Hemorrhoids Flashcards

1
Q

Where are internal hemorrhoids?

A

Above the dentate line

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2
Q

Do internal hemorrhoids have nervous innervation?

A

Nope

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3
Q

Where are external hemorrhoids located?

A

Below the dentate line

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4
Q

What causes external hemorrhoids to be painful?

A

They possess nervous innervation and are painful when thrombosed

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5
Q

Hemorrhoidal venous cushions contribute what to the anal canal?

A

Normal anal pressures and ensure a water tight closure of the anal canal

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6
Q

Internal hemorrhoids commonly occur in which 3 primary locations?

A

Right anterior, right posterior and left lateral

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7
Q

What can cause hemorrhoids?

A

Straining at stool, constipation, prolonged sitting, pregnancy, obesity and low fiber diets

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8
Q

Thrombosis of external hemorrhoids results in?

A

Perianal hematoma

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9
Q

What condition is characterized by acute onset, exquisitely painful, tense and bluish perianal nodule that may be several centimeters in size?

A

Perianal hematoma

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10
Q

How long does the pain last in a perianal hematoma?

A

Most severe in first few hours but gradually eases over 2-3 days

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11
Q

What are the stages of internal hemorrhoids?

A

Stage 1: Confined to anal canal
Stage 2: Enlarges and protrudes from anal canal, reduces spontaneously
Stage 3: May require manual reduction
Stage 4: Chronically protruding and unresponsive to manual reduction

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12
Q

A sense of full ness, or discomfort and mucoid perianal discharge and soiling of underclothes may result from what condition?

A

Chronically prolapsed hemorrhoids

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13
Q

What imagining should be done on patients with hematochezia?

A

Colonoscopy

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14
Q

What is initial treatment of external hemorrhoids?

A

Sitz baths

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15
Q

If seen in the first 24-48 hours, what may hasten symptomatic relief?

A

Removal of clot

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16
Q

Describe the procedure of removing of clot from a hemorrhoid

A

Place patient in lateral position
Anesthetize with 1% lidocaine with a TB syringe, 30g needle
Eclipse skin and evacuate clot
Dry gauze dressing for 12-24hrs w/ sitz baths

17
Q

What conservative treatment may be done on patients with stage 1 or stage 2 hemorrhoids?

A

High fiber diet, increase fluid intake
Ex. Bran powder, benefiber, Metamucil, Citrucel

18
Q

For 5-10% of patients with stage 3 and stage 4 hemorrhoids, what procedure should e done?

A

Surgical excision (hemorrhoidectomy)

19
Q

What is definitive treatment for internal hemorrhoids?

A

Surgical banding

20
Q

Should surgical banding be done on external hemorrhoids?

A

No, it is done on internal hemorrhoids due to lack of nervous innervation