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    Hemorrhoids

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    iron
    Hemorrhoids are abnormally dilated veins in the anal canal that affect over 1 million people per year in Western civilization. They are the most common cause of lower gastrointestinal bleeding. Hemorrhoids are diagnosed through physical examination and inspection of the perianal region. Treatment options include banding, sclerotherapy, excision, and stapled or sutured hemorrhoidectomy. Complications can include pain, infection, recurrent bleeding, urinary retention, fecal incontinence, anal stenosis, and ectropion. No procedures should be done in immunocompromised patients or those with active proctitis.

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    Hemorrhoids

    Uploaded by

    iron
    105 views13 pages
    Hemorrhoids are abnormally dilated veins in the anal canal that affect over 1 million people per year in Western civilization. They are the most common cause of lower gastrointestinal bleeding. Hemorrhoids are diagnosed through physical examination and inspection of the perianal region. Treatment options include banding, sclerotherapy, excision, and stapled or sutured hemorrhoidectomy. Complications can include pain, infection, recurrent bleeding, urinary retention, fecal incontinence, anal stenosis, and ectropion. No procedures should be done in immunocompromised patients or those with active proctitis.

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    Hemorrhoids are abnormally dilated veins in the anal canal that affect over 1 million people per year in Western civilization. They are the most common cause of lower gastrointestinal bleeding. Hemorrhoids are diagnosed through physical examination and inspection of the perianal region. Treatment options include banding, sclerotherapy, excision, and stapled or sutured hemorrhoidectomy. Complications can include pain, infection, recurrent bleeding, urinary retention, fecal incontinence, anal stenosis, and ectropion. No procedures should be done in immunocompromised patients or those with active proctitis.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    105 views13 pages

    Hemorrhoids

    Uploaded by

    iron
    Hemorrhoids are abnormally dilated veins in the anal canal that affect over 1 million people per year in Western civilization. They are the most common cause of lower gastrointestinal bleeding. Hemorrhoids are diagnosed through physical examination and inspection of the perianal region. Treatment options include banding, sclerotherapy, excision, and stapled or sutured hemorrhoidectomy. Complications can include pain, infection, recurrent bleeding, urinary retention, fecal incontinence, anal stenosis, and ectropion. No procedures should be done in immunocompromised patients or those with active proctitis.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 13

    HEMORRHOIDS

    isl
    Incidence & Epidemiology

    Symptomatic hemorrhoids
    Affects > 1 million individuals in Western
    civilization per year

    Prevalence
    not selective for age or sex
    less in underdeveloped countries
    hemorrhoids

    Permanently distended veins that protrude


    into the anal canal (Saladins anatomy)

    Most common cause of lower GI bleeding


    (med. Secrets)

    Blood on the toilet paper, on the surface of


    the stool or dripping into the toilet (Bates)
    The Staging and Treatment of
    Hemorrhoids
    Diagnosis of HD

    physical examination

    inspection of the perianal region for evidence


    of thrombosis or excoriation is performed

    followed digital examination


    Treatment

    elliptical excision
    acutely thrombosed hemorrhoid can be excised
    within the first 72 h

    Additional therapy for bleeding hemorrhoids


    banding
    sclerotherapy
    sutured hemorrhoidectomy
    stapled hemorrhoidectomy
    Banding
    bands are placed around the engorged tissue
    aids in fixing the tissue proximally in the anal canal
    patients may complain of a dull ache for 24 h
    following band application

    Sclerotherapy
    12 mL of a sclerosant (sodium tetradechol sulfate)
    is injected using a 25-gauge needle into the
    submucosa of the hemorrhoidal complex
    sutured and stapled
    hemorrhoidectomy

    equally effective in the treatment of symptomatic 3rd


    & 4th degree hemorrhoids

    sutured hemorrhoidectomy
    involves the removal of redundant tissue down to
    the anal verge, unpleasant anal skin tags are
    removed

    stapled hemorrhoidectomy
    less discomfort
    this procedure does not remove anal skin tags
    NOTE ! ! !

    No procedures on hemorrhoids should


    be done in patients who are
    immunocompromised or who have active
    proctitis
    complications

    Acute complications

    pain
    infection
    recurrent bleeding
    urinary retention
    Late complications
    fecal incontinence
    injury to the sphincter during the dissection

    anal stenosis
    overzealous excision, with loss of mucosal skin bridges
    for reepithelialization

    ectropion (prolapse of rectal mucosa from the anal canal)


    Patients complain of a "wet" anus as a result of inability
    to prevent soiling once the rectal mucosa is exposed
    below the dentate line.

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