Haemorrhoids

Question 1

what are haemorrhoids

Answer 1

anal vascular cushions become enlarged and engorged with a tendency to protrude, bleed or prolapse in the anal canal

Question 2

what are the two types of haemorrhoids

Answer 2

internal and external

Question 3

difference between internal and external haemorrhoids

Answer 3

internal haemorrhoids arise from the superior haemorrhoidal plexus and lie ABOVE the dentate line. external ones lie BELOW the dentate line

internal ones tend to bleed but don’t cause pain, external ones cause pain

Question 4

what is the dentate line

Answer 4

a line that divides the upper 2/3 and Lower 1/3 of the anal canal and represents the handout-proctodeum junction

Question 5

degree of haemorrhoids

Answer 5

1st degree - no prolapse
2nd degree - prolapse with defaection and reduce spontaneously
3rd degree- prolapse with manual reduction
4th degree - prolapsed haemorrhoid which cant be reduced

Question 6

aetiology of haemorrhoids

Answer 6

disorganisation of the fibromuscular stroma of anal cushions

Question 7

risk factors for developing haemorrhoids

Answer 7

constipation, prolonged straining, portal hypertension, pregnancy and deranged of internal anal sphincter

Question 8

epidemiology

Answer 8

common

peak ages 45-65 years

Question 9

presenting symptoms of haemorrhoids

Answer 9

usually asymptomatic

bleeding (bright red on TOILET paper, will not mix with stool)
itching, anal lumps and prolapsing tissue

Question 10

what symptoms will there NOT be in someone with only haemorrhoids

Answer 10

no symptoms such as weight loss, anaemia, change in bowel habit, stool with blood/mucus

Question 11

physical examination

Answer 11

1st or 2nd degree haemorrhoids are usually not visible on external inspection
internal haemorrhoids are NOT normally palpable on a digital rectal examination UNLESS THROMBOSED

Question 12

what screening can be used to view haemorrhoids

Answer 12

proctoscopy

Question 13

differential diagnoses for haemorrhoids

Answer 13

anal tags, anal fissure, rectal prolapse, polyps and tumours

Question 14

investigations

Answer 14

DRE (digital rectal examination)
proctoscopy
rigid or flexible sigmoidoscopy

IMPORTANT TO EXCLUDE A RECTAL/SIGMOID SOURCE OF BLEED

Question 15

conservative management plan

Answer 15

high-fibre diet, lots of water, no straining, bulk laxatives

Question 16

non surgical treatments

Answer 16

injection sclerotherapy- it induces fibrosis of the dilated veins

banding- rubber band ligation; Barrons bands are applied proximal to the haemorrhoids, they fall off after a few days

Question 17

surgical treatments

Answer 17

for 3rd/4th degree prolapsed haemorrhoids
milligan-morgan haemorrhoidectomy; excision of three haemorrhoidal cushions
stapled haemorrhoidectomy is an alternative method

Question 18

what should patients be given after haemorrhoidectomy

Answer 18

laxatives to prevent constipation

Question 19

possible complications of haemorrhoids

Answer 19

bleeding, prolapse, thrombosis, gangrene

Question 20

possible complications of injection sclerotherapy

Answer 20

prostatitis, perineal sepsis, impotence, retroperitoneal sepsis, hepatic abscess

Question 21

possible complications of surgical haemorrhoidectomy

Answer 21

pain, bleeding, incontinence and anal stricture

Question 22

prognosis

Answer 22

often chronic and high rate of reoccurrence

surgery is long term relief