Haemorrhoids Flashcards
(23 cards)
ESSENCE
Enlarged vascular cushions
AETIOLOGY
Risk factors
- Age 45-65
- Constipation - causes chronic straining
- Pregnancy or space occupying lesion
- Obesity
- Increased intra-abdominal pressure (weightlifting or chronic coughing)
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ANATOMY
What are anal cushions
Specialised submucosial tissue that contains connections between arteries and veins, making them very vascular
Supported by smooth muscle and connective tissue
Help control anal incontinence
Where are anal cushions located (clock face)
- If patient in lithotomy position (on back legs raised)
- Located at 3, 7 and 11 oclock
CLASSIFICATION
- 1st degree
- No prolapse
- 2nd degree
- Prolapse when straining and returning on relaxing
- 3rd degree
- Prolapse when straining, do not return on relaxing but can be pushed back
- 4th degree
- Permanently prolapsed
CLINICAL FEATURES
Presentation
- May be asymptomatic
- Often associated with constipation and straining
- Common presentation is painless, bright red bleeding
- Blood not mixed with stool
- Sore/itchy anus
- Feeling lump around or inside anus
CLINICAL FEATURES
Examination findings
- External (prolapsed)
- Visible on inspection as swellings covered in mucosa
- Internal
- May be felt on PR exam
- May appear if patient asked to bear down
INVESTIGATION
First choice
Proctoscopy
MANAGEMENT
General principles
- Consider differential diagnosis for patients presenting with rectal bleeding
- Consider testing for anaemia
- Topical treatments can be given for symptomatic relief
- Treatment for prevention of constipation
- Non-surgical treatment for haemorrhoids
- Surgical treatment for haemorrhoids
MANAGEMENT
Topical treatments for symptomatic relief
- Anusol (contains chemicals to shrink haemorrhoid - astringents)
- Anusol HC (also contains hydrocortisone, used short term)
- Germaloids cream (contains lidocaine, local anaesthetic)
- Proctesedyl ointment (contains cinchocaine and hydrocortisone, short term)
MANAGEMENT
Prevention and treatment of constipation
- Increase fibre in diet
- Maintain good fluid intake
- Use laxatives as required
- Consciously avoiding straining when opening bowels
MANAGEMENT
Non-surgical treatment for haemorrhoids
- Subber band ligation
- Injection sclerotherapy
- Infra-red coagulation
- Bipolar diathermy
What is rubber band ligation
Fitting a tight rubber band around base of haemorrhoid to cut blood supply
What is injection sclerotherapy
Injection of phenol oil into the haemorrhoid to cause sclerosis and atrophy
What is infra-red coagulation
Infra red light applied to damage blood supply
What is bipolar diathermy
Electrical current applied directly to haemorrhoid to destroy it
MANAGEMENT
Surgical options
- Haemorrhoid artery ligation
- Haemorrhoidectomy
- Stapled haemorrhoidectomy
What is haemorrhoidal artery ligation
Proctoscope to identify bloods vessels that supplies haemorrhoid, suturing to cut it off
What is stapled haemorrhoidectomy
Using special device to excise ring of haemorrhoid tissue at same time as adding circle of staples in anal canal, which stay in place long term
Key complication
- Thombosis - thrombosed haemorrhoids
- Caused by strangulation at base of haemorrhoid
Presentation of thrombosed haemorrhoids
- Can be very painful
- Appear as purplish, very tender, swollen lumps around anus
Treatment of thrombosed haemorrhoids
Resolve with time, although can take weeks
