Haemorrhoids Flashcards
What is haemorrhoidal tissue?
part of the normal anatomy which contributes to anal continence
mucosal vascular cushions are found in the left lateral, right posterior and right anterior portions of the anal canal
What are haemorrhoids?
When haemorrhoidal tissue becomes enlarged, congested and symptomatic
What are the presenting features of haemorrhoids?
painless rectal bleeding
pruritus
pain: usually not significant unless piles are thrombosed
soiling may occur with third or forth degree piles
What are the types of haemorrhoids?
External
Internal
What are the features of internal haemhorroids?
originate above the dentate line
do not generally cause pain
What are the features of external haemhorroids?
originate below the dentate line
prone to thrombosis, may be painful
What is the dentate line?
line which divides the upper two-thirds and lower third of the anal canal
How are internal haemorrhoids graded?
Grade I- Do not prolapse out of the anal canal
Grade II - Prolapse on defecation but reduce spontaneously
Grade III - Can be manually reduced
Grade IV - Cannot be reduced
How are haemorrhoids managed?
Soften stools
Topical local anaesthetics and steroids
Outpatients treatments
Surgery
How can stools be soften?
Increased dietary fibre and fluid intake
How do acutely thrombosed external haemorrhoids present?
Sig pain
Purplish, oedematous, tender subcutaneous perianal mass
How should acutely thrombosed external haemorrhoids be managed?
presenting within 72 hours then referral for excision
otherwise managed conservatively, with symptoms settling 10 days
What outpatient procedures can be used to treat haemorrhoids?
Rubber band ligation
When is surgery used for haemorrhoids?
Large symptomatic haemorrhoids which do not respond to outpatient treatments
How are haemorrhoids diagnosed?
Visualisation of protruding tissue
Anoscopic visualisation
