Haemorrhoids and Nausea and Vomiting

Question 1

Outline the structure of Haemorrhoids

Answer 1

They are submucosal (anal) cushions that are found in 3 discrete places of the anal canal.

Question 2

List the non-vascular components of the anal cushions

Answer 2

Connective tissue and ligaments

Question 3

List the vascular components of the anal cushions

Answer 3

arterioles (brings blood to the cushions) and venules (brings blood back to the heart)

Question 4

Where do internal haemmorhoids sit?

Answer 4

They sit above the dentate line

Question 5

Where do external haemmorhoids sit?

Answer 5

They sit below the dentate line

Question 6

Describe the sliding anal cushion theory

Answer 6

1. supporting tissue of the anal cushion degenerates
2. downwards stress causes displacement of the anal cushions and distending of veins
   3.

Question 7

Define hyper-vascularisation theory

Answer 7

The presence of blood vessels
lead to an increase in blood flow –> veins distend –> stagnation of blood

Question 8

What are the symptoms of Internal haemorrhoids ?

Answer 8

• rarely causes discomfort
• painless bleeding during bowel movements
• Haemmorhoid pushes through anal canal

Question 9

Where do haemmorhoids develop?

Answer 9

They develop inside the rectum and around the anus

Question 10

List the 4 consequences of Haemmorhoids

Answer 10

1. Anameia
2. Thrombosis
3. Anal fistula
4. Anal stenosis

Question 11

List 3 non-pharmalogical recommendations

Answer 11

1. Drink plenty of water and eat more fibre
2. Reduce consumption of coffee, tea and alcohol
3. Regular exercise

Question 12

List 2 medications to treat Haemmorhoids

Answer 12

1. Cinchocaine
2. Hydrocortisone - topical corticosteroid

Question 13

“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

Answer 13

YES

Question 14

Outline the physiology of vomiting

Answer 14

1. stimuli in differnet organs activate the vomiting centre
2. innervation of vomiting reflex

Question 15

Which drug agents treats nausea and vomiting

Answer 15

Antiemetics

Question 16

Outline 4 acute causes and 4 chronic causes of Nausea and Vomiting

Answer 16

Acute:
- Motion sickness
- Food poisoning
- Acute abdominal injury
- Head Injury

Chronic:
- Mechanical obstruction in GI tract
- Migraines
- Untreated reflux
- Anxiety and Depression

Question 17

Outline the practise points of Metoclopramide
(Include brand name, regimen, what does it treat?

Answer 17

1. Anagraine
2. Regimen: 10 mg every 8 hours
3. Nausea and Vomiting associated with migraines

Question 18

Outline the practise points of Hyoscine
(Include brand name, regimen, what does it treat)

Answer 18

1. Kwells
2. 300 to 600 mcg every 4 to 6 hours and 30 minutes before travel
3. Motion sickness

Question 19

Which drug class does metocloparamide come under?

Answer 19

Dopamine antagonists

Question 20

Which drug class does hysocine come under?

Answer 20

Muscuranic Receptor Antagonists

Question 21

Which drug class does promethazine come under?

Answer 21

Antihistamines

Question 22

Outline the practise points of promethazine
(Include brand name, regimen, what does it treat)

Answer 22

1. Phernagan
2. 25mg the night before or 1-2 hours for trabel

Question 23

List 4 non-pharmalogical recommendation for Nausea and Vomiting

Answer 23

1. Eating small, frequent, high carbohydrate, low-fat meals
2. Snacking on high protein foods before meals
3. Avoiding spicy foods and strong odours
4. Eating crackers or plain biscuits before getting out of bed