Hemorrhoids

Question 1

Internal Hemorrhoids are located where?

Answer 1

above the dentate line

Question 2

External Hemorrhoids Arise from:
and where?

Answer 2

Arise from the inferior hemorrhoidal veins
Below the dentate line

Question 3

What hemorrhoid’s are painful when thrombosed?

Answer 3

External

Question 4

What hemorrhiods bleed and involve:
Connective tissue
Blood vessels
Muscularis

Answer 4

Internal Hemorrhoids

Question 5

Hemorrhoidal venous cushions are normal anatomic structures of the anorectum and are universally present unless…….

Answer 5

a previous intervention has taken place

Question 6

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.

Answer 6

External hemorrhoids

Question 7

______ 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.

Answer 7

Internal hemorrhoids

Question 8

Internal hemorrhoids commonly occur in three primary locations

Answer 8

right anterior, right posterior and
left lateral.

Question 9

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.

Answer 9

perianal hematoma.

Question 10

How many stages are there of internal hemorrhoids?

Answer 10

4

Question 11

What stage of Internal Hemorrhoids
Internal hemorrhoids are confined to the anal canal

Answer 11

1

Question 12

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

Answer 12

2

Question 13

What stage of Internal Hemorrhoids
the prolapsed hemorrhoids remain chronically protruding
and unresponsive to manual reduction

Answer 13

4

Question 14

What stage of Internal Hemorrhoids
prolapsed hemorrhoids may require manual reduction after bowel movements

Answer 14

3

Question 15

What may result in a sense of fullness or discomfort and mucoid perianal discharge, resulting in irritation and soiling of underclothes

Answer 15

Chronically prolapsed hemorrhoids

Question 16

PE Findings
________ are visible as protuberant purple nodules covered by mucosa

Answer 16

Prolapsed hemorrhoids

Question 17

PE Findings
______ are not visible but may protrude through the anus
with gentle straining.

Answer 17

Non-prolapsed internal hemorrhoids

Question 18

PE Findings
The perianal region should also be examined for other signs of disease such as

Answer 18

fistulas, fissures, skin tags, or dermatitis.

Question 19

On digital examination, uncomplicated internal hemorrhoids are

Answer 19

neither palpable nor painful

Question 20

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.

Answer 20

External hemorrhoids

Question 21

Differential Diagnosis
Small volume rectal bleeding may be caused by:

Answer 21

(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.

Question 22

Labs to order for hemorrhoids

Answer 22

None…..

Question 23

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.

Answer 23

hematochezia

Question 24

Initial Care
(1) In acute onset stay with _______.
(2) Patients who present with Stage 3 (problematic) Stage 4 require further assessment for _______.

Answer 24

1) treatment protocol
2) surgical correction

Question 25

Treatment
Thrombosed external hemorrhoids

Answer 25

(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.

Question 26

Treatment
If seen in the first ____ hrs, removal of the clot may hasten symptomatic relief

Answer 26

24-48

Question 27

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.

Answer 27

a) lateral position
b) 30 gauge
c) clot
d) wound checks

Question 28

PE Findings
________ are visible as protuberant purple nodules covered by mucosa

Answer 28

Prolapsed hemorrhoids