Haemorroids Flashcards
Define haemorroids
Haemorroidal cushions are normal part of the anal canal. They are vascular-rich connective tissue sitting above the dentate line
As they enlarge, they can protrude out the canal-external haemorrhoids-and cause Sx (painless bleed, perianal pain and peri anal mass)
Aetiology and risk factors of haemorroids
Primary aetiology tends to be excessive straining due to constipation and/or diarrhoea. As the vascular tissue comes out, they engorge-and tear easily causing bleeds. might need manual reduction
grade 1-in canal
grade 2-beyond canal but reduces on its own
grade 3-need manual reduction
grade 4-cant reduce them
Risk factors: White>black peak age-45-65 Hx of contraption or diarrhoea Pregnancy Mass occupying lesion in abdomen
Epidiemology of Haemmoroids
about 4% of the us, more among white than black
peak age-45-65
Unexpliquable decreasing in prevalence
Signs and Sx of Haemoroids
Rectal bleeding-bright red blood on paper-can be painless Painful perianal (associated with feelings of incomplete evacuation)
Anal itchyness/puritis
Anal mass visible and feelable on DRE
Investigations for Haemorroids
Just look-observation-diagnostic
DRE-feel the mass
FBC-microcytic aneamia
FIT-positive
sigoidoscopy should be normal-suggested to exclude other path
Management of haemorrodis
Aim for relief of Sx
Mild intermittent bleeding-diet and exercise can be enough
Topical steroids can help the itch
endoscopic examination is suggested
external haemorroids-
photocoagulation (small ones), rubber band ligation (stage 2 or 3)
Surgical haemorrectomy for stage 4
Complications of heamorroids
Aneamia-microcytic aneamia from the bleed
QOL decrease
Acute thrombosis of the haemoroids-analgesia and possible surgery
Faecal incontinence (mainly farts, but can go to poop)
Pelvis sepsis-rarer but need to be aware
Prognosis of haemorrhoids
Good. Most Mx of Sx leads to disappearance of it, with low reacurance
Surgery offers the best longterm change
followed by rubber band ligation
