Haemorrhoids

Question 1

What is a haemorrhoid?

Answer 1

A haemorrhoid is an enlargement of the vascularity of the anal cushions in the anal canal.
The anal cushions increase in size and can project distally, both within the anal canal and externally

Question 2

What is the aetiology behind haemorrhoids?

Answer 2

Associated with constipation (it is thought haemorrhoids can develop as a result of straining)
Often develop for the first time during pregnancy.
Caused by congestion of the internal and/or external venous plexuses in the anal region.

Question 3

What is the name of the classification system for haemorrhoids?

Answer 3

Goligher’s classification

Question 4

What is defined as first degree haemorroids?

Answer 4

anal cushions bleed but remain in the rectum (no prolapse)

Question 5

What is defined as second degree haemorrhoids?

Answer 5

prolapse of haemorrhoids on defaecation or straining (spontaneously reduces)

Question 6

What is defined as third degree haemorrhoids?

Answer 6

prolapse of haemorrhoids on defaecation or straining (requires manual reduction)

Question 7

What is defined as fourth degree haemorrhoids?

Answer 7

prolapse remains at all times and is irreducible

Question 8

What are the 5 risk factors for haeorrhoids?

Answer 8

1. Constipation
2. Increased age
3. Increased abdominal pressure, such as pregnancy and labour
4. Diarrhoea
5. High BMI

Question 9

What are 5 typical symptoms of haemorrhoids?

Answer 9

1. Pruritis ani
2. Rectal bleeding
3. palpable lump in or around anus
4. Pain
5. Discomfort around the anus, fullness or feeling of incomplete defaecation (tenesmus)

Question 10

What are anal cushions?

Answer 10

specialised mucosal tissue that contain connections between arteries and veins

Question 11

What is the function of anal cushions?

Answer 11

They help control continence with the internal and external sphincters

Question 12

What artery supplies the anal cushions?

Answer 12

Rectal arteries

Question 13

How is the location of haemorrhoids described?

Answer 13

using a clock face (12 o’clock is towards the genitals and 6 o’clock is toward the back)

Question 14

In which 3 clock face positions are haemorrhoids most commonly found?

Answer 14

1) 3 o’clock
2) 7 o’clock
3) 11 o’clock

Question 15

Describe 2 examination findings associated with haemorrhoids:

Answer 15

1) external (prolapsed) haemorrhoids are visible on inspection
2) internal haemorrhoids may be felt on a perirectal exam

Question 16

What investigation can be used for proper inspection of haemorrhoids?

Answer 16

protoscopy

Question 17

Give 4 differential diagnoses for a haemorrhoid-like presentation:

Answer 17

1) anal fissures
2) diverticulosis
3) inflammatory bowel disease
4) colorectal cancer

Question 18

What investigation is used to rule out colorectal cancer?

Answer 18

Faecal immunochemical test

Question 19

Name 3 topical symptom relievers for haemorrhoids:

Answer 19

1) anusol
2) Germoloid’s cream
3) Proctosedyl ointment

Question 20

How does Germoloid’s cream relieve haemorrhoid symptoms?

Answer 20

it contains lidocaine, a local anaesthetic

Question 21

How does proctosedyl ointment relieve haemorrhoid symptoms?

Answer 21

it contains hydrocortisol and cinchocaine anaesthetic

Question 22

Name 4 non-surgical treatments for haemorrhoids:

Answer 22

1) rubber band ligation
2) injection sclerotherapy
3) infra-red coagulation
4) bipolar diathermy

Question 23

What is rubber band ligation?

Answer 23

A tight rubber band is fitted around the base of the haemorrhoid to cut off the blood supply

Question 24

Describe injection sclerotherapy:

Answer 24

an injection of phenol oil is made into a haemorrhoid to cause sclerosis and atrophy

Question 25

Describe infra-red coagulation:

Answer 25

infra-red light is applied to the haemorrhoid to damage to blood supply and cause its destruction

Question 26

Describe bipolar diathermy:

Answer 26

electrical current is applied to destroy a haemorrhoid

Question 27

Name 3 surgical treatments for haemorrhoids:

Answer 27

1) haemorrhoidal artery ligation
2) haemorrhoidectomy
3) stapled haemorrhoidectomy

Question 28

Describe haemorrhoidal artery ligation:

Answer 28

using a proctoscope to identify the blood vessel that supplies the haemorrhoids and suturing to cut off the blood supply

Question 29

Describe a staple haemorrhoidectomy:

Answer 29

excising the haemorrhoid using a special device that simultaneously adds a circle of staples into the anal canal

Question 30

Give 4 lifestyle changes that can prevent/ treat haemorrhoids:

Answer 30

1) increasing dietary fibre
2) maintaining a good fluid intake
3) using laxatives when required
4) avoiding straining when using the toilet

Question 31

What causes thrombosed haemorrhoids?

Answer 31

thrombosed haemorrhoids?
strangulation at the base of the haemorrhoid causing coagulation

Question 32

How do thrombosed haemorrhoids present?

Answer 32

painful, purplish swollen lumps found around the anus