Haemorrhoids Flashcards
Definition of haemorrhoids?
Disrupted and dilated anal cushions
What is an anal cushion?
Mass of spongy vascular tissue
Where on the clock are the anal cushions located?
3, 7 and 11
Which kind of piles are painful, those that originate above or below the dentate line?
Below
What grade of internal haemorrhoids are permanently hanging outside of the anus and cannot be pushed back inside
Grade 4
Grade 1 - never prolapse
Grade 2 - Partly appear during defaecation only, reduce spontaneously
Grade 3 - Appear fully only during defaecation and need to be pushed back in
When do women become susceptible to piles?
During pregnancy
Venous congestion can contribute to causing piles, what can cause venous congestion?
Pregnancy
Abdo tumour
Portal vein hypertension
3 main symptoms of haemorrhoids?
Fresh painless PR bleeding
Pruritis ani
Lump in perianal area
Can you palpate piles during a DRE?
No, only when thrombosed
Four main differentials for haemorrhoids?
TUMOUR
Perianal haematoma
Fissure
Abscess
Conservative Mx of piles? (2)
Increase fibre intake
stop straining
Medical Mx of piles? (3)
Lactulose
Anusol (topical hydrocortisone)
Topical analgesics
Interventional Mx of piles? (4)
Injection with sclerosant
Barron’s banding
Cryotherapy
Infra-red coagulation
Surgical Mx of piles?
Haemorrhoidectomy
Lactulose and metronidazole 1wk pre-op
Discharge with laxatives
What do severely painful haemorrhoids indicate?
Thrombosis
How do you manage a thrombosed haemorrhoid?
Analgesia
Ice packs
Stool softners
Bed rest
Pain usually resolves in 2-3weeks without heamorrhoidectomy
