Hemorrhoids Flashcards
Patho
Arise from plexus or cushion of dilated channels and connective tissue
External
- distal/ below dentate line
- painful due to sensation is epithelialized skin
Internal
- above the dentate line
- less painful because its intestinal
Mixed
proximal and distal to dentate line
Classification of internal
Grade 1- visualized on anoscopy; may bulge into lumen but doesn’t prolapse below dentate line
Grade 2- prolapse out of anal canal with defecation or with straining but reduces spontaneously
Grade 3- prolapse out of anal canal with defecation/ straining and requires manual reduction
Grade 4- irreducible and may strangulate
RF
- aging
- diarrhea
- pregnancy
- pelvic tumors
- prolonged sitting
- straining, chronic constipation
- anticoag/antiplatelet therapy
Clinical
- Asymptomatic
- painless bleeding; bright red blood per rectum
- anal pruritis
- prolapse
- pain due to thrombosis
Dx tools
Visulaization
Digital Rectal exam
Anoscopy
Endoscopy
Essentials for DX
Suspect with: - bright red blood per rectum - anal pruritis - acute onset perianal pain Visualize hemorrhoids
Tx
Dietary- increase water and fiber intake
Toilet habits- avoid lingering
Sitz bath- soaks anus and keeps it clean
Office Tx
- banding
- coagulation
- sclerotherapy
Initial Tx External and Grade 1/2
- Dietary therapy
- educate about toilet habits
- oral/ local analgesic
- topical agents to reduce swelling/ treat dermatitis (topical astringent and protectants, topical corticosteriods, topical antiinflammatory agents)
- Decrease sphincter spasms (antispasmotic)
- Venoactive agents to increase venous tone
- Banding
Who gets surgery?
- sx despite conservative measures
- grade 4 (+/-) strangulation
- Grade 3 with symptoms
- severe pain with thrombosis
Surgical Tx
- hemorrhoidectomy
- hemorrhoidal artery ligation
- staple hemmorrhoidectomy
Tx Thrombosed Hemorrhoids
Excision and I&D
