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Gastrointestinal > Haemorrhoids > Flashcards

Haemorrhoids Flashcards

1
Q

Define Haemorrhoids?

A

Anal vascular cushions become enlarged and engorged with a tendency to protrude, bleed or prolapse in the anal canal

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2
Q

What are two main classifications of Haemorrhoids?

A

Internal:

  • Arise from the superior haemorrhoidal plexus
  • Lie ABOVE the dentate line

External:
- Lie BELOW the dentate line

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3
Q

What is the dentate line?

A

A line that divides the upper 2/3 and the lower 1/3 of the anal canal and represents the hindgut-proctodeum junction

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4
Q

What are the four degrees of Haemorrhoids?

A

1st Degree - haemorrhoids that don’t prolapse
2nd Degree - prolapse with defecation but reduce spontaneously
3rd Degree - prolapse and require manual reduction
4th Degree - prolapse that can’t be reduced

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5
Q

What is the aetiology of Haemorrhoids?

A

Exact cause is disputed

Caused by disorganisation of the fibromuscular stroma of the anal cushions

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6
Q

What are the risk factors for Haemorrhoids?

A 
Constipation
Prolonged straining 
Derangement of the internal anal sphincter 
Pregnancy 
Portal hypertension
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7
Q

What is the epidemiology of Haemorrhoids?

A

COMMON

Peak age: 45-65 yrs

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8
Q

What are the presenting symptoms of Haemorrhoids?

A 
Usually asymptomatic 
Bleeding 
Absence of alarm symptoms 
Itching 
Anal lumps 
Prolapsing tissue
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9
Q

What is the nature of the bleeding in Haemorrhoids?

A

Bright red blood that is on the toilet paper and drips into the pan after passage of stool
Blood will not be mixed with the stool

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10
Q

What are the alarm symptoms that are absent in Haemorrhoids?

A 
Weight Loss
Anaemia 
Change in bowel habit 
Passage of clotted or dark blood
Mucus mixed with the stool
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11
Q

Why can Haemorrhoids sometimes be very painful?

A

External Haemorrhoids that have thrombosed can be very PAINFUL

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12
Q

What are the signs of Haemorrhoids on physical examination?

A

1st or 2nd degree haemorrhoids are NOT usually visible on external inspection
Internal haemorrhoids are NOT usually palpable on DRE unless they are thrombosed
Haemorrhoids are usually visible on proctoscopy

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13
Q

What are some of the other differential diagnoses for Haemorrhoids?

A 
Anal tags 
Anal fissures 
Rectal Prolapse 
Polyps 
Tumours
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14
Q

What investigations would you do for Haemorrhoids?

A

DRE
Proctoscopy
Rigid or flexible sigmoidoscopy

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15
Q

Why do we do a sigmoidoscopy for Haemorrhoids?

A

Important to exclude a rectal or sigmoid source of bleeding

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16
Q

What’s important to remember when investigating Haemorrhoids?

A

Haemorrhoids are common so the presence of haemorrhoids doesn’t mean that you shouldn’t consider any other sources of bleeding

17
Q

What are some of the management plans for Haemorrhoids?

A

Conservative
Injection Sclerotherapy
Banding
Surgery

18
Q

What is the Conservative management plan for Haemorrhoids?

A

High-fibre diet
Increased fluid intake
Bulk laxatives
Topical creams (e.g. local anaesthetics)

19
Q

Why do we do Injection Sclerotherapy for Haemorrhoids?

A

Induces fibrosis of the dilated veins

20
Q

How does banding for Haemorrhoids work?

A

Barron’s bands are applied proximal to the Haemorrhoids
The Haemorrhoids will then fall off after a few days
Higher cure rate but may be more painful than injection sclerotherapy

21
Q

What is the surgical management plan for Haemorrhoids?

A

Reserved for symptomatic 3rd and 4th degree haemorrhoids
Milligan-Morgan haemorrhoidectomy - excision of thre haemorrhoidal cushion
Stapled haemorrhoidectomy is an alternative method
Post-operatively the patient should be given laxatives to avoid constipation

22
Q

What are the possible complications of Haemorrhoids?

A

Bleeding
Prolapse
Thrombosis
Gangrene

23
Q

What are the complications of Injection Sclerotherapy in Haemorrhoids?

A 
Prostatitis 
Perineal Sepsis 
Impotence 
Retroperitoneal Sepsis
Hepatic abscess
24
Q

What are the complications of Haemorrhoidectomy in Haemorrhoids?

A

Pain
Bleeding
Incontinence
Anal stricture

25
Q

What is the prognosis for patients with Haemorrhoids?

A

Often CHRONIC
High rate of recurrence
Surgery can provide long-term relief

Gastrointestinal (61 decks)

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