Haemorrhoids

Question 1

What are haemorrhoids?

Answer 1

Haemorrhoids are normal anatomical structures located within anal canal

Vascular-rich connective tissue cushions.

Question 2

Internal vs external haemorrhoids?

Answer 2

Internal haemorrhoids lie proximal to dentate (pectinate) line in anal canal; external haemorrhoids are located distal to dentate line.

Question 3

How do haemorrhoids become pathological?

Answer 3

If they enlarge, can protrude outside anal canal, causing symptoms.
Haemorrhoidal dis presents as painless rectal bleeding/ sudden onset perianal pain with a tender palpable perianal mass.

Question 4

How is a diagnosis of haemorrhoidal disease usually confirmed?

Answer 4

Confirmed with visualisation of protruding tissue/ anoscopic visualisation.

Question 5

Pathophysiology of haemorrhoidal disease?

Answer 5

Haemorrhoidal dis= only when cause symptoms.

Strain at stool→ haemorrhoids pulled lower into anal canal and swell→ thin epithelial lining easily torn→ bleeding (bright blood on cleansing/ in bowl)

Haemorrhoids can enlarge to point that protrude from anal canal→ can cause sensation of incomplete evacuation

Question 6

Classification of internal haemorrhoids?

Answer 6

Grade 1 - protrusion limited to within anal canal
Grade 2 - protrudes beyond anal canal but spontaneously reduces on cessation of straining
Grade 3 - protrudes outside anal canal and reduces fully on manual pressure
Grade 4 - protrudes outside anal canal and is irreducible

Question 7

Aetiology of haemorrhoids?

Answer 7

Excessive straining (chronic constipation/ diarrhoea)

Increased intra-abdo pressure: pregnancy/ ascites

Question 8

Risk factors for haemorrhoids?

Answer 8

• Age 45-65yo
• Constipation
• Pregnancy/ space-occupying pelvic lesion
• Low fibre diet
  Weak:
• Hepatic insufficiency
• Ascites
• Chronic cough

Question 9

Signs and symptoms of haemorrhoids?

Answer 9

• Rectal bleeding
• Intermittent protusion
• Perianal pain/ discomfort
• Anal pruritus
• Tender palpable perianal lesion
• Anal mass

Question 10

Main investigations for haemorrhoids?

Answer 10

Anoscopy/ proctoscopy: most specific and conclusive diagnostic test (visible)

Colonoscopy: used to exclude serious pathology such as IBD or cancer; usually normal, may reveal other pathologies

FBC: ordered only if concerned that patient has experienced significant prolonged rectal bleeding and signs of anaemia present

Question 11

When is a faecal occult test done under investigations for suspected haemorrhoids?

Answer 11

When no significant haemorrhoidal tissue seen on examination

Positive result

Question 12

Lifestyle modification as management of haemorrhoids?

Answer 12

Dietary fibre and hydration

Question 13

Medications used for management of haemorrhoids?

Answer 13

Lidocaine, steroid cream and laxatives

Question 14

Surgical management of haemorrhoids? (4 types)

Answer 14

Rubber band ligation

Injection sclerotherapy (damage blood vessels feeding hemorrhoid so shrinks)

Infrared coagulation (uses heat to coagulate veins to cut off blood supply to haemorrhoid)

Haemorrhoidectomy

Question 15

Potential complications of haemorrhoids?

Answer 15

• Bleeding
• IDA (iron deficieny anaemia)
• Prolapse
• Strangulation
• Ulceration