Hemorrhoids

Question 1

Etiology and Pathogenesis

Answer 1

• congenital insufficiency of vascular walls
• muscular dystrophic factors in the longitudinal muscle of the rectal sub mucous layer and ligament of Parks which form fibro-muscular skeleton of internal hemorrhoids
• blood flow disorder in this area

Normally in submucous layer of the distal rectal region there are carvenous vascular structures from which hemorrhoids form
They are situated at 3,7,11 o’clock on the dial
Chronic functional disturbances of intramural cochlear arteries in carvenous veins are bases of hemorrhoids formation

Question 2

Clinical presentation of Hemorrhoids

Answer 2

• during defecations there are hermorrhages of bright red colour
• quantity of blood loss in a moment can be from several mm to (50-100ml), it results in anemia
• clinical presentation intensifies after food intake irritating GIT

There are 4 stages of hemorrhoids according to modern classification
Stage 1-characterised by hemorrhages , discomfort,
-on anascopy hemorrhoids are seen but they are not prolapsed

Stage 2- pruritis occurs(itchy skin), prolapsed hemorrhoids are seen in the anal canal

Stage 3- prolapsed hemorrhoids which need manual reduction

Stage 4- pain appears , they are irreducible prolapsed hemorrhoids

Question 3

Diagnosis of Hemorrhoids

Answer 3

• examination of anus at a straining effort
• digital rectal examination
• anascopy
• investigation by means of renal speculum

Proctosigmoidoscopy and sigmoidoscopy are compulsory

Differential diagnosis from renal cancer, polyp, anal fissure, paraproctitis.

Question 4

Complications of Hemorrhoids

Answer 4

1. Thrombophlebitis
   - This is inflammation of Hemorrhoids
   - Clinical picture-acute intensive pain in the area of -Hemorrhoids, hemorrhage become dense , cyanotic,sharply painful
   - Treatment is conservative

2.Anemia
Anemia in this case has a chronic nature
Slerotherapy of hemorrhoids produces a positive effect if there are hemorrhoidal bleedings
Treatment-stabizol, refortan, polyglycinum, substituting therapy with blood preparations is prescribed at severe degrees of hemorrhage

3. Chronic anal fissure
4. Perianal itch

Question 5

Treatment of hemorrhoids

Answer 5

-in the initial stages (1st and 2nd)treated by conservative methods -regulation of defeacation and stool consistency by keeping an appropriate diet or taking preparations containing dietary fibers
The patient should take sufficient quantity of liquid including fruits and vegetable juices
Phlebotropic preparations serve as a basis for treatment of the disease

Also infrared photo coagulation, sclerotherapy , ligation by latex rings, electro coagulation at initial stages

Surgical treatment is used in the 3rd-4th stages of the disease
Milligan-Morgan’s operation is widely practiced
Hemorrhoids are excusised from outside inside with ligation of vascular pedicles of the hemorrhoids, cutting them off,

-Ultrasonic scalpel, apparatus Liga Sure, circular staplers for hemorrhoidectomy is possible

Patients are discharged on the 8th-10th day after operation when stool becomes normal
Prognosis of the disease is favourable