Haemorrhoids (piles) Flashcards
what are piles?
Disrupted and dilated anal cushions
what are anal cushions?
3 discontinuous masses of spongy vascular tissue that line the anus
they contribute to anal closure
how are the anal cushions attached?
by smooth muscle and elastic tissue
prone to disruption and displacement
what 3 things make the cushions bulky + loose (and then protrude to form piles?
the effects of:
- gravity
- increased anal tone (?stress)
- effects of straining stool
are piles varicose veins?
NO
why is the blood they bleed bright red?
its from capillaries
of the underlying lamina propria
why are piles not painful?
there are no sensory fibres above the dentate line (squamomucosal junction)
cause of piles
constripation + straining
bowel habit may be normal
vicious cycle of pathogenesis
protrusion of vascular cushions through a tight anus
become more congested + hypertrophy to protrude again more readily
protrusions may then strangulate
symptoms
bright red rectal bleeding
severe anaemia
What should you to investigate any rectal bleeding?
abd exam
PR exam
proctoscopy
sigmoidoscopy
Tx medical (1st degree)
increase fluid + fibre
topical analgesics
stool softener
Tx non-operative (2nd & 3rd degree, or 1st if medication has failed)
rubber band ligation- produces an ulcer to anchor the mucosa
sclerosants
infra-red coagulation- coagulates vessels + tethering mucosa to subcut tissue
Tx surgical
excision haemorrhoiectomy
surgical complications
constipation
infection
stricture
bleeding
