HAEMORRHOIDS

Question 1

Define hemorrhoids or piles

Answer 1

Enlarged or displaced anal cushions derived from engorged veins, which primarily presents with anal bleeding

Question 2

Classification of hemorrhoids

Answer 2

First degree
Second degree
Third degree

Question 3

First degree hemorrhoids

Answer 3

Remain in anal canal

Question 4

Second degree hemorrhoids

Answer 4

They prolapse, but reduce spontaneously

Question 5

Third degree burns

Answer 5

Prolapse and have to be replaced manually or remain prolapsed permanently until surgically treated

Question 6

Treatment is required for asymptomatic hemorrhoids. T/F

Answer 6

False

Question 7

Purgatives should be avoided in hemorrhoids. T/F

Answer 7

True

Question 8

Causes of hemorrhoids

Answer 8

Increased intra-abdominal pressure
Excessive straining at stools from constipation or diarrhoea
Familial predisposition
Chronic liver disease with portal hypertension
Anorectal tumours

Question 9

Factors that can increase intraabdominal pressure

Answer 9

Chronic cough
Pregnancy
Intra-abdominal or pelvic tumours

Question 10

Symptoms of hemorrhoids

Answer 10

Passage or bright red blood at defecation
Mucoid discharge
Swelling at anus
Perianal irritation or itch (pruritus ani)
Discomfort after opening bowels
Anal pain (occurs during an acute attack of prolapse with thrombosis, congestion and oedema)
Symptoms of anaemia

Question 11

Anal pain in hemorrhoids occurs during an acute attack and presents with……………., ……………… and ……………

Answer 11

Thrombosis
Congestion
Edema

Question 12

Signs of hemorrhoids

Answer 12

Redundant folds of skin (skin tags) seen in the position of the haemorrhoids
Straining may show the haemorrhoids
Swelling at the anus (in 3rd degree haemorrhoids)
Palpable thrombosed internal haemorrhoids on rectal examination
Signs of complications
Pallor

Question 13

Inspection of the anus and digital rectal examination may be normal in hemorrhoids. T/F

Answer 13

True

Question 14

Signs of complications in hemorrhoids

Answer 14

Profuse bleeding Anaemia
Haemorrhagic shock
Prolapse
Strangulation
Thrombosis
Infection
Ulceration

Question 15

Investigations done in hemorrhoids

Answer 15

FBC
Proctoscopy (the gold standard for diagnosis)
Sigmoidoscopy (to exclude carcinoma of rectum)

Question 16

Treatment objectives in hemorrhoids

Answer 16

To correct anaemia, if present
To relieve symptoms
To prevent complications

Question 17

Surgical treatment of hemorrhoids

Answer 17

Rubber band ligation for second-degree haemorrhoids.
Haemorrhoidectomy for third degree haemorrhoids.

Question 17

Non-pharmacological interventions on hemorrhoids

Answer 17

Increase intake of fluid and roughage
Avoid prolonged straining at defecation
For prolapsed haemorrhoids, lie patient down and elevate the foot
end of the bed. Try gentle digital reduction after application of local
anaesthetic cream. If this fails, apply cold compresses. Sedation of
the patient may be required
For infected haemorrhoids, warm sitz baths 2-3 times a day
Surgical treatment:

Question 18

Is surgery indicated for hemorrhoids developed during pregnancy

Answer 18

Haemorrhoids developing during pregnancy should be managed
conservatively as most will resolve after delivery

Question 19

Traetment of itching in hemorrhoids

Answer 19

Soothing agent (with or without steroids), applied or inserted rectally,
Adults
One suppository 12 hourly for 7-10 days

Question 19

Management of hemorrhoid associated constipation

Answer 19

Liquid paraffin, oral,
Adults
10-30 ml at night

Or

Senna granules, oral,
Adults
1 sachet with water after supper

Question 20

First line treatment for infected hemorrhoids

Answer 20

Gentamicin, IV,
Adults
40-80 mg 8 hourly for 5 to 7 days

And

Metronidazole, oral,
Adults
400 mg 8 hourly for 5 to 7 days

Question 20

Third line treatment for infected hemorrhoids

Answer 20

Amoxicillin, oral,
Adults
500 mg 8 hourly

Question 20

Second line treatment for infected hemorrhoids

Answer 20

Ciprofloxacin, oral,
Adults
500 mg 12 hourly

And

Metronidazole, oral,
Adults
400 mg 8 hourly for 5 - 7 days

Question 20

Management of anemia in hemorrhoids

Answer 20

Iron preparation (ferrous sulphate/fumarate)
Blood transfusion as indicated