Haemorrhoids and diverticular disease Flashcards
1
Q
Signs of haemorrhoids?
A
- Painless rectal bleeding
- Anal pruritus
- Feeling of something sliding in and out of rectum on defection
- Soiling with 3rd or 4th degree piles
2
Q
Management of haemorrhoids?
A
- Increase fibre and fluid intake
- Topical LA
- Rubber band ligation
- Surgery reserved for symptomatic haemorrhoids
- Doppler guided haemorrhoidal artery ligation
3
Q
Signs of a thrombosed haemorrhoids?
A
- Painful defecation
- Purplish, oedematous tender subcut mass
4
Q
Treatment of a thrombosed haemorrhoid?
A
- Excision if presenting within 72 hours
- If >72 hours then treat with stool softeners, ice packs, and analgesia; symptoms settle itching 10 days
5
Q
Risk factors for diverticulosis?
A
- Increasing age
- Lack of dietary fibre
- Obesity
- Sedentary lifestyle
6
Q
Signs of diverticulosis?
A
- Intermittent LLQ pain
- Bloating
- Change in bowel habit, diarrhoea or constipation
7
Q
Management for simple diverticulosis?
A
High fibre diet
8
Q
Symptoms of diverticulitis?
A
- Severe LLQ pain
- N&V (may be due to ileum or obstruction)
- Change in bowel habit (constipation in 50%, diarrhoea in 25%)
- PR bleeding
- Urinary frequency, urgency or dysuria (bladder irritation)
- Pneumaturia or faecaluria suggest colovesical fistula
- Vaginal passage of flatus Orr faeces suggests colovaginal fistula
9
Q
Signs of diverticulitis?
A
- Pyrexia
- Tachycardia
- Tender LLQ with possible mass
- Possible reduced bowel sounds
- Guarding, rigidity, and rebound tenderness may suggest perforation
- Lack of improvement with treatment suggests abscess
10
Q
Investigations forr diverticulitis?
A
- FBC: raised WCC
- Raised CRP
- Erect CXR may show pnuemoperitoneum in perforation
- AXR may show dilated bowel loops, obstruction or abscess
- Colonoscopy (avoid in early disease due to perforation risk)
11
Q
Management of diverticulitis?
A
- Mild cases: oral antibiotics, liquid diet, analgesia
- Severe or don’t settle in 72 hours: admit forr IV antibiotics
