Haemorrhoids

Question 1

What is a haemorrhoid?

Answer 1

abnormal swelling or enlargement of the anal vascular cushions

Question 2

What do the anal vascular cushions usually do?

Answer 2

act to assist the anal sphincter in maintaining continence

Question 3

Where are the three vascular cushions in the anus positioned in regard to a clock?

Answer 3

3, 7 and 11

Question 4

What is a 1st degree haemorrhoid?

Answer 4

Remain in the rectum

Question 5

What is a 2nd degree haemorrhoid?

Answer 5

Prolapse through got anus on defecation but spontaneously reduce

Question 6

What is a 3rd degree haemorrhoid?

Answer 6

Prolapse through the anus on defecation but require digital reduction

Question 7

What is a 4th degree haemorrhoid?

Answer 7

Remain persistently prolapsed

Question 8

What are the main risk factors for Haemorrhoids?

Answer 8

excessive straining (chronic constipation) increasing age, raised intra-abdominal pressure e.g. pregnancy, chronic cough or ascites, pelvic or abdominal masses, family history, cardiac failure or portal hypertension

Question 9

What are the clinical features of haemorrhoids?

Answer 9

Painless bright red rectal bleeding commonly after defecation and seen on paper or covering the pain, blood is seen on the surface of the stool not mixed in, pruritus, rectal fullness, soiling

Question 10

If a haemorrhoid is large and prolapsed what can it do?

Answer 10

Thrombose

Question 11

How will a thromboses haemorrhoid present?

Answer 11

purple/blue, oedematous, tense and tender perianal mass

Question 12

What are the differential diagnoses of haemorrhoids?

Answer 12

malignancy, IBD, diverticular disease, fissure-in-ano, perianal abscess, fistula in ano, external piles, skin tags or sentinel piles from a fissure in ano

Question 13

What investigations are preformed for Haemorrhoids?

Answer 13

Proctoscopy

Question 14

What is the management for Haemorrhoids?

Answer 14

increasing daily fibre and fluid intake, prescribing laxatives, topical analgesia (lignocaine gel) but not opioids as they cause constipation so may make it worse

Question 15

What are some non-surgical techniques used for haemorrhoids?

Answer 15

Rubber band ligation where the haemorrhoid is drawn into the end of a suction gun and a rubber band is placed over the neck of the haemorrhoid, or can use photocoagulation, bipolar diathermy, direct current electrotherapy, haemorrhoid artery ligation

Question 16

What are some surgical techniques for haemorrhoids?

Answer 16

stapled or Milligan morgan haeorrhoidectomy (usually 3rd or 4th degree)

Question 17

What are some complications of haemorrhoids?

Answer 17

Thrombosis, ulceration, gangrene, skin tags or perianal sepsis