haemorrhoids Flashcards
Define haemorrhoids
anal vascular cushions become enlarged and engorged with a tendency to protrude, bleed or prolapse in the anal canal
where is Haemorrhoidal tissue present?
present at 3, 7 and 11 o’clock
how to classify Haemorrhoids?
- internal
• Lie ABOVE the dentate line, can be painful - external
not often painful
what are the degrees of haemorrhoids?
Grade I=
Do not prolapse out of the anal canal
Grade II= Prolapse on defecation but reduce spontaneously
Grade III = Prolapse but can be manually reduced
Grade IV = Prolapse but cannot be reduced
what are the risk factors for haemorrhoids ?
o Constipation o Prolonged straining o Derangement of the internal anal sphincter o Pregnancy o Portal hypertension
epidemiology for haemorrhoids?
- COMMON
* Peak age: 45-65 yrs
presenting symptoms of haemorrhoids?
• Usually ASYMPTOMATIC • Bleeding o Bright red blood on the toilet paper and drips into the pan o Blood will NOT be mixed with the stool o Painless bleeding • Itching • Anal lumps • Prolapsing tissue
what are the signs of haemorrhoids ?
- Haemorrhoids are usually visible on proctoscopy
- some can be felt on DRE
what is the nature of thrombosed haemorrhoids?
purple , oedematous, very tender masses
investigations for haemorrhoids ?
- DRE
- Proctoscopy
- Rigid or flexible sigmoidoscopy
managing haemorrhoids?
- Soften stools: increase fibre and fluids
- Topical local anaesthetics and steroids
- Rubber band ligation
- Injection sclerotherapy
- Surgery
how to manage thrombosed haemorrhoids?
• If patient presents within 72 hours then referral should be considered for excision
managed with stool softeners, ice packs and analgesia
• Symptoms settle within 10 days
complications of haemorrhoids ?
- Bleeding
- Prolapse
- Thrombosis
- Gangrene
prognosis for haemorrhoids ?
- Often CHRONIC
* High rate of recurrence
