Haemorrhoids Flashcards

1
Q

Discuss haemorrhoids

A

Commonly affect people age >40 to 65 y/o, 50% of people over 50 experience at some point

Rare in children/adults <20 y/o

Caused by downward pressure on haemorrhoidal cushion

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2
Q

What are the risk factors for haemorrhoids?

A

Excessive or recurrent straining (constipation)

Inc anal canal pressure

Intra-abdominal pressure = preg, space occupying lesion in pelvis

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3
Q

List the symptoms of haemorrhoids

A

Straining/pain on going to toilet

Blood on toilet paper or in toilet (bright red)

Internal haemorrhoids are graded 1-4 in size of prolapse

External haemorrhoid = felt outside anal canal, itch (pruritis), feeling of incomplete bowel movement, severe perianal pain (straining –> thrombosed external haemorrhoid)

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4
Q

Question to ask when someone presents with a potential haemorrhoid

A

What are symptoms? when did they first appear?

What else has been happening that is different from normal? (potential contributing factors [constipation], sign of something more serious)

If constipation present = what is normal bowel habit, what makes it worse/better? what have they tried?

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5
Q

Mention key considerations for haemorrhoids

A

History of straining with constipation

Slight rectal bleed associated with straining/defecation = bowl or on surface of stool

Perianal discomfort/pain with internal or external haemorrhoid = dull ache (inc when strain), sharp pain can be anal fissure

Anal itching (pruritis)

Symptom duration = refer >3 wks consistent symptoms

Symptoms should be localised

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6
Q

When should you refer someone with suspected haemorrhoids?

A

Persistent change in bowel habit, bleeding, unexplained bleeding in patient older than 40 y/o (less if cancer Hx)

Anything more mild than haemorrhoid, having to manually reduce haemorrhoid

Sever pain, blood mixed in stool, fever

symptoms >3 wks, symptoms not localised, medication making condition worse

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7
Q

Explain some differential diagnoses for haemorrhoids

A

Dermatitis (contact usually) = pruritis or itching, main feature

Anal fissure = tear in anal mucosa, painful bleeding on defecation (like passing glass), pain cont. described as burning, skin tag

IBD = rectal bleeding associated with diarrhoea, fam history

Colorectal cancer = altered bowel habit (diarrhoea and/or constipation), unexplained weight loss, abdominal pain, fam history

Rectal prolapse = protruding rectal mass, pain, discharge (mucous/blood), faecal incontinence

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8
Q

What do we aim to do with treatment of haemorrhoids?

A

Relieve symptoms, improve QoL, reduce risk/prevent complications

Prevent symptom recurrence through lifestyle mod = inc fibre, adequate fluids

Manage with evidence based treatment = pharmacy med, pharmacist only med, medical procedure (higher grades)

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9
Q

List the medication classes used in haemorrhoid treatment

A

Anaesthetics

Astringents

Corticosteroids

Protectorants

Antiseptics

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10
Q

Name the anaesthetics used in haemorrhoid treatment, mention key information

A

Lidocaine, lignocaine, cinchocaine

Shor-lived relief from discomfort, req freq application, may cause sensitisation

no direct evidence

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11
Q

Name the astringents used in haemorrhoid treatment, mention key information

A

Zinc, aluminium

Effect may be placebo, theoretically form protective coat

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12
Q

Name the corticosteroids used in haemorrhoid treatment, mention key information

A

hydrocortisone

Pharmacist only, anti-inflammatory effect, reduce swelling

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13
Q

Name the protectorants used in haemorrhoid treatment, mention key information

A

Shark oil

claimed to improve coating, NO EVIDENCE

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14
Q

Name the antiseptics used in haemorrhoid treatment, mention key information

A

Chlorhexidine = inhibit bacterial growth, kills bacteria

Concentration dependent and no evidence to support use

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15
Q

Mention some haemorrhoid prevention and self-care techniques

A

Diet rich in fibre (25g-30g) = food or supplements

adequate hydration, manage constipation if present

avoid straining, sitting on toilet for long

go to toilet when urge is felt

Moist gentle cleaning after bowel movement = wipes available

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