Haemorrhoids

Question 1

Risk factors

Answer 1

Excessive straining
Increasing age
Raised IA pressure

Question 2

clinical features

Answer 2

Painless bright red rectal bleeding
Pruritis
Rectal fullness
Soiling 
Large prolapsed haemorrhoids can thrombose which are very painful

Question 3

Differentials

Answer 3

Malignancy
IBD
Diverticular
Fissure-in -ano
Perineal abscess
Fistula in ano

Question 4

Investigations to confirm diagnosis

Answer 4

Protoscopy

Question 5

What would you do if there is prolonged bleeding or signs of anaemia

Answer 5

FBC and clotting screen

Question 6

What is advised before surgical intervention of haemorrhoids

Answer 6

Colonoscopy to exclude anorectal pathology

Question 7

management

Answer 7

Mainly conservative- Increase fibre, fluid intake, prescribe laxatives. Topical analgesia. No oral opioid as can make constipation worse

Question 8

Treatment of 1st and 2nd degree haemorrhoids

Answer 8

Rubber band ligation (drawing it to end of suction gun and rubber band being placed over its neck)

Question 9

Main surgical intervention for 2nd and 3rd degree haemorrhoids

Answer 9

Haemorrhoidal artery ligation (main vessel supplying it is identified through Doppler and then tied off so it infarcts and falls off)

Question 10

Main surgical intervention for 3rd and 4th degree

Complications?

Answer 10

Haemorrhoidectomy (excising it)

Recurrence, anal structuring, incontinence