Haemorrhoids Flashcards
What is haemorrhoidal tissue?
Haemorrhoidal tissue is part of the normal anatomy that contributes to anal continence. These mucosal vascular cushions are found in the anal canal.
Where are haemorrhoidal tissues located in the anal canal?
They are located in the left lateral, right posterior, and right anterior portions of the anal canal (3 o’clock, 7 o’clock, and 11 o’clock respectively).
What defines the existence of haemorrhoids?
Haemorrhoids are said to exist when they become enlarged, congested, and symptomatic.
What is the most common symptom of haemorrhoids?
Painless rectal bleeding is the most common symptom.
What are other clinical features of haemorrhoids?
Other features include pruritus and pain, which is usually not significant unless piles are thrombosed.
What may occur with third or fourth degree piles?
Soiling may occur with third or fourth degree piles.
What are the two types of haemorrhoids?
The two types are external and internal haemorrhoids.
Where do external haemorrhoids originate?
External haemorrhoids originate below the dentate line and are prone to thrombosis, which may be painful.
Where do internal haemorrhoids originate?
Internal haemorrhoids originate above the dentate line and do not generally cause pain.
What are the grades of internal haemorrhoids?
Grade I: Do not prolapse out of the anal canal.
Grade II: Prolapse on defecation but reduce spontaneously.
Grade III: Can be manually reduced.
Grade IV: Cannot be reduced.
What is the management for haemorrhoids?
Management includes softening stools by increasing dietary fiber and fluid intake, using topical local anaesthetics and steroids, outpatient treatments like rubber band ligation, and surgery for large symptomatic haemorrhoids.
What are newer treatments for haemorrhoids?
Newer treatments include Doppler guided haemorrhoidal artery ligation and stapled haemorrhoidopexy.
What are the symptoms of acutely thrombosed external haemorrhoids?
They typically present with significant pain and examination reveals a purplish, oedematous, tender subcutaneous perianal mass.
What should be done if a patient presents with thrombosed external haemorrhoids within 72 hours?
Referral should be considered for excision.
How can patients with thrombosed external haemorrhoids be managed if they present after 72 hours?
Patients can usually be managed with stool softeners, ice packs, and analgesia. Symptoms usually settle within 10 days.
What are the typical presentations of thrombosed haemorrhoids?
They typically present with significant pain and a tender lump.
What does the examination reveal in thrombosed haemorrhoids?
Examination reveals a purplish, oedematous, tender subcutaneous perianal mass.
What should be considered if a patient presents within 72 hours?
Referral should be considered for excision.
How can patients usually be managed if they present after 72 hours?
Patients can usually be managed with stool softeners, ice packs, and analgesia.
How long do symptoms of thrombosed haemorrhoids usually take to settle?
Symptoms usually settle within 10 days.
