HAEMORRHOIDS Flashcards
Define hemorrhoids or piles
Enlarged or displaced anal cushions derived from engorged veins, which primarily presents with anal bleeding
Classification of hemorrhoids
First degree
Second degree
Third degree
First degree hemorrhoids
Remain in anal canal
Second degree hemorrhoids
They prolapse, but reduce spontaneously
Third degree burns
Prolapse and have to be replaced manually or remain prolapsed permanently until surgically treated
Treatment is required for asymptomatic hemorrhoids. T/F
False
Purgatives should be avoided in hemorrhoids. T/F
True
Causes of hemorrhoids
Increased intra-abdominal pressure
Excessive straining at stools from constipation or diarrhoea
Familial predisposition
Chronic liver disease with portal hypertension
Anorectal tumours
Factors that can increase intraabdominal pressure
Chronic cough
Pregnancy
Intra-abdominal or pelvic tumours
Symptoms of hemorrhoids
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
Anal pain in hemorrhoids occurs during an acute attack and presents with……………., ……………… and ……………
Thrombosis
Congestion
Edema
Signs of hemorrhoids
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
Inspection of the anus and digital rectal examination may be normal in hemorrhoids. T/F
True
Signs of complications in hemorrhoids
Profuse bleeding Anaemia
Haemorrhagic shock
Prolapse
Strangulation
Thrombosis
Infection
Ulceration
Investigations done in hemorrhoids
FBC
Proctoscopy (the gold standard for diagnosis)
Sigmoidoscopy (to exclude carcinoma of rectum)
Treatment objectives in hemorrhoids
To correct anaemia, if present
To relieve symptoms
To prevent complications
Surgical treatment of hemorrhoids
Rubber band ligation for second-degree haemorrhoids.
Haemorrhoidectomy for third degree haemorrhoids.
Non-pharmacological interventions on hemorrhoids
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:
Is surgery indicated for hemorrhoids developed during pregnancy
Haemorrhoids developing during pregnancy should be managed
conservatively as most will resolve after delivery
Traetment of itching in hemorrhoids
Soothing agent (with or without steroids), applied or inserted rectally,
Adults
One suppository 12 hourly for 7-10 days
Management of hemorrhoid associated constipation
Liquid paraffin, oral,
Adults
10-30 ml at night
Or
Senna granules, oral,
Adults
1 sachet with water after supper
First line treatment for infected hemorrhoids
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
Third line treatment for infected hemorrhoids
Amoxicillin, oral,
Adults
500 mg 8 hourly
Second line treatment for infected hemorrhoids
Ciprofloxacin, oral,
Adults
500 mg 12 hourly
And
Metronidazole, oral,
Adults
400 mg 8 hourly for 5 - 7 days
Management of anemia in hemorrhoids
Iron preparation (ferrous sulphate/fumarate)
Blood transfusion as indicated
