Hemorrhoids Class PPT PDF

HEMORRHOIDS (PILES) ❖ ❖ ❖ ❖ Illustrate the etiology of hemorrhoids. Explain the pathogenesis of hemorrhoids. Recognize the manifestation of hemorrhoids. To describe the treatment for hemorrhoids - Non-pharmacologic therapies. - Non prescription therapies. ❖ Counsel the patients of hemorrhoids....

HEMORRHOIDS (PILES) ❖ ❖ ❖ ❖ Illustrate the etiology of hemorrhoids. Explain the pathogenesis of hemorrhoids. Recognize the manifestation of hemorrhoids. To describe the treatment for hemorrhoids - Non-pharmacologic therapies. - Non prescription therapies. ❖ Counsel the patients of hemorrhoids. Hemorrhoids ❖ ❖ ❖ ❖ ❖ Hemorrhoids, or “piles,” are swollen or dilated veins of the rectum or anus. Hemorrhoids may be located just inside the anal canal (internal hemorrhoid) or surrounding the anal opening (external hemorrhoids). External hemorrhoids are the most common and most troublesome. Hemorrhoids may be present for years but go undetected until bleeding occurs. Anal fissures are tears of the sensitive mucosal lining of the anus. Two type of haemorrhoids: Superior to anal sphincter: called dentate (Change from Squamous to Columnar epithelial tissue) (a) below the dentate line (round the anus) called External Hemorrhoid (b) above the dentate line (in the rectum) called Internal Hemorrhoid Hemorrhoids : Causes and risk factors Possible causes and risk factors include: • Hemorrhoids occur when there’s too much pressure on the veins around anus. • Rare in children less 20 years. • Most common in 45 – 65 years of age. • Straining during a bowel movement. • Sitting for a long period of time, especially on the toilet. • Chronic constipation or diarrhea. • Family history of hemorrhoids. • Engaging in consistent heavy lifting or other activities that strain body. • Obesity. • Sexual intercourse, which can irritate hemorrhoids. • Being pregnant (an enlarged uterus presses on the vein in the colon, causing it to bulge). • Over the age of 50 years. Differential cases from hemorrhoid Cases NonHemorrhoid Dermatitis (no blood) Anal fissure or Anorectal abscess Rectal bleeding Ulcerative colitis Crohn's disease Upper GI bleeds Colorectal cancer Proctitis Manifestation of Hemorrhoids ( Sign/symptoms) Internal • Asymptomatic. • Symptomatic for long period until prolapsed strangulation occur. • Blood on the tissue after having a bowel movement. • Painless (unless ulcerated)+bleeding + drainage/mucous. External • Extreme itching around the anus. • Uncomfortable lump(s) or swelling near anus. • Aches or pain around the anus, especially when sitting. • Uncomfortable rectal mass (tender & swollen). Complications • Iron-deficiency anemia, if significant blood loss. • Severe pain caused by a blood clot in a hemorrhoid. • Infection or ulceration of a hemorrhoid. I. Do you have Pain on defection & other time (like sitting) + slight rectal bleeding (bright red)------Hemorrhoid. □ Sharp or stabbing pain at the time of defection------may be fissure or tear. □ Stool with blood— GIT bleeding. □ Blood no relation with defecation---- Carcinoma. II. Localized perianal & anal itching ---- Dermatitis III. Symptoms less than 3 weeks you can manage, if it is more than 3 weeks refer to GP. Diagnosis of Hemorrhoids • Visual examination. • To confirm the diagnosis doctor may do a different examination to check for any abnormalities within the anus. • Digital rectal exam • Anoscopy (anus) • Sigmoidoscopy (rectum, examines the last 2 feet, 50 centimeters of the colon) • Colonoscopy (examines the entire colon) Treatment of Hemorrhoids • Treat sympathetically & away from other. Non-pharmacological therapies • Sitz Baths: to minimize pain, soak in a warm tub of water for at least 10 minutes every day. • Sit on a warm water bottle to relieve the pain of external hemorrhoids. • Anal hygiene: soap with water • Orthopedic Donut Cushion Hemorrhoid pillows Treatment of Hemorrhoids Non-prescription medications ▣ Anesthetics (Lidocaine, benzocaine & benzyl alcohol, dyclonine, tetracaine) ▣ Combined [anesthetic with analgesic (acetaminophen, ibuprofen /antipruritic (hydroxyzine, hydrocortisone topical cream)]  Menthol, camphor: Relief pain & itching & menthol make cooling sensation. ▣ Protectants: (shark liver oil, coca butter, lanolin, mineral oil, white petroleum(for both internal & external ▣ Glycerin applied as protectants only externally. • Astringent: e.g. Bismuth, zinc oxid, calamina • Also can be used with additional protectant ingredient e.g. Calamina, shark liver oil with Zinc oxide, AlOH gel. • Vasoconstrictors: e.g. Ephedrine, phenylephrine & epinephrine. • Keratolytics : resorcinol not use as OTC because of desquamation. • Hydrocortisone: relief of anal itching e.g. Anusol • Laxative :e.g. bulk laxative (psyllium and methylcellulose), stool softener • Best OTC: anesthetic + hydrocortisone & manual reduction) Case/Patient complaining from pain , bleeding, perianal itching If, Female (pregnant)----only protectants can be given other female/male ask about Age <12 –refer to physician Age >12 with 7 days problem with bleeding- refer to GP. Does she/he suffer from high BP, heart disease, thyroid, difficulty in urination, prostate enlargement---Not Give vasoconstriction anti-hemorrhoid medicines. If Not: The drug recommend: Combination anesthetic/analgesic or hydrocortisone or astringent or protectants--etc Non surgical: *Sclerotherapy Inj.Phenol in almond oil *Rubber band ligation Surgical: *Hemorrhoidectomy *Laser treatment 1. 2. 3. 4. 5. Abdominal pain Blood in stool Fever Patient who have to reduce manually Unexplained rectal bleeding Prevention of Hemorrhoids • Proper diet and habits to produce softer stools, reducing the need to strain. • Add plenty of fiber to diet (fruits, vegetables, legumes, and whole grains). • Drink plenty of fluids (8 to 10 glasses of water daily). • Don’t hurry or strain to push bowel movements but avoid prolonged toilet sitting. • Lose weight, if overweight. • Exercise regularly.