hemor hoid
TRANSCRIPT
-
8/10/2019 Hemor Hoid
1/22
Ronny S,dr,SpOT
Haemorrhoids
-
8/10/2019 Hemor Hoid
2/22
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
-
8/10/2019 Hemor Hoid
3/22
External
Internal
AnodermSwell, discomfort,difficult hygiene
Pain?
-> Thrombosed
Pain?-> painless
Bright red bleedingProlapse associatedwith defecation
-
8/10/2019 Hemor Hoid
4/22
Anatomy
-
8/10/2019 Hemor Hoid
5/22
-
8/10/2019 Hemor Hoid
6/22
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
-
8/10/2019 Hemor Hoid
7/22
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
-
8/10/2019 Hemor Hoid
8/22
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
-
8/10/2019 Hemor Hoid
9/22
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
-
8/10/2019 Hemor Hoid
10/22
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:
-
8/10/2019 Hemor Hoid
11/22
Thrombosed
internal
haemorrhoids
Thrombosed
eternal
haemorrhoids
9omplications
* ;lceration
& )hrombosis
3 Sepsis and abscess formation
' Incontinence
-
8/10/2019 Hemor Hoid
12/22
-
8/10/2019 Hemor Hoid
13/22
-
8/10/2019 Hemor Hoid
14/22
-
8/10/2019 Hemor Hoid
15/22
Haemorrhoids
!nternal H" Treatment :
7rade 182
Dietary modi,ication high ,ibre diet "tool o,tener
Bathing in +arm +ater
9opical cream :9 5;CH
-
8/10/2019 Hemor Hoid
16/22
-
8/10/2019 Hemor Hoid
17/22
-
8/10/2019 Hemor Hoid
18/22
-
8/10/2019 Hemor Hoid
19/22
-
8/10/2019 Hemor Hoid
20/22
-
8/10/2019 Hemor Hoid
21/22
-
8/10/2019 Hemor Hoid
22/22
If presentation less than