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Dr. Angelo Smith M D
WHPL
Alternative Names
Rectal Lump
Piles
Lump in the Rectum
Definition:
Dilated or enlarged veins in the
lower portion of...
10 million
Peak ages: 45-65 years
½ of adults experience
hemorrhoids by age 50
Common among pregnant
women
Temporary
Right anterior, Right posterior and Left
lateral positions
Those originating above the dentate line
which are termed int...
Internal Hemorrhoids Disease
 Manifested by two main symptoms
- Painless Bleeding
- Protrusion
(Pain is rare as they orig...
Grades:
I- Hemorrhoids only bleed
II- Prolapse and reduce spontaneously
III- Require replacement
IV- Permanently Prolapsed
Pressure
 Constipation
 Diarrhea
 Sitting or standing for long periods of time
 Obesity
 Heavy Lifting
 Pregnancy
 Rectal Bleeding
 Bright red blood in stool
 Dripping in the toilet
 On wiping after defecation
 Pain during bowel mo...
 Asymptomatic
 except when secondary thrombosed
 Thrombosis may result from defecatory straining or
extreme physical ac...
Rectal Examination
 Visual
 Digital
Tests
 Stool Guaiac (FOBT)
 Sigmoidoscopy
 Anaoscopy
 Proctoscopy
Patients should be examined in the
left lateral decubitus position (while
asking the patient to bear down)
 any rashes, ...
 lubricated finger should be gently inserted into
the anal canal
 the resting tone of the anal canal should be
ascertain...
 Gastroenterologists
 Seek emergency care if :
 large amounts of rectal bleeding
 Lightheadedness
 Weakness
 Rapid H...
The blood in the enlarged veins may
form clots and the tissue surrounding
the hemorrhoids can die (Necrosis)
This causes...
Varies from simple reassurance to
operative hemorrhoidectomy.
Treatments are classified into three
categories:
1) Dietar...
 The main goal of this treatment is to minimize
straining at stool.
 Achieved by increasing fluid and fiber in the diet,...
Apply and OTC cream or
suppository containing
hydrocortisone
Keep anal area clean
Soak in a warm bath
Apply ice packs ...
If prolapses, gently push back into anal
canal
Use a sitz bath with warm water
Use moist towelettes or wet toilet paper...
 Grade I or Grade II hemorrhoids
and, in some circumstances,
Grade III hemorrhoids.
 Complications include bleeding,
pai...
Generates infrared
radiation which
coagulates tissue
protein and
evaporates water
from cells.
Most beneficial in
Grade I...
Injection of an irritating material into the
sub mucosa in order to decrease
vascularity and increase fibrosis.
Injectin...
Manual anal dilatation was first
described by Lord .
Cryotherapy was used in the past with
the belief that freezing the ...
The triangular shaped hemorrhoid is
excised down to the underlying sphincter
muscle.
Wound can be closed or left open
S...
Eat high fiber diet
Drink Plenty of Liquids
Fiber Supplements
Exercise
Avoid long periods of standing or
sitting
Don...
Hemorrhoids
Hemorrhoids
Hemorrhoids
Hemorrhoids
Hemorrhoids
Hemorrhoids
Hemorrhoids
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Hemorrhoids : Internal and External

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Hemorrhoids

  1. 1. Dr. Angelo Smith M D WHPL
  2. 2. Alternative Names Rectal Lump Piles Lump in the Rectum Definition: Dilated or enlarged veins in the lower portion of the rectum or anus.
