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Published by: sarah90222 on Feb 26, 2012
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definition ‡ Disrupted and dilated anal cushions ± Anal cushions are discontinuous masses of spongy vascular tissue ± Positions at 3. elastic tissue but prone to displacement and disruption ‡ Gravity. loose and protrude to form piles. blocking venous return . ‡ Vulnerable to trauma and will bleed ‡ No sensory fibres above the dentate line (squamomucosal junction).7 11 o clock positions ‡ Attached by smooth muscle. effects of straining at stool may make them more bulky. increased anal tone. piles are not painful unless they thrombose when they protrude and are gripped by the anal sphincter.

Differential diagnosis ‡ ‡ ‡ ‡ ‡ Perianal haematoma Anal fissure Abscess Tumour Proctalgia fugax .

causes ‡ Constipation with prolonged straining is a key factor ‡ Bowel habit can be normal ‡ Congestion from a pelvic tumour. CCF. pregnancy. portal hypertension .

pathogenesis ‡ Vicious cycle ‡ Vascular cushion protrude through a tight anus and become congested ‡ Hypertrophying to protrude again more readily .

investigations ‡ ‡ ‡ ‡ Abdominal examinations PR exam Proctoscope internal haemorrhoids Sigmoidoscopy rectal pathology higher up .

treatment ‡ Infra-red coagulation coagulating vessels ‡ Sclerosants injected into pile about dentate line ‡ Rubber band ligation ‡ Cryotherapy freezing ‡ Haemorrhoidectomy excision. ligation of vascular pedicles day case surgery .

classification .

. B represents an external prolapsed hemorrhoid.The image above shows the rectum and anus. In this figure A represents an internal hemorrhoid. D is a thrombosed hemorrhoid and E is an external hemorrhoid. The external sphincter is at the bottom and the internal shpincter is shown by the pectinate line at the top. C is a mixed hemorrhoid (both internal and external).

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