haemorrhoids Flashcards
which factors contribute to the development of haemorrhoids?
raise intra-abdominal pressure, such as COPD, intraabdominal pathology, or constipation
what is the epithelium of internal haemorrhoids, venous drainage and blood supply?
these are above the dentate line and are columnar epithelium
drained by superior rectal vein
supplied by nerves of inferior hypogastric plexus
what is the epithelium of external haemorrhoids, venous drainage and blood supply?
- stratified squamous
- middle/inferior rectal veins
- inferior rectal nerves
what’s the difference in how external vs internal haemorroids present?
- internal are painless
- external are painful, external more commonly itch and become irritated
what is the main risk to external haemorrhoids?
thrombosis
what are the different grades for an internal haemorrhoid?
- grade 1= no prolapse
grade 2= prolapse on defecation with spontaneous reduction
grade 3= manual reduction
grade 4= cannot be reduced
prolapsed haemorrhoids risk herniation
when should a thromboses external haemorrhoid be suspected?
should be considered if tense, swollen, and acutely painful mass in the rectum (purple-blue colour)
what is the investigation of choice for haemorrhoids?
proctoscopy
how to manage thrombosed external haemorrhoids?
within 72 hours of onset, consider admitting them to the hospital for reduction or excision.
If thrombosed external haemorrhoids present after 72 hours they can usually be managed with stool softeners, ice packs, and analgesia and often settle within 10 days
what is the first line management for haemorrhoids?
Conservative management: ensuring that patients are not constipated (increase dietary fibre and fluid intake as required) and avoiding itching around the anus to promote healing
Analgesia: simple analgesics such as paracetamol can be considered but opioid analgesics should be avoided as they can cause constipation.
Topical haemorrhoidal preparations: can be considered; e.g. Anusol and Proctosedyl (local anaesthetic)
what are some second line managements for haemorrhoids?
ubber band ligation: involves controlled strangulation of the haemorrhoid with a band. This is currently the best available outpatient treatment of haemorrhoids and is superior to injection sclerotherapy
Injection sclerotherapy: causes obliteration of haemorrhoidal vessels and atrophy of the haemorrhoid
what are haemorrhoids?
vascular tissues in the anal canal which can become enlarged
what is the line which separates internal and external haemorrhoids?
dentate line
what are complications of haemorrhoids?
Perianal thrombosis [1]
Ulceration: from thrombosis of external haemorrhoids [1]
Incarceration of prolapsed haemorrhoidal tissue [1]
Anal stenosis [1]
Anaemia from excessive bleeding [1
