Haemorrhoids Flashcards
What is a haemorrhoid?
A haemorrhoid is an enlargement of the vascularity of the anal cushions in the anal canal.
The anal cushions increase in size and can project distally, both within the anal canal and externally
What is the aetiology behind haemorrhoids?
Associated with constipation (it is thought haemorrhoids can develop as a result of straining)
Often develop for the first time during pregnancy.
Caused by congestion of the internal and/or external venous plexuses in the anal region.
What is the name of the classification system for haemorrhoids?
Goligher’s classification
What is defined as first degree haemorroids?
anal cushions bleed but remain in the rectum (no prolapse)
What is defined as second degree haemorrhoids?
prolapse of haemorrhoids on defaecation or straining (spontaneously reduces)
What is defined as third degree haemorrhoids?
prolapse of haemorrhoids on defaecation or straining (requires manual reduction)
What is defined as fourth degree haemorrhoids?
prolapse remains at all times and is irreducible
What are the 5 risk factors for haeorrhoids?
- Constipation
- Increased age
- Increased abdominal pressure, such as pregnancy and labour
- Diarrhoea
- High BMI
What are 5 typical symptoms of haemorrhoids?
- Pruritis ani
- Rectal bleeding
- palpable lump in or around anus
- Pain
- Discomfort around the anus, fullness or feeling of incomplete defaecation (tenesmus)
What are anal cushions?
specialised mucosal tissue that contain connections between arteries and veins
What is the function of anal cushions?
They help control continence with the internal and external sphincters
What artery supplies the anal cushions?
Rectal arteries
How is the location of haemorrhoids described?
using a clock face (12 o’clock is towards the genitals and 6 o’clock is toward the back)
In which 3 clock face positions are haemorrhoids most commonly found?
1) 3 o’clock
2) 7 o’clock
3) 11 o’clock
Describe 2 examination findings associated with haemorrhoids:
1) external (prolapsed) haemorrhoids are visible on inspection
2) internal haemorrhoids may be felt on a perirectal exam
What investigation can be used for proper inspection of haemorrhoids?
protoscopy
Give 4 differential diagnoses for a haemorrhoid-like presentation:
1) anal fissures
2) diverticulosis
3) inflammatory bowel disease
4) colorectal cancer
What investigation is used to rule out colorectal cancer?
Faecal immunochemical test
Name 3 topical symptom relievers for haemorrhoids:
1) anusol
2) Germoloid’s cream
3) Proctosedyl ointment
How does Germoloid’s cream relieve haemorrhoid symptoms?
it contains lidocaine, a local anaesthetic
How does proctosedyl ointment relieve haemorrhoid symptoms?
it contains hydrocortisol and cinchocaine anaesthetic
Name 4 non-surgical treatments for haemorrhoids:
1) rubber band ligation
2) injection sclerotherapy
3) infra-red coagulation
4) bipolar diathermy
What is rubber band ligation?
A tight rubber band is fitted around the base of the haemorrhoid to cut off the blood supply
Describe injection sclerotherapy:
an injection of phenol oil is made into a haemorrhoid to cause sclerosis and atrophy
Describe infra-red coagulation:
infra-red light is applied to the haemorrhoid to damage to blood supply and cause its destruction
Describe bipolar diathermy:
electrical current is applied to destroy a haemorrhoid
Name 3 surgical treatments for haemorrhoids:
1) haemorrhoidal artery ligation
2) haemorrhoidectomy
3) stapled haemorrhoidectomy
Describe haemorrhoidal artery ligation:
using a proctoscope to identify the blood vessel that supplies the haemorrhoids and suturing to cut off the blood supply
Describe a staple haemorrhoidectomy:
excising the haemorrhoid using a special device that simultaneously adds a circle of staples into the anal canal
Give 4 lifestyle changes that can prevent/ treat haemorrhoids:
1) increasing dietary fibre
2) maintaining a good fluid intake
3) using laxatives when required
4) avoiding straining when using the toilet
What causes thrombosed haemorrhoids?
thrombosed haemorrhoids?
strangulation at the base of the haemorrhoid causing coagulation
How do thrombosed haemorrhoids present?
painful, purplish swollen lumps found around the anus
