Hemorrhoids Flashcards
Internal Hemorrhoids are located where?
above the dentate line
External Hemorrhoids Arise from:
and where?
Arise from the inferior hemorrhoidal veins
Below the dentate line
What hemorrhoid’s are painful when thrombosed?
External
What hemorrhiods bleed and involve:
Connective tissue
Blood vessels
Muscularis
Internal Hemorrhoids
Hemorrhoidal venous cushions are normal anatomic structures of the anorectum and are universally present unless…….
a previous intervention has taken place
What arises from the inferior hemorrhoidal veins located below the dentate line and are covered with squamous epithelium of the anal canal or perianal region.
External hemorrhoids
______ are subepithelial vascular cushions consisting of connective tissue, smooth muscle fibers, and arteriovenous communications between terminal branches of the superior rectal artery and rectal veins.
Internal hemorrhoids
Internal hemorrhoids commonly occur in three primary locations
right anterior, right posterior and
left lateral.
Thrombosis of the external hemorrhoidal plexus results in a________
(a) It most commonly occurs in otherwise healthy young adults and may be precipitated by coughing, heavy lifting, or straining at stool.
(b) The condition is characterized by the relatively acute onset of an exquisitely painful, tense and bluish perianal nodule covered with skin that may be up to several centimeters in size.
(c) Pain is most severe within the first few hours but gradually eases over 2-3 days as edema subsides.
perianal hematoma.
How many stages are there of internal hemorrhoids?
4
What stage of Internal Hemorrhoids
Internal hemorrhoids are confined to the anal canal
1
What stage of Internal Hemorrhoids
the internal hemorrhoids may gradually enlarge and protrude from the anal opening. At first, this mucosal prolapse occurs during straining and reduces spontaneously
2
What stage of Internal Hemorrhoids
the prolapsed hemorrhoids remain chronically protruding
and unresponsive to manual reduction
4
What stage of Internal Hemorrhoids
prolapsed hemorrhoids may require manual reduction after bowel movements
3
What may result in a sense of fullness or discomfort and mucoid perianal discharge, resulting in irritation and soiling of underclothes
Chronically prolapsed hemorrhoids
PE Findings
________ are visible as protuberant purple nodules covered by mucosa
Prolapsed hemorrhoids
PE Findings
________ are visible as protuberant purple nodules covered by mucosa
Prolapsed hemorrhoids
PE Findings
______ are not visible but may protrude through the anus
with gentle straining.
Non-prolapsed internal hemorrhoids
PE Findings
The perianal region should also be examined for other signs of disease such as
fistulas, fissures, skin tags, or dermatitis.
On digital examination, uncomplicated internal hemorrhoids are
neither palpable nor painful
PE findings for what?
(a) Are readily visible on perianal inspection.
(b) They appear as a tense bluish perianal nodule covered with skin that may be up to several centimeters in size.
(c) They are extremely tender to palpation on exam.
External hemorrhoids
Differential Diagnosis
Small volume rectal bleeding may be caused by:
(a) Anal fissure or fistula,
(b) Neoplasms of the distal colon or rectum,
(c) Ulcerative colitis or Crohn colitis,
(d) Infectious proctitis, or
(e) Rectal ulcers.
Labs to order for hemorrhoids
None…..
RADS
Colonoscopy should be performed in all patients with _______ to exclude disease in the rectum or sigmoid colon that could be misinterpreted in the presence of hemorrhoidal bleeding.
hematochezia
Initial Care
(1) In acute onset stay with _______.
(2) Patients who present with Stage 3 (problematic) Stage 4 require further assessment for _______.
1) treatment protocol
2) surgical correction
Treatment
Thrombosed external hemorrhoids
(a) Warm sitz baths
(b) Analgesics and ointments
(c) If seen in the first 24-48 hrs, removal of the clot may hasten symptomatic relief.
Treatment
If seen in the first ____ hrs, removal of the clot may hasten symptomatic relief
24-48
If seen in the first 24-48 hrs, removal of the clot may hasten symptomatic relief.
1) Procedure:
a) Place the patient in a ________.
b) Anesthetize the skin around and over the lump with 1% lidocaine using a tuberculin syringe with a ___-gauge needle.
c) An ellipse of skin is then excised, and the ____ is evacuated.
d) A dry gauze dressing is applied for 12- 24hrs and daily sitz baths are then begun.
e) The patient should follow- up for daily _____ until healed.
a) lateral position
b) 30 gauge
c) clot
d) wound checks
