HEMORRHOIDS Flashcards
Pathophysiology
Engorgement, prolapse or thrombosis of the internal or external hemorrhoidal veins
Clinical Features
Painless rectal blood covering stool +/- Dripping into toilet bowl
Mild fecal incontinence, musuc discharge, wetness, sensation of perianal fullness in the perianal area with prolapsed internal hemorrhoids
Irritation or itching of the perianal area
perianal pain and a palpable perianal “lump” from thrombosis
Red Flags
Severe intractable pain
Continued bleeding
Incarceration
Strangulation
Weight loss
Night sweats
DDx
Anal tags
Perianal Abscess
Fistula in Ano
Cryptitis
Proctitis
Anal Fissures
Anorectal Tumor
Management of irritation or pruritis
Topical Hydrocortisone 1% cream bid for 2 weeks
Warm sitz baths
Bulking agent
Limit treatment to 1 week
Management of bleeding hemorrhoids
Dietary Modification
External creams
Office procedures for persistently bleeding hemorrhoids
Management of thrombosed hemorrhoids
Watch and wait (resorption occured witin 3-5 days)
Excision of thrombosis for persistent / severe pain
Management of prolapsed internal hemorrhoids
Grade III-IV:
Rubber band ligation
Surgery
Surgical Management of thrombosed painful hemorrhoids (<48 hrs)
Clot excision
Describe clot excision
Local anesthetic with long acting local
Elliptical skin incision
Removal of the clot
Packing and pressure dressing
Removal of dressing after 6 hrs with sitz bath
Conservative treatment for all patients
Increased fiber: dietary insoluble fiber OR metmucil
Hydrocortisone 1% cream or suppository 25 mg
Hydrocortisone - Lidocaine Cream (2.8%-5.5%)
Sitz baths 15 min tid and after defecation
Indications for referral to surgery
Symptomatic low grade (I-II) internal hemorrhoids refractory to 6-8 weeks treatment
Symptomatic high grade (III-IV) internal hemorrhoids
