Hemorrhoids pg 2156 Flashcards
What is the dividing line for hemorrhoids being internal or external? Which is which?
internal hemorrhoids are above the dentate line
external hemorrhoids are below the dentate line
do internal or external hemorrhoids have nerve innervation?
external
three primary locations of internal hemorrhoids?
right anterior, right posterior, and left lateral.
they lack a nerve supply so they are not painful.
External hemorrhoids arise from veins located where?
inferior hemorrhoidal veins located below dentate line. covered with squamous epithelium of the anal canal and perianal region.
Are painful when thrombosed.
conditions or activities that contribute to hemorrhoids
anything that increases venous pressure resulting in distention or engorgement
e.g. straining, constipation, prolonged sitting, pregnancy, obesity, low fiber diets.
What causes a perianal hematoma?
thrombosis of the external hemorrhoidal plexus. (coughing, heavy lifting, straining)
acute onset and painful first few hours, subsides over 2-3 days.
Stages of Internal Hemorrhoids:
Stage I- internal hemorrhoids confined to internal canal
Stage II- prolapse with straining, with spontaneous reduction
Stage III- prolapsed hemorrhoids with manual reduction after movements
Stage IV- chronically protruding and unresponsive to manual reduction
What is the one RAD to be performed for hemorrhoids?
Colonoscopy should be performed in all patients with hematochezia to exclude disease in the rectum or sigmoid colon that could be misinterpreted in presence of hemorrhoidal bleeding.
Treatment for hemorrhoids
warm sitz bath
analgesia and ointments
removal of clot within 24-48 hrs
gentle manual reduction e.g. suppositories or tucks pads
surgical excision is reserved for severe stage III and IV.
procedure for removal of hemorrhoid clot
lateral position
1% lidocaine, TB syringe, 30 G needle
ellipse of skins, evacuate clot
dry gauze for 12-24 hrs. daily sitz bath
F/U daily until healed.
