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Z Year3 Gastro Conditions > Haemorrhoids > Flashcards

Haemorrhoids Flashcards

1
Q

Where are internal haemorrhoids?

A

lie proximal to the dentate line in the anal canal

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2
Q

What are external haemorrhoids?

A

located distal to the dentate line

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3
Q

What is the prevalence of haemorrhoids?

A

US: 4%

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4
Q

What are risk factors for haemorrhoids?

A
  1. Age between 45 and 65 years
  2. History of constipation
  3. Pregnancy
  4. Presence of space occupying pelvic lesion
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5
Q

What are the symptoms of haemorrhoids?

A
  1. Rectal bleeding: bright
  2. Perianal pain / discomfort
  3. Anal pruritis
  4. Tender palpable perianal lesion
  5. Anal mass
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6
Q

What are the differential diagnosis of haemorrhoids?

A
  1. Anal fissure
  2. Crohn’s disease
  3. UC
  4. Colorectal cancer
  5. Anal fistula
  6. Rectal prolapse
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7
Q

What investigations would you do for haemorrhoids?

A
  1. Anoscopic examination
  2. Colonscopy/felxible sigmoidoscopy
  3. FBC
  4. Stool of occult haem
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8
Q

What would the anoscopic examinations how for haemorrhoids?

A

haemorrhoids

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9
Q

What would colonoscopy/flexible sigmoidoscopy show for haemorrhoids?

A

usually normal; may reveal other pathologies

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10
Q

What would FBC show in haemorrhoids?

A

may demonstrate microcytic/hypochromic anaemia

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11
Q

What would occult of haem show in haemorroids?

A

positive

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12
Q

What is the 1st line treatment for acute haemorrhoids?

A

dietary and lifestyle modification

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13
Q

What adjunct would you use for grade 1 haemorrhoids?

A

topic corticosteroids

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14
Q

What adjunct would you use for grade 2, prolapsing internal haemorrhoids?

A

rubber band ligation or sclerotherapy or infrared photocoagulation or haemorrhoid arterial ligation or stapled haemorrhoidpexy

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15
Q

What adjunct would you use for grade 3 prolapsing internal haemorrhoids?

A

rubber band ligation

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16
Q

What adjunct would you use for grade 4 internal, external or mixed internal and external haemorrhoids?

A

surgical haemorrhodectomy

17
Q

What is the 1st line treatment for ongoing haemorrhoids with treatment failure of rubber band ligation, sclerotherapy, infrared photocoagulation, transanal haemorrhoidal de-arterialisation, or stapled haemorrhoidopexy?

A

surgical haemorrhoidectomy

18
Q

What are the possible complications of haemorrhoids?

A
  1. Anaemia from continuous/excessive bleeding
  2. Thrombosis
  3. Incarceration
  4. Faecal intolerance
  5. Pelvic sepsis
  6. Anal stenosis
19
Q

What is the key phrase for haemorrhoids?

A

Painless bleeding associated with defecation: bright red

20
Q

What is 1st line investigation and diagnsotic?

A

anoscopic examination

21
Q

What does a surgical haemorrhoidectomy invovle?

A
  • First line treatment for grade 4 internal haemorrhoids.
  • Under General anesthesia
  • Only takes ~20 mins
  • Surgeon excises or uses a stapler to remove haemorrhoids
22
Q

What does a prolapse mean?

A

protrusion beyond anal opening

23
Q

What is a grade 1 haemorrhoid?

A

no prolapse, just prominent blood vessels, only bleeds

24
Q

What is a grade 2 haemorrhoid?

A

prolapse upon bearing down, but spontaneously reduce

25
Q

What is a grade 3 haemorrhoid?

A

prolapse upon bearing down and required manual reduction

26
Q

What is a grade 4 haemorrhoid?

A

menant prolapse and cannot be manually reduced

27
Q

What is a significant complication of haemorrhoid?

A

thrombosed haemorrhoid

28
Q

How does a thrombosed haemorrhoid present?

A

significant pain and a tender lump

29
Q

What is the examintion finding of thrombosed haemorrhoid?

A

purplish, oedematous, tender subcutaneous perianal mass

30
Q

What is the management of a thrombosed haemorrhoid?

A
  • if patient presents within 72 hours then referral should be considered for excision.
  • Otherwise patients can usually be managed with stool softeners, ice packs and analgesia. Symptoms usually settle within 10 days

Z Year3 Gastro Conditions (48 decks)

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