HEMORRHOIDS- anatomy, pathophysiology, clinical features, diagnosis and management.pptx

This is one of the most common causes of lower gastrointestinal bleedin

1. HEMORRHOIDS/PILES Anatomy Types Classification Etiology Investigations Complications Treatment V isit 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 V isit 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. V isit 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. V isit 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.   V isit on youtube : @nexus medical media

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. V isit 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 V isit 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  V isit 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. V isit 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   V isit 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 V isit 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 V isit on youtube : @nexus medical media

13. HEMORRHOIDS/PILES SEVERITY MEDICAL PARASURGICAL SURGICAL 1st degree Medical interventions are usually enough • Sclerotherapy can be done  • DGHAL can be done 2nd degree Medical interventions are 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 surgery  DGHAL can be done Hemorrhoidectomy is gold standard  V isit on youtube : @nexus medical media

14. HEMORRHOIDECTOMY V isit on youtube : @nexus medical media