Terms in this set (15)
What are hemorrhoids?
Engorgement of the venous plexuses of the rectum, anus, or both; with protrusion of the mucosa, anal margin, or both
Why do we have "healthy" hemorrhoidal tissue?
It is thought to be involved with fluid/air continence
What are the signs/symptoms?
Anal mass/prolapse, bleeding, itching, pain
Which type, internal or external, is painful?
External, below the dentate line
If a patient has excruciating anal pain and history of hemorrhoids, what is the likely diagnosis?
Thrombosed external hemorrhoid (treat by excision)
What are the causes of hemorrhoids?
Constipation/straining, portal hypertension, pregnancy
What is an internal hemorrhoid?
Hemorrhoid above the (proximal) dentate line
What is an external hemorrhoid?
Hemorrhoid below the dentate line
What are the three "hemorrhoid quadrants"?
1. Left lateral 2. Right posterior 3. Right anterior
Define the following terms for internal hemorrhoids:
First-degree hemorrhoid: Hemorrhoid that does not prolapse
Second-degree hemorrhoid: Prolapses with defecation, but returns on its own
Third-degree hemorrhoid: Prolapses with defecation or any type of Valsalva maneuver and requires active manual reduction (eat fiber!)
Fourth-degree hemorrhoid: Prolapsed hemorrhoid that cannot be reduced
What is the treatment?
High-fiber diet, anal hygiene, topical steroids, sitz baths Rubber band ligation (in most cases anesthetic is not necessary for internal hemorrhoids) Surgical resection for large refractory hemorrhoids, infrared coagulation, harmonic scalpel
What is a "closed" vs. an "open" hemorrhoidectomy?
Closed (Ferguson) "closes" the mucosa with sutures after hemorrhoid tissue removal Open (Milligan-Morgan) leaves mucosa "open"
What are the dreaded complications of hemorrhoidectomy?
Exsanguination (bleeding may pool proximally in lumen of colon without any signs of external bleeding) Pelvic infection (may be extensive and potentially fatal) Incontinence (injury to sphincter complex) Anal stricture
What condition is a contraindication for hemorrhoidectomy?
Classically, what must be ruled out with lower GI bleeding believed to be caused by hemorrhoids?
Colon cancer (colonoscopy)
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