Haemorrhoids Flashcards
What is the definition?
This is dilation of the anal cushions which line the anus.
Can be internal (above the dentate line usually from the superior hemorroidal plexus) or external (below the dentate line)
There are 4 grades:
> Grade 1 - this does not prolapse
>Grade 2 - this will prolapse upon defecation but will spontaneously
>Grade 3 - this will prolapse but can be manually redeuce
>Grade 4 - will prolapse and cannot be reduced
What is the aetiology/ risk factors?
The anal cushions are at 3, 7 and 11 o’clock where lots of blood feeds in. This makes them prone to dilation.
Risk factors: Constipation Pregnancy Straining Derangement of the internal anal sphincter Portal hypertension
What is the epidemiology?
Very common especially in 45-65 year old’s
What are the symptoms of Haemorrhoids?
Usually asymptomatic
Can present with bleeding which will be bright red BUT will not mix with stools.
But may present with:
Anal lumps
prolapsing tissue
itching
external haemorrhoids which have thrombosed are very painful
What are the signs of haemorrhoids?
1st and 2nd degree are not seen on external examination .
Internal haemorrhoids are not palpable on DRE unless thrombosed.
Visible on proctoscopy.
What are differential diagnoses?
Anal fissure Anal tag rectal prolapse polyps tumours
what are the investigations for haemorrhoids?
Abdominal examination
DRE
Sigmoidoscopy and colonoscopy
proctoscopy
what is the management of haemorrhoids?
1st degree - conservative (lifestyle and diet (high fibre), laxatives, increase fluid, topical creams)
2nd and 3rd degree - ligation bands (these fall off by themselves) or sclerotherpay (medicine in the blood vessels causes them to shrink)
4th - surgery (haemorrhoidectomy)
what are possible complications?
bleeding
thrombosis
gangrene
prolapse
what is the prognosis?
this is chronic and often will come back. surgery will provide long term relief.
