Flashcards in Haemorrhoids (piles) Deck (19)
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1
what are piles?
Disrupted and dilated anal cushions
2
what are anal cushions?
3 discontinuous masses of spongy vascular tissue that line the anus
they contribute to anal closure
3
how are the anal cushions attached?
by smooth muscle and elastic tissue
prone to disruption and displacement
4
what 3 things make the cushions bulky + loose (and then protrude to form piles?
the effects of:
1. gravity
2. increased anal tone (?stress)
3. effects of straining stool
5
are piles varicose veins?
NO
6
why is the blood they bleed bright red?
its from capillaries
(of the underlying lamina propria)
7
why are piles not painful?
there are no sensory fibres above the dentate line (squamomucosal junction)
8
cause of piles
constripation + straining
bowel habit may be normal
9
vicious cycle of pathogenesis
protrusion of vascular cushions through a tight anus
become more congested + hypertrophy to protrude again more readily
protrusions may then strangulate
10
symptoms
bright red rectal bleeding
severe anaemia
11
What should you to investigate any rectal bleeding?
abd exam
PR exam
proctoscopy
sigmoidoscopy
12
Tx medical (1st degree)
increase fluid + fibre
topical analgesics
stool softener
13
Tx non-operative (2nd & 3rd degree, or 1st if medication has failed)
rubber band ligation- produces an ulcer to anchor the mucosa
sclerosants
infra-red coagulation- coagulates vessels + tethering mucosa to subcut tissue
14
Tx surgical
excision haemorrhoiectomy
15
surgical complications
constipation
infection
stricture
bleeding
16
1st degree h
remain in the rectum
17
2nd degree h
prolapse through the anus on defection but spontaneously reduce
18
3rd degree
as for 2nd degree but require digital reduction
19
