Haemorrhoids Flashcards
What are haemorrhoids?
Swellings that develop from the lining of the anus and lower rectum, becoming widened and engorged with blood.
What is a major factor in the development of haemorrhoids?
Pressure in and around the anus.
Where are internal haemorrhoids located?
2-4 cm above the anal opening.
How are internal haemorrhoids graded, state what each grade means
By size and severity, on a scale of 1-4.
Grade1- small swellings on the inside lining of the rectum
Grade 2- larger, partly prolapsed but can spontaneously reduce on their own
Grade 3- internal haemorrhoids that prolapse outside the anus but must be manually pushed back in
Grade 4- internal haemorrhoid that are permanently prolapsed outside of the anus and cannot be manually pushed back in, requires surgery.
What does it mean when an internal haemorrhoid is prolapsed?
It hangs out and may need to be pushed back or will spring back in on its own.
Where do external haemorrhoids develop?
As a small lump on the outside edge of the anus.
What percentage of people in the UK are affected by haemorrhoids?
About 13-36% of people in the UK.
Are haemorrhoids common in children and young people?
No, they are rare in children and people up to age 20.
How does the prevalence of haemorrhoids change with age?
The prevalence of haemorrhoids increases with age.
What age group has the highest prevalence of haemorrhoids?
The highest prevalence is between 45-65 years of age.
What is an anatomical cause for haemorrhoids
Degradation of elastic tissue
What is a physiological cause for haemorrhoids
Pregnancy and labour- pressure of the baby lying above the rectum causing blood vessels in the rectal area to swell.
What is a mechanical cause for haemorrhoids
Constipation- straining on the toilet
What is a symptom of haemorrhoids related to defecation?
Bleeding after defecation: Bright red, painless, with spots on tissue, toilet bowl, or stool.
What does soiling refer to in the context of haemorrhoids?
Faecal or mucus soiling- Hemorrhoids can keep the muscles around your anus from closing completely, which lets small amounts of stool or mucus to leak out.
What type of discharge is associated with haemorrhoids?
Mucus discharge.
What is pruritus ani?
Itching around the anus.
Is pain a common symptom of haemorrhoids?
Pain is not common, unless there’s prolapse and strangulation (internal) or thrombosis (external); not necessarily related to defecation.
What does incomplete evacuation refer to?
Feeling that the bowel has not been fully emptied. This can be a symptom of haemorrhoids
What is an anal fissure and what are the associated symptoms?
An anal fissure is a tear or open sore (ulcer) that develops in the lining of the large intestine, near the anus. Symptoms include Intense pain on defecation and bright red blood.
What is ulcerative colitis & Crohn’s disease, and what are their symptoms?
Ulcerative colitis and Crohn’s disease are both inflammatory bowel diseases (IBDs) that cause inflammation and ulcers in the digestive tract.
Ulcerative colitis is limited to inflammation in the large intestine whereas Crohn’s disease is inflammation anywhere in the GI tract, from the mouth to anus.
Symptoms include: Watery bloody stools, fever, and abdominal pain, weight loss, fatigue
What indicates upper GI bleeds?
Possible NSAID (Non-steroidal anti-inflammatory drugs) use, erosion of stomach wall or upper intestine, and tarry (black, sticky consistency)stools.
What are the symptoms of colorectal cancer?
Long-term change in bowel habit and rectal bleeding.
What symptoms are associated with irritable bowel syndrome ?
Lower abdominal pain, alternating diarrhea and constipation.
What are some general measures someone with haemorrhoids should take?
- increase dietary fibre
- increase fluid intake ~ 2L
- fibre supplements
- avoid codeine- based painkillers
- avoid undue straining, intense exercises etc
- do not hold, go to toilet when needed
- keep clean and dry to aid healing
What are common skin protectants/soothing agents used in the treatment of haemorrhoids?
Zinc oxide, balsam of Peru, and allantoin.
What properties do these skin protectants/soothing agents provide?
They provide emollient and protective properties and help prevent local irritation.
What are three active ingredients often seen in local anaesthetics used to treat haemorrhoids?
.Lidocaine (e.g. seen in anusol)
.benzocaine
.cinchocaine.
What symptoms do local anesthetics relieve in haemorrhoid treatment?
Pain, burning, and itching, works by temporarily dumbing the area providing a cooling sensation
For how long can local anesthetics be used in haemorrhoid treatment?
Maximum of 7 days.
What warnings should be given to patients when starting local anaesthetics
Do not apply on broken skin/ open wounds. Do not ingest as they may be toxic
What symptoms do astringents/ skin protectants relieve in haemorrhoids treatment?
Relieve local irritation and inflammation which reduces blood in stool
What is a common astringents/skin protectant seen in haemorrhoid treatment?
Bismuth oxide (witch hazel extract) a natural remedy that acts as a astringent
How do astringents/ skin protectants work in treating haemorrhoids?
Upon application, proteins are precipitated on skin, forming a protective layer.
What does hydrocortisone do in haemorrhoid treatment
Hydrocortisone is an anti-inflammatory steroid medication commonly used to treat inflammation and itching caused by haemorrhoids. It helps reduce inflammation and swelling, relieves itching and irritation, and promotes healing of affected skin.
This is also seen in anusol
When is it best to apply a haemorrhoids cream
Best after bowel movement (morning and night) to ensure that the cream is applied to clean skin and can provide the most effective relief
What is the purpose of rubber band ligation in secondary care treatments for hemorrhoids?
Rubber band ligation cuts off blood flow to hemorrhoids, causing them to wither and fall off.
How does injection sclerotherapy work for hemorrhoids?
Phenol oil is injected into the submucosa of the rectum, causing collapse and fibrotic reaction, which obliterates hemorrhoid vessels and leads to atrophy of the hemorrhoid.
What is infrared coagulation or photocoagulation used for in hemorrhoid treatment?
It is a secondary care treatment to reduce or eliminate hemorrhoids by using infrared light to cut off blood flow.
What is the purpose of bipolar diathermy and direct-current electrotherapy in hemorrhoid treatment?
These methods use electrical current to shrink hemorrhoids by cauterizing blood vessels.
What surgical procedure is commonly used to treat severe hemorrhoids?
Hemorrhoidectomy.
