Haemorrhoids Flashcards
1
Q
Define Haemorrhoids
A
Vascular and connective tissue complexes form a plexus of dilated veins (cushion)
2
Q
Haemorrhoid Aetiology
A
- internal: superior hemorrhoidal veins, above dentate line, portal circulation
- external: inferior hemorrhoidal veins, below dentate line, systemic circulation
3
Q
Haemorrhoid Risk Factors
A
increased intra-abdominal pressure: chronic constipation, pregnancy, obesity, portal hypertension, heavy lifting
4
Q
Internal Haemorrhoid Presentation
A
- engorged vascular cushions usually at 3, 7, 11 o’clock positions (patient in lithotomy position)
- PAINLESS rectal bleeding, anemia, prolapse, mucus discharge, pruritus, burning pain, rectal fullness:
5
Q
Internal Haemorrhoid Types and Treatments
A
- 1st degree: bleed but do not prolapse through the anus
* treatment: high fibre/bulk diet, sitz baths, steroid cream, parmoxine (Anusol®), rubber band ligation, sclerotherapy, photocoagulation- 2nd degree: bleed, prolapse with straining, spontaneous reduction
- treatment: rubber band ligation, photocoagulation
- 3rd degree: bleed, prolapse, require manual reduction
- treatment: same as 2nd degree, but may require closed haemorrhoidectomy
- 4th degree: bleed, permanently prolapsed, cannot be manually reduced
- treatment: closed haemorrhoidectomy
- 2nd degree: bleed, prolapse with straining, spontaneous reduction
6
Q
External Haemorrhoid Types and Presentation
A
- dilated venules usually mildly symptomatic
* PAIN after bowel movement, associated with poor hygiene- thrombosed hemorrhoids are very painful:
- resolve within 2 wks, may leave excess skin = perianal skin tag
- thrombosed hemorrhoids are very painful:
7
Q
External Haemorrhoid Types and Management
A
- dilated venules
* medical treatment: dietary fibre, stool softeners, steroid cream (short course), parmoxine (Anusol®), avoid prolonged straining- thrombosed hemorrhoids
- treatment: consider surgical decompression within first 48 h of thrombosis, otherwise medical treatment
- thrombosed hemorrhoids
