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ANKI GI > [15] Haemorrhoids > Flashcards

[15] Haemorrhoids Flashcards

1
Q

What are haemorrhoids?

A

Abnormal swellings or enlargement of the anal vascular cushions

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2
Q

What is the purpose of the anal vascular cushions?

A

They act to assist the anal sphincter in maintaining continence

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3
Q

How many vascular cushions are there in the anus?

A

3

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4
Q

Where are the vascular cushions in the anus positioned?

A

3-, 7-, and 11- o’clock position (when looked at with the patient in the lithotomy position)

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5
Q

What happens when the vascular cushions in the anus become abnormally enlarged?

A

They can cause symptoms and become pathological, termed haemorrhoids

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6
Q

What is the prevalence of haemorrhoids?

A

It varies, mainly due to the wrong attribution of anorectal symptoms

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7
Q

When is the peak prevalence of haemorrhoids?

A

45-65 years

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8
Q

What are haemorrhoids classified according too?

A

Their size

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9
Q

What is a 1st degree haemorrhoid?

A

One that remains in the rectum

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10
Q

What is a 2nd degree haemorrhoid?

A

One that prolapses through the anus on defecation, but spontaneously reduces

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11
Q

What is a 3rd degree haemorrhoid?

A

One that prolapses through the anus on defecation, but requires digital reduction

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12
Q

What is a 4th degree haemorrhoid?

A

One that remains persistently prolapsed

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13
Q

What is the cause of most haemorrhoids?

A

Most are idiopathic

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14
Q

What are the main risk factors for the development of haemorrhoids?

A

Excessive straining
Increasing age
Raised intra-abdominal pressure

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15
Q

What can cause excessive staining?

A

Chronic constipation

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16
Q

What can cause raised intra-abdominal pressure leading to haemorrhoids?

A

Pregnancy
Chronic cough
Ascites

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17
Q

What are the less common risk factors for haemorrhoids?

A

Pelvic or abdominal masses
Family history
Cardiac failure
Portal hypertension

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18
Q

How do haemorrhoids typically present?

A

Painless bright red bleeding
Pruritis
Prolapse
Soiling

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19
Q

Describe the features of the blood in haemorrhoids

A

It commonly occurs after defecation, and is often seen either on the paper or covering the pan
Blood is seen on the surface of the stool, not mixed in

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20
Q

What causes pruritis in haemorrhoids?

A

Chronic mucus discharge and irritation

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21
Q

How does prolapse in haemorrhoids present?

A

As rectal fullness or an anal lump

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22
Q

What causes soiling in haemorrhoids?

A

Impaired continence or mucus discharge

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23
Q

What can happen to large prolapsed haemorrhoids?

A

They can thrombose

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24
Q

How does a thrombosed haemorrhoid present?

A

It is incredibly painful, and these patients frequently present acutely as an emergency patient

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25
Q

What will be found on examination with haemorrhoids?

A

Examination will usually be normal unless the haemorrhoids have prolapsed

26
Q

How will a thrombosed prolapsed haemorrhoid present?

A

As a purple/blue, oedematous, tense, and tender palpable mass

27
Q

What is it important to exclude when a patient presents with suspected haemorrhoids?

A

Other causes of rectal bleeding, such as malignancy, inflammatory bowel disease, or diverticular disease

28
Q

What other perianal differentials should be considered in a patient with suspected haemorrhoids?

A 
Fissure-in-ano
Perianal haematoma
Perianal abscess
Skin tag
Prolapsing rectal polyps
29
Q

What investigations may be done in haemorrhoids?

A

Proctoscopy
FBC
Flexible sigmoidoscopy or colonoscopy

30
Q

What is the purpose of proctoscopy in haemorrhoids?

A

To confirm the diagnosis

31
Q

Why may a FBC be required in haemorrhoids?

A

If there is any significant/prolonged bleeding, or signs of anaemia

32
Q

What is the purpose of a flexible sigmoidoscopy or colonoscopy in haemorrhoids?

A

May be considered to exclude malignancy or polyps

33
Q

What % of haemorrhoids can be managed conservatively?

A

95%

34
Q

What is involved in the conservative management of haemorrhoids?

A

Lifestyle changes
Laxatives if necessary
Topical analgesia

35
Q

What lifestyle advice should be given in haemorrhoids?

A

Increasing daily fibre and fluid intake

36
Q

Give an example of a topical analgesia used in haemorrhoids?

A

Lignocaine gel

37
Q

Why should oral opioids be avoided in haemorrhoids?

A

As they can compound any constipation

38
Q

How can symptomatic 1st degree and 2nd degree haemorrhoids be treated?

A

Rubber-band ligation

39
Q

What happens in rubber band ligation?

A

The haemorrhoid is drawn into the end of a suction gun, and rubber band is placed over the neck of the haemorrhoid

40
Q

What are the main complications of rubber band ligation?

A

Recurrence
Pain
Bleeding

41
Q

When will rubber band ligation cause pain?

A

If the band is mistakenly placed below the dentate line

42
Q

When does bleeding normally occur following rubber-band ligation?

A

Approximately 10 days

43
Q

Why does bleeding occur approximately 10 days after rubber band ligation?

A

Because this is when the band and haemorrhoid drops off

44
Q

What can rarely happen with the bleeding following a rubber band ligation of haemorrhoids?

A

It can be severe, and require surgical intervention

45
Q

What are the other options for non-surgical intervention for haemorrhoids?

A

Infrared coagulation/photocoagulation
Bipolar diathermy
Direct-current electrotherapy
Haemorrhoid artery ligation

46
Q

When will rubber band ligation cause pain?

A

If the band is mistakenly placed below the dentate line

47
Q

When does bleeding normally occur following rubber-band ligation?

A

Approximately 10 days

48
Q

Why does bleeding occur approximately 10 days after rubber band ligation?

A

Because this is when the band and haemorrhoid drops off

49
Q

What can rarely happen with the bleeding following a rubber band ligation of haemorrhoids?

A

It can be severe, and require surgical intervention

50
Q

What to patients often want in terms of management of their haemorrhoids?

A

Just want reassurance that bleeding is not caused by malignancy, and are not too troubled by their symptoms. Reassurance alone may therefore by sufficient management for many people

51
Q

What is good about haemorrhoidal artery ligation?

A

It has an effectiveness level similar to that of surgical interventions

52
Q

Why may a patient choose rubber-band ligation over haemorrhoidal artery ligation?

A

HAL is more painful, therefore patients may prefer a course of RBL to the more invasive HBL

53
Q

What % of patients with haemorrhoids will eventually need a haemorrhoidectomy?

A

5%

54
Q

When is a haemorrhoidectomy indicated?

A

If patients are symptomatic and not responding to conservative therapies, yet are unsuitable for banding/injection

55
Q

What class of haemorrhoids typically are more likely to need haemorrhoidectomies?

A

3rd and 4th degree

56
Q

What are the techniques used in haemorrhoidectomy?

A

Stapled haemorrhoidectomy

Milligan Morgan haemorrhoidectomy

57
Q

What are the main complications of haemorrhoidectomies?

A 
Bleeding
Infection
Constipation 
Stricture
Anal fissures 
Faecal incontinence
58
Q

Is a haemorrhoidectomy a painful procedure?

A

Yes, notoriously so

59
Q

What are the complications of haemorrhoids?

A

Ulceration due to thrombosis
Skin tags
Ischaemia, thrombosis, or gangrene
Perianal sepsis

60
Q

When may ischaemia, thrombosis, or gangrene occur in haemorrhoids?

A

4th degree internal haemorrhoids

ANKI GI (43 decks)

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