Haemorrhoids Flashcards
Where are internal haemorrhoids?
lie proximal to the dentate line in the anal canal
What are external haemorrhoids?
located distal to the dentate line
What is the prevalence of haemorrhoids?
US: 4%
What are risk factors for haemorrhoids?
- Age between 45 and 65 years
- History of constipation
- Pregnancy
- Presence of space occupying pelvic lesion
What are the symptoms of haemorrhoids?
- Rectal bleeding: bright
- Perianal pain / discomfort
- Anal pruritis
- Tender palpable perianal lesion
- Anal mass
What are the differential diagnosis of haemorrhoids?
- Anal fissure
- Crohn’s disease
- UC
- Colorectal cancer
- Anal fistula
- Rectal prolapse
What investigations would you do for haemorrhoids?
- Anoscopic examination
- Colonscopy/felxible sigmoidoscopy
- FBC
- Stool of occult haem
What would the anoscopic examinations how for haemorrhoids?
haemorrhoids
What would colonoscopy/flexible sigmoidoscopy show for haemorrhoids?
usually normal; may reveal other pathologies
What would FBC show in haemorrhoids?
may demonstrate microcytic/hypochromic anaemia
What would occult of haem show in haemorroids?
positive
What is the 1st line treatment for acute haemorrhoids?
dietary and lifestyle modification
What adjunct would you use for grade 1 haemorrhoids?
topic corticosteroids
What adjunct would you use for grade 2, prolapsing internal haemorrhoids?
rubber band ligation or sclerotherapy or infrared photocoagulation or haemorrhoid arterial ligation or stapled haemorrhoidpexy
What adjunct would you use for grade 3 prolapsing internal haemorrhoids?
rubber band ligation
What adjunct would you use for grade 4 internal, external or mixed internal and external haemorrhoids?
surgical haemorrhodectomy
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?
surgical haemorrhoidectomy
What are the possible complications of haemorrhoids?
- Anaemia from continuous/excessive bleeding
- Thrombosis
- Incarceration
- Faecal intolerance
- Pelvic sepsis
- Anal stenosis
What is the key phrase for haemorrhoids?
Painless bleeding associated with defecation: bright red
What is 1st line investigation and diagnsotic?
anoscopic examination
What does a surgical haemorrhoidectomy invovle?
- First line treatment for grade 4 internal haemorrhoids.
- Under General anesthesia
- Only takes ~20 mins
- Surgeon excises or uses a stapler to remove haemorrhoids
What does a prolapse mean?
protrusion beyond anal opening
What is a grade 1 haemorrhoid?
no prolapse, just prominent blood vessels, only bleeds
What is a grade 2 haemorrhoid?
prolapse upon bearing down, but spontaneously reduce
What is a grade 3 haemorrhoid?
prolapse upon bearing down and required manual reduction
What is a grade 4 haemorrhoid?
menant prolapse and cannot be manually reduced
What is a significant complication of haemorrhoid?
thrombosed haemorrhoid
How does a thrombosed haemorrhoid present?
significant pain and a tender lump
What is the examintion finding of thrombosed haemorrhoid?
purplish, oedematous, tender subcutaneous perianal mass
What is the management of a thrombosed haemorrhoid?
- 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
