Hemorrhoids Flashcards
Hemorrhoids clinical features
*protruding anal mass whichi s usually painless, bleeding during defecation, boil around anus, anal tear
* Associated symptoms: itching, bowel habit changes,
fever, weight
loss, anemia, tenesmus
Causes of hemorroids
portal hypertension, multiparty, constipation, chronic cough,
malignancy (colorectal cancer), occupation like heavy weight lifting, pregnancy
Signs to see physically on the patient
abdominal mass, skin rashes, scarring, discolouration, lumps
Investigations for hemorrhoids
DRE (rectal wall mass, decreased anal
rectal tone), proctoscopy, FBC, colonoscopy, bariumenema, swab m/c/s
Classification of hemorroids
a.Based on position: primary (3’, 7’, 11), secondary (located between primary sites)
B. Based on etiology: primary (etiology), secondary (based on known causes commonly
t u m o r )
C. Grading
1st degree: internal, it bleeds but does not prolapse
2nd degree: it
prolapses
but returns spontaneously
3rd degree: prolapses but can manually be reduced
4 degree: permanently prolapsed
D. Types: Internal (above the dentate line), External (below the dentate line)
Treatment of hemorrhoids conservative
Conservative: diet adjustment, sitz bath, Pharmacological: antibiotics, laxatives (motilinum, magnesium sulphate, aluminum sulphate), NSAIDs, analgesics
Surgical treatment
Lord’s dilatation ( 4 degree)
Sclerosing therapy
Band ligation (Pelvic abscess and fistula, 2nd degree) Cryosurgery Infrared coagulation Laser therapy
Hemorrhoidectomy
Indication for hemorrhoidectomy
3rd and4 *degrees
- Failure of conservative treatment
- fibrosed hemorrhoids
Complications of hemorroids
strangulation, ulceration, thrombosis, gangrenous, fibrosis, anal stenosis,
suppuration
Complications of surgery
Complications of surgery:
urinary retention, infection, renal stenosis, stricture
