Hemorrhoids: Difference between revisions

Latest revision as of 02:29, 6 January 2022

Background

Anatomy of the anus.

Internal and external hemorrhoids divided by pectinate (dentate) line

Pathologic state cccurs when internal or external hemorrhoid plexus become engorged, prolapsed, or thrombosed
Bleeding is usually limited (surface of stool, on toilet tissue, at end of defecation)
- Passage of blood clots requires evaluation for colon lesions

Risk Factors

Constipation and straining at stool
Frequent diarrhea
Older age
IBD

Types

External hemorrhoid

Thrombosed external hemorrhoid

Internal hemorrhoid
- Originate above the dentate line
- Painless
External hemorrhoid
- Originate below the dentate line
- Painful

Internal hemorrhoid chart

Internal hemorrhoid grades
Grade	Description	Diagram	Picture
I	Luminal protrusion above dentate line No prolapse Painless bleeding
II	Prolapse with spontaneous reduction Prolapse during straining
III	Prolapse requires manual reduction Prolapse during straining
IV	Prolapse—nonreducible Can result in edema and strangulation

Treatment

Increase fiber
Sitz baths
Topical steroid - Hydrocortizone
Topical anti-spasmodic - Nifedipine
See also treatment by specific type:
- Internal hemorrhoid
- External hemorrhoid

References

Authors:

@@ Line 1: / Line 1: @@
-*[[Internal hemorrhoid]]
-*[[External hemorrhoid]]
 ==Background==
-{{Hemorroids background}}
+{{Hemorrhoid background}}
-==Differential Diagnosis==
-{{Anorectal DDX}}
-{{Lower GI bleeding DDX}}
 ==Types==
+[[File:M 44 anus 22.jpg|thumb|[[External hemorrhoid]]]]
+[[File:Perianal thrombosis 01.jpg|thumb|Thrombosed [[external hemorrhoid]]]]
+*[[Internal hemorrhoid]]
+**Originate above the dentate line
+**Painless
+*[[External hemorrhoid]]
+**Originate below the dentate line
+**Painful
+{{Internal Hemorrhoid Chart}}
-===External===
+==Treatment==
-*Occur distal to dentate line
+*Increase fiber
-*Can be seen at external inspection
+*Sitz baths
-**More prominent with Valsalva
+*Topical steroid - Hydrocortizone
-*Thrombosed hemorrhoids (bluish-purple discoloration) cause painful defecation
+*Topical anti-spasmodic - Nifedipine
-**Non-thrombosed hemorrhoids are usually painless
+*See also treatment by specific type:
-***If pt c/o pain but hemorrhoids are not thrombosed suspect:
+**[[Internal hemorrhoid]]
-****Perianal/intersphincteric abscesses
+**[[External hemorrhoid]]
-****Anal fissures
-*Prolapse
-**Requires periodic reduction by the pt
-====Treatment====
-#Usually self-limiting w/ resolution in 1 week
-#Thrombosed:
-##Consider sitz baths and bulk laxatives if:
-###Thrombosis has been present >48 hr
-###Swelling has started to shrink
-###Pain is tolerable
-##Consider excision if:
-###Pt is not immunocompromised, child, pregnant woman, has portal HTN, coagulopathic
-###Thrombosis is acute (<48 hr)
-###Extremely painful
-###See [[External Hemorrhoid Excision]]
 ==See Also==
-*[[Anorectal Disorders]]
+*[[Anorectal disorders]]
-==Source==
+==References==
-Tintinalli
+<references/>
 [[Category:GI]]