  3. 3. 10 million Peak ages: 45-65 years ½ of adults experience hemorrhoids by age 50 Common among pregnant women Temporary
  4. 4. Right anterior, Right posterior and Left lateral positions Those originating above the dentate line which are termed internal Those originating below the dentate line which are termed external
  5. 5. Internal Hemorrhoids Disease  Manifested by two main symptoms - Painless Bleeding - Protrusion (Pain is rare as they originate above dentate line)  Most popular etiologic theory states that Hemorrhoids result from chronic straining at defecation  Continued straining causes engorgement and bleeding, as well as hemorrhoidal prolapse
  6. 6. Grades: I- Hemorrhoids only bleed II- Prolapse and reduce spontaneously III- Require replacement IV- Permanently Prolapsed
  7. 7. Pressure  Constipation  Diarrhea  Sitting or standing for long periods of time  Obesity  Heavy Lifting  Pregnancy
  8. 8.  Rectal Bleeding  Bright red blood in stool  Dripping in the toilet  On wiping after defecation  Pain during bowel movements  Anal Itching  Rectal Prolapse (while walking, lifting weights)  Thrombus  Extreme pain, bleeding and occasionally signs of systemic illness in case of strangulation
  9. 9.  Asymptomatic  except when secondary thrombosed  Thrombosis may result from defecatory straining or extreme physical activity or may be random event  Patient presents with constant anal pain of acute onset  Physical examination identifies external thrombosis as purple mass at anal verge  Management - Depends on patients symptoms - In the first 24 – 72 hours after onset, pain increase and excision is warranted - After 72 hours, pain generally diminishes
  10. 10. Rectal Examination  Visual  Digital Tests  Stool Guaiac (FOBT)  Sigmoidoscopy  Anaoscopy  Proctoscopy
  11. 11. Patients should be examined in the left lateral decubitus position (while asking the patient to bear down)  any rashes, condylomata, or eczematous lesions.  external sphincter function  Any abscesses, fissures or fistulae
  12. 12.  lubricated finger should be gently inserted into the anal canal  the resting tone of the anal canal should be ascertained as well as the voluntary contraction of the puborectalis and external anal sphincter.  masses should be noted as well as any areas of tenderness.
  13. 13.  Gastroenterologists  Seek emergency care if :  large amounts of rectal bleeding  Lightheadedness  Weakness  Rapid HR < 100 BPM
  14. 14. The blood in the enlarged veins may form clots and the tissue surrounding the hemorrhoids can die (Necrosis) This causes painful lumps in the anal area. Severe bleeding can occur causing iron deficiency anemia.
  15. 15. Varies from simple reassurance to operative hemorrhoidectomy. Treatments are classified into three categories: 1) Dietary and lifestyle modification. 2) Non operative / office procedures. 3) Operative hemorrhoidectomy.
  16. 16.  The main goal of this treatment is to minimize straining at stool.  Achieved by increasing fluid and fiber in the diet, recommending exercise, and perhaps adding fiber agents to the diet such as psyllium.  If necessary, stool softeners may be added. "you don't defecate in the library so you shouldn't read in the bathroom".
  17. 17. Apply and OTC cream or suppository containing hydrocortisone Keep anal area clean Soak in a warm bath Apply ice packs or compresses x 10min
  18. 18. If prolapses, gently push back into anal canal Use a sitz bath with warm water Use moist towelettes or wet toilet paper instead of dry toilet paper.
  19. 19.  Grade I or Grade II hemorrhoids and, in some circumstances, Grade III hemorrhoids.  Complications include bleeding, pain, thrombosis and life threatening perianal sepsis.  Successful in two thirds to three quarters of all individuals with first and second degree hemorrhoids.
  20. 20. Generates infrared radiation which coagulates tissue protein and evaporates water from cells. Most beneficial in Grade I and small Grade II hemorrhoids.
  21. 21. Injection of an irritating material into the sub mucosa in order to decrease vascularity and increase fibrosis. Injecting agents have traditionally been phenol in oil, sodium morrhuate, or quinine urea.
  22. 22. Manual anal dilatation was first described by Lord . Cryotherapy was used in the past with the belief that freezing the apex of the anal canal could result in decreased vascularity and fibrosis of the anal cushions.
  23. 23. The triangular shaped hemorrhoid is excised down to the underlying sphincter muscle. Wound can be closed or left open Stapled hemorrhoidectomy has been developed as an alternative to Standard hemorrhoidectomy
  24. 24. Eat high fiber diet Drink Plenty of Liquids Fiber Supplements Exercise Avoid long periods of standing or sitting Don’t Strain Go as soon as you feel the urge
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