Haemorrhoids Flashcards
(18 cards)
What are haemorrhoids?
Abnormally swollen varicose veins of vascular mucosal cushions in the anal canal caused by increased pressure on the haemorrhoids plexus.
What are common risk factors for developing haemorrhoids?
- Constipation
- Straining
- Age+
- Heavy lifting
- Chronic cough
- Conditions with raised intra-abdominal pressure (e.g. pregnancy, childbirth)
What are the two main types of haemorrhoids?
- External
- Internal
Where are external haemorrhoids located?
Below the dentate line.
What type of epithelium is found in external haemorrhoids?
Squamous epithelium with lots of pain fibres.
What symptoms are associated with external haemorrhoids?
- Itchy
- Painful
- Palpable external lump
- Anal pruritis
- Perinatal pain
- Thromboses (very painful)
Where are internal haemorrhoids located?
Above the dentate line.
Are internal haemorrhoids usually painful?
Not usually painful unless strangulated.
How are internal haemorrhoids graded?
Graded I-IV by degree of prolapse and whether they are reducible.
What are common symptoms of internal haemorrhoids?
- Painless bright red rectal bleeding
- Prolapse
- Pain (if strangulated)
- Anal itching/irritation
- Rectal fullness
What investigations can be done for haemorrhoids?
- PR Exam
- Proctoscopy
What is a differential diagnosis for bright red blood and sharp pain when defecating?
Anal fissure.
In an AF there is pain on defecation
What is the procedure to confirm a diagnosis of internal haemorrhoids?
Anoscopy.
What is the management approach if a patient presents with haemorrhoids < 72 hours?
Surgery.
What is the management approach if a patient presents with haemorrhoids > 72 hours?
Conservative management e.g. stool softeners and ice-packs
What are some conservative management strategies for haemorrhoids?
- Fluids and fibre intake
- Laxatives
- Increase fluid intake
- Avoid straining
What are some non-surgical treatments for haemorrhoids?
- Band ligation (Internal I-III)
- Sclerotherapy
- Diathermy
What surgical procedures are indicated for haemorrhoids?
- Haemorrhoidectomy (External, Internal III and IV, combined if not treated conservatively)
- Artery ligation (Internal III)
