )
Prolapsing anal mass at defecation
Mucus anal discharge which can soil underwear
Pruritus ani
Drug history relevant
Past use of anticoagulants
Stages of hemorrhoids
Stage 1 -> symptoms + no prolapse of anal cushion
Stage 2 -> symptoms + prolapse on défalcation + spontaneous recoil after defecation
Stage 3 -> symptoms + prolapse + no spontaneous recoil + no prolapse after mechanical recoil until next défalcation
Stage 4
Examination findings
Lump at anal orifice
Anemia symptoms
Pallor
Abdominal mass palpation
Anal fissure
Fistula in ano
Rectal masses
Blood on examining finger
Investigations
Proctosigmoidoscopy
FBC
GXM -> severe anemia needing transfusion
Differential
Rectal varices
Non surgical treatment
Diet (high fiber stage 1-3)
3 l of fluids/day
Open bowel at regular time
Local anesthetic cream on prolapsed hemorrhoids
Cold compressed , decompressing agents
Topical nitroglycerin
Warm sitz bath
Medical flavonoids
See surgical techniques
