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Perianal Disorders (Haemorrhoids (Piles) (Main causes (Effects of gravity…
Perianal Disorders
Haemorrhoids (Piles)
Pathophysiology - the normal/healthy anus is lined by discontinuous masses of spongy vascular tissue - the anal cushions, which contribute to anal closure.
Classification
Internal haemorrhoids
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4 degrees
- 1st - remain in rectum
- 2nd - prolapse through the anus on defecation but spontaneously reduce
- 3rd - prolapse but can be reduced normally
- 4th - remain persistently prolapsed
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Main causes
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Congestion from a pelvic tumour, pregnancy, portal hypertension
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Clinical Presentation
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Bright red rectal bleeding (since blood from capillaries) that often coats stools, seen on tissue or drips into toilet
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Differential Diagnosis
Perianal haemotoma, anal fissure, abscess, tumour
Key Facts
Definition: disrupted and dilated anal cushions masses of spongy VASCULAR (veins and arteries) tissue due to swollen veins around the anus
The anus is lined by discontinuous masses of spongy vascular tissue - the anal cushions, which contribute to anal closure
Diagnosis
PR exam - prolapsing piles are obvious, internal haemorrhoids are not palpable
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Treatment
1st degree - increase fluid and fibre, topical analgesic and stool softener
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Prolapsed of thrombolised piles - treat with analgesia, ice packs & stool softeners. Pain usually resolved 2-3 weeks
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Anal Fistula
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Diagnosis
MRI - to exclude sepsis, to detect associated conditions e.g. Crohn's or TB
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Epidemiology
Blockage of deep intramuscular gland ducts is thought to predispose to the formation of accesses, which discharge to form the fistula
Main causes - perianal sepsis, abscesses, Crohn's, TB, diverticular disease, rectal carcinoma
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An abnormal connection between the epithelised surface of the anal canal and skin - essentially a track communicates between the skin and anal canal/rectum
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