Hemorrhoids Flashcards Preview

Clin Med 2 > Hemorrhoids > Flashcards

Flashcards in Hemorrhoids Deck (16):
1

Patho

Arise from plexus or cushion of dilated channels and connective tissue

2

External

- distal/ below dentate line
- painful due to sensation is epithelialized skin

3

Internal

- above the dentate line
- less painful because its intestinal

4

Mixed

proximal and distal to dentate line

5

Classification of internal

Grade 1- visualized on anoscopy; may bulge into lumen but doesn't prolapse below dentate line
Grade 2- prolapse out of anal canal with defecation or with straining but reduces spontaneously
Grade 3- prolapse out of anal canal with defecation/ straining and requires manual reduction
Grade 4- irreducible and may strangulate

6

RF

- aging
- diarrhea
- pregnancy
- pelvic tumors
- prolonged sitting
- straining, chronic constipation
- anticoag/antiplatelet therapy

7

Clinical

- Asymptomatic
- painless bleeding; bright red blood per rectum
- anal pruritis
- prolapse
- pain due to thrombosis

8

Dx tools

Visulaization
Digital Rectal exam
Anoscopy
Endoscopy

9

Essentials for DX

Suspect with:
- bright red blood per rectum
- anal pruritis
- acute onset perianal pain
Visualize hemorrhoids

10

Tx

Dietary- increase water and fiber intake
Toilet habits- avoid lingering
Sitz bath- soaks anus and keeps it clean

11

Office Tx

- banding
- coagulation
- sclerotherapy

12

Initial Tx External and Grade 1/2

- Dietary therapy
- educate about toilet habits
- oral/ local analgesic
- topical agents to reduce swelling/ treat dermatitis (topical astringent and protectants, topical corticosteriods, topical antiinflammatory agents)
- Decrease sphincter spasms (antispasmotic)
- Venoactive agents to increase venous tone
- Banding

13

Who gets surgery?

- sx despite conservative measures
- grade 4 (+/-) strangulation
- Grade 3 with symptoms
- severe pain with thrombosis

14

Surgical Tx

- hemorrhoidectomy
- hemorrhoidal artery ligation
- staple hemmorrhoidectomy

15

Tx Thrombosed Hemorrhoids

Excision and I&D

16

When to refer

- melena, dark red blood per rectum, postural vital signs
- sx suggesting malignancy
- positive fecal occult blood stools
- positive family history of familial polyposis