Haemorrhoids

Question 1

Name 5 continence factors.

Answer 1

Distensible rectum 
Firm bulky faeces 
Normal anorectal angle 
Anal cushions
Normal anal sphincters

Question 2

What is the internal anal sphincter made of and what contribution does it make to resting anal pressure?

Answer 2

Thickening of circular muscle

80% of resting pressure

Question 3

What is unique about the deep section of the EAS?

Answer 3

Mixes with fibres of levator ani and joins with puborectalis to form a sling

Question 4

Name 5 risk factors for haemorrhoids.

Answer 4

Straining/ constipation 
Low fibre diet 
Pregnancy 
Portal hypertension (anorectal varices) 
Heavy weight lifting

Question 5

Outline treatment for internal haemorrhoids.

Answer 5

Increased hydration and high fibre diet
Rubber band ligation
Surgery (haemorrhoidectomy)
Anti-itching agents (pramoxine)

Question 6

Name 2 things that predispose to anal fissures.

Answer 6

Reduced IAS tone

Reduced blood flow to anal mucosa

Question 7

What is the treatment for anal fissures.

Answer 7

Hydration, high fibre and analgesia
Warm baths
Medication - relax IAS

Question 8

What are the top 3 most common causes of haematochezia?

Answer 8

Diverticular disease
Angiodysplasia 
Colitis (IBD infective etc) 
(Colorectal cancer) 
(Anorectal disease) 
(Upper GI large bleed with fast transit time)

Question 9

Give 3 common causes for malaena.

Give 3 less common causes.

Answer 9

PUD
Upper GI cancer (oesophagus/ gastric)
Varicella bleeds

gastritis
Meckel’s diverticulum
Iron supplements