Haemorrhoids Flashcards

1
Q

What are clinical haemorrhoids

A

Clinical haemorrhoids = enlargement of the haemorrhoidal cushions that protrude outside the anal canal to cause symptoms

Haemorrhoidal cushions = normal anatomical structure located within the anal canal, usually occupying the left lateral and right anterior and posterior positions.

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2
Q

Aetiology of haemorrhoids

A

Excessive/repetitive/prolonged straining (chronic constipation, diarrhoea)
Causes downward stress on vascular haemorrhoids cushions -> haemorrhoids pulled lower -> cushions engorge -> thin epithelial lining tears -> bleeding -> enlargement -> protrusion -> tenesmus

Also increased intra-abdominal pressure (pregnancy, ascites)
Presence of SOL in the pelvis

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3
Q

Risk factors for Haemorrhoids

A

45-65
Constipation
Pregnancy or SOL, pelvis
Hepatic insufficiency
Ascites

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4
Q

What is the grading system for Haemorrhoids

A

Grade 1 - protrusion is limited to within the anal canal, no prolapse

Grade 2 - protrudes beyond the anal canal but spontaneously reduces on cessation of straining.

Grade 3 - protrudes outside the anal canal and reduces fully on manual pressure.

Grade 4 - protrudes outside the anal canal and is irreducible.

External = located in the distal canal, distal to the dentate line and covered by sensate anoderm or skin

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5
Q

Symptoms of Haemorrhoids

A

Rectal bleeding - often PAINLESS (bright red blood on defection/straining/cleaning/on bowl)
Peri-anal pain/discomfort (severe in thrombosed external haemorrhoids, painless above the dentate line, painful below)
Tenesmus
Anal pruritus
Palpable mass

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6
Q

Signs of Haemorrhoids on examination

A

tender palpable peri-anal lesion

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7
Q

Investigations for Haemorrhoids

A

Anoscopic examination: shows haemorrhoids

Stool for occult haem: +ve (unnecessary unless nothing seen on exam)

FBC: may show anaemia (prolonged bleeding)

Colonoscopy/flexible sigmoidoscopy: usually normal, may reveal other pathologies

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8
Q

Management for Haemorrhoids

A
Conservative: diet and lifestyle mods
Increase fibre 20-30g
Adequate fluid intake
Avoid straining on spending excessive time on the toilet
Moist and gentle cleaning

Grade I - topical corticosteroids e.g. hydrocortisone
Grade II - Rubber band ligation, sclerotherapy, infrared photocoagulation, haemorrhoids arterial ligation, stabled haemorrhoidoplexy
Grade III - rubber band ligation, stabled haemorrhoidoplexy
Grade IV - Surgical haemorrhoidectomy

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9
Q

Complications of Haemorrhoids

A

Anaemia
Thrombosis
Incarceration
Faecal incontinence
Pelvic sepsis
Anal stenosis

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10
Q

Prognosis of Haemorrhoids

A

Good prognosis after treatment
Low rates of recurrence, although residual symptoms or recurrent symptoms may occur
Surgical haemorrhoidectomy confers the best long-term effect

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