Hemorrhoids Flashcards
What is the pertinent anatomy for internal hemorrhoids?
Located above the dentate line.
Subepithelial cushions of the anorectum.
-Submucosa
—connective tissue and blood vessels
No nervous innervation
What is the pertinent anatomy of external hemorrhoids?
Arise from the inferior hemorrhoidal veins, below the dentate line, covered with squamous epithelium, do possess nervous innervation. Painful when thrombosed.
What is the pertinent physiology for hemorrhoids?
Hemorrhoidal venous cushions. Normal anatomical structures of the anorectum in all adults.
Contribute to normal anal pressures.
Provide a water tight closure of the anal canal.
Highly vascular, sensitive location.
Tendency to engorge and prolapse.
Internal hemorrhoids commonly occur in three locations. Right anterior, right posterior, and left lateral.
What is the pertinent pahthophysiology of hemorrhoids?
Hemorrhoids become symptomatic when activities that increase venous pressure occur. Without treatment/change internal hemorrhoidal cushions may bleed and protruse.
What causes thrombosis of external hemorrhoids?
relatively acute onset
exquisitely painful tense
bluish perianal nodule covered with skin that may be up to several centimenters in size
pain is most sever within the first few hours and gradually eases over 2-3 days as edema subsides
What are the physical findings of hemorrhoids?
Internal hemorrhoids usually painless but cause bright red bleeding with streaks visible on toilet paper or stool, prolapses, and mucoid discharge. Rarely is bleeding sever enough to result in anemia. Pain is unusual with internal hemorrhoids occuring only when there is extensive inflammation and thrombosis of irreducible tissue or with thrombosis of an external hemorrhoid.
What are the stages of hemorrhoids?
Stage I: Dilated, confined to the anal canal
Stage II: Prolapsed during straining, reduces spontaneously
Stage III: Prolapsed, reqqires manual reduction
Stage IV: Chronically prolapsed and unable to manually reduce
What can result from chronically prolapsed hemorrhoids?
A sense of fullness or discomfort, mucoid perianal discharge
What are the physical findings of external hemorrhoids?
readily visible on perianal inspection, they appear as a tense bluish perianal nodule covered with skin that may be up to several centimeters in size and are extremely tender to palpation on exam.
What are some of the differentials for hemorrhoids?
anal fissure or fistula
neoplasms of the distal colon or rectum
ulcerative colitis or crohn colitis
infectious prostatis
rectal ulcers
How do you treat external hemorrhoids?
warm sitz baths
analgesics and ointments
if seen in the first 24-48 hrs remocal of the clot may hasten symptomatic relief
place the patient in a lateral position, anesthetize the skin around the lump, excise the skin and evacuate the clot, with the patient initiating daily sitz baths and daily wound checks for healing.
