Haemorrhoids

Question 1

How many people do haemorrhoids affect.

Answer 1

Haemorrhoids affect 50% of the population over the age of 50.

Question 2

What are some predisposing conditions for developing haemorrhoids. (2)

Answer 2

Straining with defaecation.

Pregnancy.

Question 3

What are haemorrhoids.

Answer 3

Displacement and dilatation of one or more anal cushions. (vascular tissue)

Question 4

How are haemorrhoids classified.

Answer 4

They are classified into grades 1 to 4.

Question 5

What is a grade 1 haemorrhoid.

Answer 5

A grade one haemorrhoid will only bleed.

Question 6

What is a grade 2 haemorrhoid.

Answer 6

A grade two haemorrhoid will prolapse, but will spontaneously reduce.

Question 7

What is a grade 3 haemorrhoid.

Answer 7

A grade three haemorrhoid will prolapse and require manual replacement.

Question 8

What is a grade 4 haemorrhoid.

Answer 8

A grade 4 haemorrhoid will be permanently prolapsed.

Question 9

What are the symptoms of haemorrhoids. (4)

Answer 9

Painless red PR bleeding (usually after defecation).
Perianal lump.
Mucous discharge.
Pruritus ani.

Question 10

What are the signs of haemorrhoids. (2)

Answer 10

Visible prolapsed haemorrhoids.

Anaemia. (if the bleeding is brisk)

Question 11

What should you always do if someone presents with PR bleeding. (4)

Answer 11

Examine the abdomen for masses.
PR exam.
Proctoscopy.
Sigmoidoscopy.

Question 12

Where are the anal cushions situated.

Answer 12

At 3 o’clock.
At 7 o’clock.
At 11 o’clock.
As viewed form the lithotomy position.

Question 13

What are anal cushions.

Answer 13

Anal cushions are where the 3 major arteries that feed the vascular plexuses enter the anal canal.

Question 14

What is another name for haemorrhoids.

Answer 14

Piles.

Question 15

What is the differential diagnosis for haemorrhoids. (5)

Answer 15

Perianal haematoma. 
Anal fissure.
Abscess. 
Tumour. 
Proctalgia fugax.

Question 16

Define proctalgia fugax.

Answer 16

It is severe pain deep in the rectum that comes on suddenly.
It only lasts for a short time.
It is not due to organic disease.

Question 17

What are some alarm symptoms for a patient presenting with anal bleeding. (3)

Answer 17

Change in bowel habit.
Weight loss.
Tenesmus.

Question 18

What is the most common cause of rectal bleeding.

Answer 18

Haemorrhoids.

Question 19

What are primary, second degree, and third degree haemorrhoids. (3)

Answer 19

Primary - internal.
Second degree - prolapsing.
Third degree - prolapsed.