Haemorrhoids

Question 0

Classification of haemorrhoids

Answer 0

1st degree - bleed but do not prolapse
2nd degree - prolapse on defaecation but spontaneously reducible
3rd degree - prolapse, need manual reduction and prolapse back spontaneously

All may be associated with skin tags
External haemorrhoids now called perianal haematoma

Question 1

Haemorrhoids where do they occur

Answer 1

At the ano-rectal junction at 3, 7 and 11 o’clock (lithotomy position)
The three anal cushions are vascular pads which close the ano-rectal junction
They expand and prolapse during straining

Question 2

Txt of haemorrhoids

Answer 2

High fibre diet
Rubber band ligation (Barron’s bands)
Injection sclerotherapy (phenol in almond oil 80%)
Risk of secondary haemorrhage 10-14 days later
Haemorrhoidectomy
Halls procedure - high ligation of inferior haemorrhoid artery