Haemorrhoids Flashcards
What are Haemorrhoids?
abnormally swollen vascular mucosal cushions in the anal canal.
How can haemorrhoids be classified based on location?
Internal: ABOVE dentate line
External: BELOW dentate line
What are the 4 degrees of internal haemorrhoids?
1st: DONT prolapse
2nd: prolapse with defecation but reduce spontaneously
3rd: prolapse + require manual reduction
4th: prolapse, CANT be reduced
List 6 risk factors for haemorrhoids
AGE (weakening of support structures)
Constipation
Prolonged straining
Heavy lifting
Raised intra-abdominal pressure (Pregnancy, ascites)
Low fibre diet
Describe the epidemiology of haemorrhoids
COMMON
Peak age: 45-65y
List 3 symptoms of haemorrhoids
BRIGHT RED PAINLESS bleeding
Anal itching/ irritation
Feeling of incomplete evacuation
Describe signs of haemorrhoids
1st or 2nd degree: NOT usually visible on external inspection
Internal: NOT palpable on DRE unless thrombosed
List 7 differential diagnoses for haemorrhoids
Anal tags Anal fissures Rectal prolapse Polyps Tumours Perianal haematoma Abscess
What primary investigations may be performed for haemorrhoids?
Abdominal examination to r/o other diseases
DRE: prolapsing= obvious
FBC: microcytic anaemia (only if severe prolonged bleeding)
What must be remembered when considering the prevalence of haemorrhoids?
Haemorrhoids are common so their presence does NOT mean you shouldn’t consider another source of bleeding
What further investigations may be performed for haemorrhoids?
Proctoscopy: to see internal haemorrhoids
Rigid or flexible sigmoidoscopy: to exclude a rectal or sigmoid source of bleeding
Give 4 conservative management strategies for haemorrhoids
High-fibre diet
Increase fluid intake
Paracetamol
Cooling packs
Describe medical management of haemorrhoids
If constipated: bulk laxatives e.g. ispaghula
Topical steroids relieve pruritis
Describe outpatient management of haemorrhoids
Rubber band ligation: bands applied proximal to haemorrhoids which then fall off after a few days
Injection Sclerotherapy: Induces fibrosis of the dilated vein
Describe surgical management of haemorrhoids
Haemorrhoidectomy
Haemorrhoidal artery ligation
Haemorrhoidopexy
List 3 complications of haemorrhoids
Thrombosis
Soiling
Incarceration
What is the prognosis for haemorrhoids?
Often CHRONIC
High rate of recurrence
Surgery can provide long-term relief
What is the dentate line? What does this represent?
A line that divides the upper 2/3 + lower 1/3 of the anal canal
2cm from anal verge
Represents the hindgut-proctodeum junction
List 4 complications of haemorrhoidectomy
Pain
Bleeding
Incontinence
Anal stricture
What are the important negatives to note in haemorrhoids?
Usually ASYMPTOMATIC
Blood NOT be mixed with the stool
ABSENCE of FLAWS: WL, anaemia, CIBH, passage of clotted or dark blood, mucus mixed with stool
List 5 complications of injection sclerotherapy
Prostatitis Perineal sepsis Impotence Retroperitoneal sepsis Hepatic abscess
Describe presentation of acutely thrombosed external haemorrhoid
Significant pain
Purplish, oedematous, tender perianal mass
Describe management of acutely thromboses external haemorrhoids
if presents within 72h: consider for excision.
Otherwise patients can usually be managed with stool softeners, ice packs + analgesia.
Sx usually settle within 10 days
