Hemor Hoid

8/10/2019 Hemor Hoid

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Ronny S,dr,SpOT

Haemorrhoids


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Anorectal Anatomy

Anal verge

Anal canal

Arterial Supply

Inferior rectal A

middle rectal A

Venous drainage

Inferior rectal V

middle rectal V

3 hemorrhoidal

complexes

L lateral

R antero-lateral

R posterolateral

Lymphatic drainage

Above dentate: Inf !esenteric

"elo# dentate: internal iliac

$erve Supply

Sympathetic: Superior

hypogastric plexus

%arasympathetic:

S&3' (nerviergentis

%udendal $erve:

!otor and sensory


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External

Internal

AnodermSwell, discomfort,difficult hygiene

Pain?

-> Thrombosed

Pain?-> painless

Bright red bleedingProlapse associatedwith defecation


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Anatomy


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3 main processes: * Increased venous pressure

& /ea0ness in supporting fibromuscular stroma

3 Increased internal sphincter tone

Ris0 1actors

Pathological Habitual

1. Chronic diarrhea (IBD)

2. Colon malignancy

3. Portal hypertenion!. "pinal cord in#ury

$. %ectal urgery

&. 'piiotomy

. nal intercoure

1. Contipation and training

2. *o+ ,ibre high ,at-picy diet

3. Prolonged itting in toilet!. Pregnancy

$. ging

&. beity

. ,,ice +or/

0. amily tendency

Haemorrhoids

Pathogensis

Abnormal haemorrhoids are dilated cushions of arteriovenous

plexus #ith stretched suspesory fibromuscular stroma #ithprolapsed rectal mucosa


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Haemorrhoids

Classification:

Degree o, prolape through anu rigin in relation to Dentate line

1t bleed but no prolape

2nd pontaneou reduction

3rd manual reduction

!th not reducable

1. Internal aboe D*

2. '4ternal belo+ D*

3. 5i4ed


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A:Thrombosed external

B:First-degreeinternalviewed through anoscope

C:Second-degreeinternal

prolapsed reducedspontaneously

!:Third-degreeinternalprolapsed re"uiringmanual reduction

E:Fourth-degreestrangulatedinternal and thrombosedexternal

Reference : Sabiston Textbook of Surgery, 18th Edition


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Haemorrhoids

Clinical assessment

2xamination istory ( 1ull history re4uired5

*ocalInpect ,or

*ump6 note colour andreducability

iureitulae

bce

Digital5ae

Character o, blood and mucu

Per,orm proctocopy and

igmoidocopy

7eneral abdominal e4amination

aemorrhoid directed:

%ain acute6chronic6cutaneous

Lump acute6 sub-acute

%rolapse define grade"leeding fresh7 post defecation

%ruritis and mucus

8eneral 8I:9hange in bo#el habit

!ucus discharge

)enasmus6 bac0 pain/eight loss

Anorexia

ther system in4uiry


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Lab: 9"9 6 9lotting profile6 8roup and save

%roctography: if rectal prolpse is suspected

9olonoscopy: if higher colonic or sinister pathology issuspected

The diagnosis of haemorrhoids is based on

clinical assessment and proctoscopy

Further investigations should be based on a

clinical inde of suspicion

Haemorrhoids

!nvestigations:


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Thrombosed

internal

haemorrhoids

Thrombosed

eternal

haemorrhoids

9omplications

* ;lceration

& )hrombosis

3 Sepsis and abscess formation

' Incontinence


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Haemorrhoids

!nternal H" Treatment :

7rade 182

Dietary modi,ication high ,ibre diet "tool o,tener

Bathing in +arm +ater

9opical cream :9 5;CH


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If presentation less than

Hemor Hoid

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