Haemorrhoids and Nausea and Vomiting Flashcards
Outline the structure of Haemorrhoids
They are submucosal (anal) cushions that are found in 3 discrete places of the anal canal.
List the non-vascular components of the anal cushions
Connective tissue and ligaments
List the vascular components of the anal cushions
arterioles (brings blood to the cushions) and venules (brings blood back to the heart)
Where do internal haemmorhoids sit?
They sit above the dentate line
Where do external haemmorhoids sit?
They sit below the dentate line
Describe the sliding anal cushion theory
- supporting tissue of the anal cushion degenerates
- downwards stress causes displacement of the anal cushions and distending of veins
3.
Define hyper-vascularisation theory
The presence of blood vessels
lead to an increase in blood flow –> veins distend –> stagnation of blood
What are the symptoms of Internal haemorrhoids ?
- rarely causes discomfort
- painless bleeding during bowel movements
- Haemmorhoid pushes through anal canal
Where do haemmorhoids develop?
They develop inside the rectum and around the anus
List the 4 consequences of Haemmorhoids
- Anameia
- Thrombosis
- Anal fistula
- Anal stenosis
List 3 non-pharmalogical recommendations
- Drink plenty of water and eat more fibre
- Reduce consumption of coffee, tea and alcohol
- Regular exercise
List 2 medications to treat Haemmorhoids
- Cinchocaine
- Hydrocortisone - topical corticosteroid
“Do not use it for more than 7 days. If symptoms continue it is really important that you seek the doctors help as soon as possible. With extended use it can cause local infection and cause skin atrophy”
- Is this a correct statement for medications to treat haemorrhoids
YES
Outline the physiology of vomiting
- stimuli in differnet organs activate the vomiting centre
- innervation of vomiting reflex
Which drug agents treats nausea and vomiting
Antiemetics
Outline 4 acute causes and 4 chronic causes of Nausea and Vomiting
Acute:
- Motion sickness
- Food poisoning
- Acute abdominal injury
- Head Injury
Chronic:
- Mechanical obstruction in GI tract
- Migraines
- Untreated reflux
- Anxiety and Depression
Outline the practise points of Metoclopramide
(Include brand name, regimen, what does it treat?
- Anagraine
- Regimen: 10 mg every 8 hours
- Nausea and Vomiting associated with migraines
Outline the practise points of Hyoscine
(Include brand name, regimen, what does it treat)
- Kwells
- 300 to 600 mcg every 4 to 6 hours and 30 minutes before travel
- Motion sickness
Which drug class does metocloparamide come under?
Dopamine antagonists
Which drug class does hysocine come under?
Muscuranic Receptor Antagonists
Which drug class does promethazine come under?
Antihistamines
Outline the practise points of promethazine
(Include brand name, regimen, what does it treat)
- Phernagan
- 25mg the night before or 1-2 hours for trabel
List 4 non-pharmalogical recommendation for Nausea and Vomiting
- Eating small, frequent, high carbohydrate, low-fat meals
- Snacking on high protein foods before meals
- Avoiding spicy foods and strong odours
- Eating crackers or plain biscuits before getting out of bed
