HAEMORRHOIDS MEDICAL ASSISTANT NURSING PPTX

Topic about haemorrhoid nursing

1. SURGICAL SCIENCE I HAEMORRHOIDS PRESENTED BY DR. NUR IZZATI BINTI ISMAIL

2. LEARNING OBJECTIVES BY THE END OF THIS SESSION, THE STUDENTS WILL BE ABLE TO Define haemorrhoids Explain pathophysiology and etiology of haemorrhoids Enumerate clinical manifestation for haemorrhoids Describe grading for internal haemorrhoids List out investigation for haemorrhoids Explain management of haemorrhoids

3. DEFINITION Swollen blood vessels in the lower rectum. Also known as pile The anal vascular cushions act to assist the anal sphincter in maintaining continence Males tend to suffer more often and for longer periods whereas women are affected during pregnancy and puerperium.

4. PATHOPHYSIOLOGY AND ETIOLOGY Decreased venous return Prolonged sitting on a toilet can cause a relative venous return problem in the perianal area (a tourniquet effect) Aging causes weakening of the support structures, which facilitate prolapse. Excessive s training and constipation Raised intra-abdominal pressure (pregnancy, chronic cough or ascites) Portal hypertension and anorectal varices Irregular bowel habit (Ulcerative colitis / Crohn’s disease) Episiotomy Anal intercourse

5. CLINICAL MANIFESTATION Painless haematochezia Pruritus Anal lump Acute painful mass at the rectum Perform visual inspection of rectum DRE Anoscopy or proctosigmoidoscopy when appropriate

6. INVESTIGATION Proctoscopy FBC, PTT and aPTT Colonoscopy

7. MANAGEMENT Ensure to provide lifestyle advice, such as increasing daily fiber and fluid intake to avoid constipation, retraining pt’s toilet habit and prescribing laxatives if necessary. Sitz bath Daflon to increase venous tone Topical analgesia may also be required for pain relief A void oral opioid analgesia as this can compound any constipation and worsen symptoms. Symptomatic 1st and 2nd degree haemorrhoids can be treated with rubber-band ligation (RBL). This involves the haemorrhoid being drawn into the end of a suction gun and a rubber band placed over the neck of the haemorrhoid. This can be done either in a clinic setting or in theatre.

8. Haemorrhoidal artery ligation is one surgical option for 2nd or 3rd degree haemorrhoids, with equivocal effectiveness to other interventions. For 3 rd  degree and 4 th  degree haemorrhoids, another surgical option available is  haemorrhoidectomy , especially those not suitable for banding or injection