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hemorrhoid: vascular masses in lower rectum/ anus (predisposing factors…
hemorrhoid: vascular masses in lower rectum/ anus
anorectal disease
hemorrhoid
perianal abscess 肛周膿腫
fistula 瘺
fissure
fecal continence
types
internal hemorrhoids
above dentate line
above internal sphincter
external hemorrhoids
below dentate line
outside external sphincter
thrombosed hemorrhoids
blood clotted within hemorrhoid due to obstruction
pathophysiology
abnormal dilation of veins of internal hemorrhoidal venous plexus
abnormal distension of arteriovenous anastomoses
downward displacement of prolapse 脫垂 of anal cushion
destruction of anchoring connective tissue system
predisposing factors
pregnancy
prolonged standing/ sitting
persistent straining 拉傷 at defecation
chronic constipation/ diarrhea
anal infection
rectal surgery/ episiotomy
hereditary factor
exercise
coughing, sneezing, vomitting
loss of muscle tone
increase intra-abdominal pressure --> engorgement 充滿 in vascular tissue lining the anal canal
loosening of vessels from surrounding connective tissue occur with protrusion/ prolapse into anal canal
anal intercourse
clinical manifestation
non-specific
visible (if external) and palpable mass
protrusion of swollen mass after bowel movement which can be reducible/ incarcerated
most common:
bleeding during/ after defecation, bright red blood on stool due to injury of mucosa covering hemorrhoid
constipation
anal itching duw to excessive moisture
sensation of incomplete fecal evacuation 疏散
infection/ ulceration --> mucus discharge
rectal varices --> portal hypertension
classification of disease state
first-degree
hemorrhoid descend beyond dentate line with straining
do not prolapse
can associate with bleeding
second degree
anal cushion protrude below dentate line during straining
spontaneously 自發 retract
third degree
protrude outside anal canal with straining
need
manual reduction
fourth degree
remain prolapse independent of straining
irreducible
diagnostic test
digital rectal examination (DRE)
anoscopy/ proctoscopy 直腸鏡/ proctosigmoidoscopy: direct visualization
barium enema: double-contrast medium
colonoscopy: rule out 排除 serious colonic lesion causing rectal bleeding
management
symptomatic relief
asymptomatic: X treatment
high-fiber diet to keep stool soft & increase bulk
regulate bowel habit
nonirritating stool softenser
control of itching: improve anal hygiene & control moisture
frequent warm sitz bath to ease pain & reduce swelling analgesic
reduction of external hemorrhoid of prolapse
medical
topical cream, lotions, suppositories
mild astringent &soothing 收斂和舒緩 to provide comfort: Anusol cream/ suppositories
preparation H
compound with corticosteroid: anusol HC/ Ultraproct cream/ suppositories
avoid prolonged use of topical anesthetics on hemorrhoids/ fissure--> cause allergic perianal skin rash with itching
surgery
sclerotherapy 硬化療法 (blood vessel thrombosis)
cryosurgical hemorrhoidectomy 冷凍切割
infrared photocoagulation 紅外線
bipolar diathermy (heat)
laser therapy
rubber band ligation 結紮
simple excision & clot removal
hemorrhoidectomy
standard excisional hemorrhoidectomy
stapled hemorrhoidopexy =hemorrhoidectomy (circular stapler rectopexy)
nursing intervention
post op care
pain relief & promote comfort
assist frequent positioning
use pillow for comfort
warm sitz bath reduce pain and inflammation
apply anal pads, cream, suppositories as ordered
administer analgesic as prescribed
observe anal area for drainage & hemorrhage
report excessive bleeding
prevent post-op complication
infection
hemorrhage
urinary rentention
promote optimal fecal elimination
client education on diet/ lifestyle change
X remain in toilet seat foe longer than 1 min/ for reading
attempt to defecate only with sensation of eliminate
diet modification to prevent recurrence
high fiber diet to avoid bloating
adequate fluid intake: 8-10 glasses per day to prevent constipation
discourage regular use of laxative
encourage regular exercise
avoid strenuous exercise 劇烈
follow up for dressing change/ progress