Haemorrhoids Flashcards
What are haemorrhoids?
Enlarged anal vascular cushions
What is an anal cushion?
Specialised submucosal tissue that contains connections between arteries and veins - it is very vascular
How is the location of pathology in the anus described?
Described as a clock face - with 12 o clock towards the genitals, and 6 o clock towards the back
Where are the anal cushions located?
At 2, 7 and 11 o clock
What is the classification of haemorrhoids?
1st degree - no prolapse
2nd degree - prolapse when straining and return on relaxing
3rd degree - prolapse when straining, no return on relaxing, but can be pushed back
4th degree - prolapsed permanently
What is the dentate line?
The dentate line is situated 2cm from the anal verge, and divides the upper two thirds of and lower third of the anal canal
What is the pathophysiology of haemorrhoids?
Factors that contribute to raised intra-abdominal pressure can lead to swelling of the haemorrhoid tissue cushion, which can sweel or bleed
What is the presentation of haemorrhoids?
Bright red rectal bleeding
Blood is not mixed with stool
Anal itching
When are haemorrhoids painful?
External haemorrhoids can often be painful, particularly if thrombosed
Internal haemorrhoids are often painless, unless thrombosed and strangulated
What is seen on DR examination of a patient with haemorrhoids?
External haemorrhoids are visible on inspection
Internal haemorrhoids may be felt on PR exam, although this is difficult
Internal haemorrhoids can be seen on proctoscopy
What is the first line management of haemorrhoids?
Ensure patient is not constipated - increase fluid intake and dietary fibre
Analgesia
Topical haemorrhoid preparations
- Anusol - first line
What are the non-surgical options for haemorrhoids?
Rubber band ligation
Injection sclerotherapy
Infra-red coagulation
What are the surgical options for management of haemorrhoids?
Haemorrhoidal artery ligation
Haemorrhoidectomy
Stapled haemorrhoid
