Case 14 - Anal fissures, haemorrhoids, IBD, perianal abcess, fistula Flashcards
what are haemorrhoids
enlarged anal vascular cushions
why do haemorrhoids occur in pregnancy
most likely due to constipation, pressure from the baby in the pelvis and the effects of hormones that relax the connective tissue
what are anal cushions
specialised submucosal tissue that contain connections between the arteries and veins, making them very vascular.
what are anal cushions supported by
smooth muscle and connective tissue.
what do anal cushions help to do
control anal continence, along with the internal and external sphincters
what is the blood supply to anal cushions from
rectal arteries
where are anal cushions usually located
3, 7, and 11 oclock
what is a first degree haemorrhoid
no prolapse
what is a fourth degree haemorrhoid
prolapsed permanently
what are haemorrhoids often associated with
constipation and straining
what is the common presentation of haemorrhoids
painless, bright red bleeding, typically on the toilet papaer or seen after opening the bowels
in haemorrhoids, is the blood mixed with stool
the blood is not mixed with the stool, and if this is seen, it should make you think of an alternative diagnosis
what are the other symptoms of haemorrhoids
sore/itchy anus
feeling a lump around or inside the anus
what is visible on DRE for haemorrhoids
External (prolapsed) haemorrhoids are visible on inspection as swellings covered in mucosa
Internal haemorrhoids may be felt on a PR exam (although this is generally difficult or not possible)
They may appear (prolapse) if the patient is asked to “bear down” during inspection
what is required for proper visualisation and inspection
Proctoscopy is required for proper visualisation and inspection. This involves inserting a hollow tube (proctoscope) into the anal cavity to visualise the mucosa