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HEMORRHOIDS- anatomy, pathophysiology, clinical features, diagnosis and management.pptx
- 1. HEMORRHOIDS/PILES • Anatomy • Types • Classification • Etiology • Investigations • Complications • Treatment Visit on youtube: @nexus medical media
- 2. HEMORRHOIDS/PILES  The word ‘Hemorrhoid’ is derived from Greek words Haima (bleed) + Rhoos (flowing), mean bleeding.  The word pile is derived from the Latin word ‘Pila’ means ball or a mass.  Anal cushions are aggregations of blood vessels (Arterioles, venules), smooth muscles and elastic connective tissue in the submucosa that normally reside in left lateral, right posterolateral and right anterolateral anal canal.  These positions can be found at 3, 7 and 11 o’clock.  The anal canal is lined by the anal cushions Visit on youtube: @nexus medical media
- 3. HEMORRHOIDS/PILES Hemorrhoids consist of dilated venous plexus, a small artery and areolar tissue. • Piles can be mucosal or vascular.  Vascular type is seen in young.  Mucosal is seen in old. • Present concept is weakening of Park’s ligament TYPES • Hemorrhoids can either be: ➢ Internal- above the dentate (pectineal) line, covered with mucous membrane ➢ External- below the dentate (pectineal) line, covered with skin ➢ Interno-external- together occur. Visit on youtube: @nexus medical media
- 4. HEMORRHOIDS/PILES CLASSIFICATION Hemorrhoids can be classified according: ➢ Location ➢ Severity ACCORDING TO LOCATION Primary hemorrhoids: • Located at 3, 7, 11 o’clock positions related to the branches of the superior hemorrhoidal vessels which divides on the right side into 2, and on the left side it continues as 1 Secondary hemorrhoids: One which occur between the primary sites. Visit on youtube: @nexus medical media
- 5. HEMORRHOIDS/PILES ACCORDING TO SEVERTIY First degree: piles within that may bleed but does not come out Second degree: piles that prolapse during defecation but returns back spontaneously Third degree: piles prolapsed during defecation, can be replaced back only by manual help Fourth degree: pile that are permanently prolapsed.
- 6. HEMORRHOIDS/PILES ETIOLOGY  Hereditary  Idiopathic  Morphologic: weight of the blood column without valves causes high pressure. • Veins in the lower rectum are in loose submucosal plane but the veins above enter the muscular layer, which on contraction increases the venous congestion below (more prevalent in patients with constipation). • Superior rectal veins have no valves (as they are tributaries of portal vein) and so more congestion. Other causes: ➢ Straining, diarrhea, constipation, hard stool, low fiber diet, over-purgation ➢ Carcinoma rectum, portal hypertension (rare cause) ➢ Pregnancy: during pregnancy raised progesterone relaxes the venous wall and reduces its tone, enlarged uterus compresses the pelvic vein and constipation is a common problem. Visit on youtube: @nexus medical media
- 7. HEMORRHOIDS/PILES CLINICAL FEATURES • It occurs at any age but mostly between 30 to 65 years. • Incidence is equal in both sexes. • Painless Bleeding- 1st symptom- ‘splash in the pan’- ‘bright red and fresh’- occurs during defecation • Mass per anum. • Pain- may be due to prolapse, infection or spasm • Prolapse of internal hemorrhoids may produce moisture in the anal region or mucus discharge that causing itching. • Anemia- secondary Visit on youtube: @nexus medical media
- 8. HEMORRHOIDS/PILES EXAMINATION  On inspection, prolapsed piles will be visualized  On P/R examination, only thrombosed piles can be felt. INVESTIGATIONS  Proctoscopy: note number, degree, size, surface and appearance of piles as well as features of chronicity of the prolapse.  Sigmoidoscopy or colonoscopy: malignancy  Endoscopy to rule out other sources of rectal bleeding e.g. cancer and inflammatory bowel disease.  Full blood count-check for anemia (hematocrit) and platelet count Visit on youtube: @nexus medical media
- 9. HEMORRHOIDS/PILES COMPLICATIONS • Profuse hemorrhage which may require blood transfusion • Strangulation- by anal sphincter • Thrombosis- piles appear dark purple/black, feels solid and tender • Ulceration • Gangrene • Fibrosis • Stenosis • Suppuration leads to perianal or submucosal abscess • Pylephlebitis (portal pyaemia) is rare but can occur in 3rd degree piles after surgery. Visit on youtube: @nexus medical media
- 10. HEMORRHOIDS/PILES TREATMENT Medical  Sitz bath- immersing anal region for 15-20 minutes, 2-3 times a day. • To reduce edema, pain and promote healing  Analgesics, local anesthetic cream  Antihistamines  Antibiotics  Laxatives  Local anesthetics and anti-inflammatory drugs e.g. annomax Visit on youtube: @nexus medical media
- 11. HEMORRHOIDS/PILES TREATMENT Parasurgical  Sclerotherapy  Banding  Cryotherapy  Infrared coagulation (IRC)  Laser therapy  Doppler guided haemorrhoidal artery ligation (DGHAL): • good for pregnant and diabetic patients Visit on youtube: @nexus medical media
- 12. HEMORRHOIDS/PILES TREATMENT Surgical  Open haemorrhoidectomy (Milligan-Morgan)-Britain  Closed haemorrhoidectomy (Hill-Fergusson)- USA  Stapled haemorrhoidopexy (Antonio Longo)  Anal stretching Visit on youtube: @nexus medical media
- 13. HEMORRHOIDS/PILES SEVERITY MEDICAL PARASURGICAL SURGICAL 1st degree Medical interventions usually enough • Sclerotherapy can be done • DGHAL can be done 2nd degree Medical interventions usually enough • Sclerotherapy can be done • Barron’s banding is done • DGHAL can be done 3rd degree Medical interventions can help patients especially before surgery • Laser therapy can be done • DGHAL can be done Hemorrhoidectomy is gold standard 4th degree Medical interventions can help patients especially before DGHAL can be done Hemorrhoidectomy is gold standard Visit on youtube: @nexus medical media
- 14. HEMORRHOIDECTOMY Visit on youtube: @nexus medical media