July 9, 2009 | In: ABDOMINAL SURGERY
HEMORRHOIDS
21. What are hemorrhoidal tissues, and what are their normal functions?
Show answer
Hemorrhoids are cushions of vascular tissue that contribute to anal continence and protect the sphincter mechanism during defecation. Hemorrhoids are not veins, but sinusoids. Bleeding originates from presinusoidal arterioles, thus explaining the bright red arterial color.
22. What are the most common causes of pathologic hemorrhoids?
Show answer
Constipation, prolonged straining, pregnancy, and internal sphincter dysfunction.
23. What is the most important difference between internal and external hemorrhoids?
Show answer
Whereas internal hemorrhoids are located above the dentate line with visceral innervation, external hemorrhoids are located below the dentate line with somatic innervation. Ablation of internal hemorrhoids causes a pressure sensation with an urge to defecate, but a similar approach to external hemorrhoids causes excruciating pain.
24. What are the most common complaints associated with pathologic internal hemorrhoid
s?
Show answer
Bleeding, mucus discharge, and prolapsing tissue.
25. What are the most common complaints associated with external hemorrhoids?
Show answer
Pain, inflammation, thrombosis, and difficulty with anal hygiene.
26. Are there any treatment options for symptomatic internal hemorrhoids based on identifiable physical characteristics?
Show answer
Yes. Treatment is based on the degree of prolapse:
Grade 1: None
Grade 2: Spontaneous reduction
Grade 3: Manual reduction
Grade 4: Unreducible
27. How are patients with symptomatic grades 2 and 3 and occasionally grade 4 internal hemorrhoids treated?
Show answer
Diet and stool bulking, rubber band ligation, injection sclerotherapy, cryotherapy, infrared photocoagulation, anal dilatation, or electrocautery.
28. What is the last-resort treatment for recalcitrant symptomatic internal hemorrhoids or combined internal and external hemorrhoids?
Show answer
Operative hemorrhoidectomy.
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