Haemorrhoids (piles) Flashcards Preview

Liver + GI > Haemorrhoids (piles) > Flashcards

Flashcards in Haemorrhoids (piles) Deck (19):
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

4th degree

remain persistently prolapsed