| ID | 238 |
|---|---|
| Name | HEMORRHOIDS (Piles) |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: 1. Bowel is regularised by vegetable diet, exercise, plenty of water intake, isopgul & laxative. 2. Creams. 3. Injection 5% phenol in almond oil 3ml is injected into each piles just above the anorectal ring. Three injections at two weeks interval for 1st & 2nd degree hemorrhoids. 4. Cryosurgery- for 2nd & 3rd degree. 5. Hemorrhoidectomy- for 3rd & 4th degree, each hemorrhoid is ligated & excised. 6. Rubber band ligation, anorectal dilatation may also be done. 7. Stapled hemorrhoidectomy (Longs operation). |
| Introduction | Piles are dilated, elongated & tortuous veins in the wall of the anal canal & lower part of the rectum & is formed by superior, middle & inferior rectal veins. They are of four degrees: A. 1st degree- the piles only bleeds. B. 2nd degree- bleeding & prolapse during defecation, but reduces spontaneously. C. 3rd degree- prolapse can be reduced manually. D. 4th degree- prolapsed permanently. |
| History | |
| Etiology | Etiology: 1. Ch. constipation 2. Carcinoma of rectum 3. Sraining at micturition 4. Pregnancy 5. Pelvic tumour 6. Cardiac failure 7. Portal hypertension. |
| Clinical Features | Clinical features: 1. Bright red or fresh painless bleeding. 2. Prolapse depending on degree. 3. Mucoid discharge, pruritus & pain in complicated cases. 4. History of constipation, hereditary, cirrhosis, abdominal tumour, pregnancy & carcinoma of rectum. 5. Anemia. 6. On examination-1st degree- normal. 2nd degree- hypertrophic skin fold. 3rd degree- mucocutaneous bulge. 4th degree- permanently prolapsed finger like hemorrhoidal projections. |
| Preventions | |
| Treatment | |
| Complications | Complications of hemorrhoidectomy: 1. Post-operative pain (which may continue for 2-4 weeks) 2. Impaired continence 3. Recurrence of bleeding & hemorrhoids 4. Infection. Complications of untreated hemorrhoids: 1. Anemia due to severe bleeding 2. Strangulation 3. Thrombosis 4. Ulceration 5. Suppuration & portal pyemia. 6. Fibrosis |
| Prognosis | |
| Types | Types: 1. External: External to anal orifice and covered by skin. 2. Internal: Internal to anal orifice and covered by mucosa. 3. Intero-external: Combined. |
| Classification | |
| Observation | |
| Pathology | Pathology: Internal hemorhoids arranged in two groups- 1. Primary- 3 position along branches of sup. rectal arteries, i. 3-0 clock-left lateral, ii. 7-0 clock- right posterior. iii.11-0 clock- right anterior. 2. Secondary- between primary hemorrhoids. |
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