Haemorrhoids

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Another name is Piles

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HAEMORRHOIDS Presented by Sachchidanand Pathak Sunder Deep Pharmacy College 6/14/2012 1

HAEMORRHOIDS : 

HAEMORRHOIDS DEFINITION: Hemorrhoids develop when the veins are put under pressure and become engorged with blood. Dilated or enlarged veins in the lower portion of the rectum or anus. Hemorrhoids are a painful health disorder that occur in anal or rectum areas. It is itching, painful, or bleeding masses of swollen tissues and varicose veins located in rectum region. Now a day, it is being common in any age group of male and female. Especially women are more prone during or after pregnancy. So its prevent is better than its cure. TORTORA 6/14/2012 2

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Alternative Names: Rectal Lump Piles Types Of Haemorrhoids :- Internal- Under the skin External- Around the anus INTERNAL- You may observe bleeding but not feel any pain, due to the lack of pain receptors in this area (inside the rectum). Internal variety is covered by mucous membrane. Internal hemorrhoids are appear in the anal pipe. If you left them untreated, may form External. HARSH MOHAN 6/14/2012 3

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EXTERNAL - External variety is covered by skin. External hemorrhoids are another type of hemorrhoids which are exit outside the anal. In external hemorrhoids swollen veins form a soft lump around the anal opening. If blood clot develops, this lump would turn hard or become painful hemorrhoids . You may experience lots of pain, swelling and irritation all at once. When both are present together called intero-external haemorrhoids . HARSH MOHAN 6/14/2012 4

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GRADES : Hemorrhoids only bleed Prolapse and reduce spontaneously Require replacement Permanently Prolapsed MEDICINENET WIKIPEDIA 6/14/2012 5

SYMPTOMS: 

SYMPTOMS Rectal Bleeding Bright red blood in stool Pain during bowel movements Anal Itching or irritation Rectal Prolapse Swelling around your anus Perianal Pruritus soreness A sensitive or painful lump near your anus Leakage of faeces Mucus discharge Pain only on prolapse Anaemia Thrombus Excoriation AUTHOR STREAM 6/14/2012 6

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CAUSES Most of the time, hemorrhoids are caused by diet and straining on the toilet. These 2 main factors are directly linked with eating unbalanced diet. People have been suggested that the fast food, market food items diet, which are rich in processed food and lacking in fiber. These food items are also contributes to hemorrhoids. The style of modern toilet, unfortunately, encourage straining. Some people also read news paper while sitting on the toilet, adding undue pressure to the anal veins. These are the common reason behind hemorrhoids. AUTHOR STREAM 6/14/2012 7

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POSSIBLE CAUSES Constipation – a person who strains to pass a hard stool put pressure on the anus & rectum, this can cause the blood vessel to become irritated and inflamed. Sitting for hours – sitting for many hours with little movement can put pressure & strain on the anal. Obesity – a person who is overweight can put excessive strain on the anus & surrounding area especially when sitting. Heavy Lifting – heavy object frequently put pressure on the lower half of your body and the anal region. Pregnancy – the added weight as a baby develops can create ecxtra tension and pressure on blood vessel in the anal area. Portal hypertension and Cardiac Failure may also lead Haemorrhoids . AUTHOR STREAM 6/14/2012 8

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PATHOPHYSIOLOGY Pile mass descends – gripped by the sphincters – more engorgement. Mucosal gathering in relation to the three branches of superior rectal arteries – called anal cushions – necessary for completer continence. They slide down and internal haemorrhoids develop in the prolapsing tissues. Dilated capillaries beneath epithelium. AUTHOR STREAM 6/14/2012 9

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COMPLICATIONS The blood in the enlarged veins may form clots and the tissue surrounding the hemorrhoids can die (Necrosis) This causes painful lumps in the anal area. Severe bleeding can occur causing iron deficiency anemia. Other are- Strangulation Thrombosis Ulceration Gangrene Fibrosis Haemorrhage Inflammation Scarring Suppuration Pylephlebitis WIKIPEDIA 6/14/2012 10

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Signs And Tests Rectal Examination Visual Digital Tests Stool Guaiac (FOBT) Sigmoidoscopy Anaoscopy Proctoscopy WIKIPEDIA 6/14/2012 11

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TREATMENT Non-surgical Surgical 6/14/2012 12

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Non-surgical- Mild cases are controlled by :- Preventing constipation Drinking Fluids High-fiber diet Use of Fiber supplements Stool softeners Apply OTC cream or suppository containing hydrocortisone. Keep anal area clean. Apply ice packs for 10min Use a sitz bath with warm water Use moist wet toilet paper instead of dry toilet paper. AUTHOR STREAM 6/14/2012 13

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Surgical- Hemorrhoid Surgery ( Haemorrhoidectomy ) - Hemorrhoid surgery is the removal of enlarged veins around the anus. HAL ( Haemorrhoidal Artery Ligation) Symptomatic Injection of sclerosant Banding ( Sclerotherapy or band ligation ) Stapling – endostapler ( Stapled anopexy ) Photocoagulation Cryosurgery - abandoned AUTHOR STREAM 6/14/2012 14

Complications Of Haemorrhoidectomy: 

Complications Of Haemorrhoidectomy Pain Bleeding Haemorrhage Faecal impaction Delayed wound healing Bacteraemia Septicaemia Pain anxiety Incontinence Skin bridge swelling Serosanguinous discharge Difficult micturition Urinary retention Urinary tract infection Fissure Liver abscess Anal stenosis Large bowel obstruction Rectal perforation Nausea and vomiting Sore throat Dizziness Blurred vision Shivering Headache Itching Aches and pains Backache Injection site pain Confusion Memory loss Bladder problems Muscle pains Respiratory depression Respiratory infection Damage to teeth, lips or tongue Ocular injury Nerve damage Fourniers gangrene AUTHOR STREAM 6/14/2012 15

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PROCEDURE HAL Doppler - A novel therapy for the treatment of hemorrhoids STEP 1 Before proceeding to the ultrasound guided haemorrhoidal artery ligation, the doctor accurately locates the terminal of all different branches of the superior rectal artery considering the vessels depth. Firstly, the xylocaine jelly is applied to the tip of the instrument and to the anus. The HAL Doppler is slowly inserted into the anus and rotated to locate the artery to be ligated . The arterial sound is clearly audible when the Doppler transducer is directly over the hemorrhoidal artery. AUTHOR STREAM 6/14/2012 16

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STEP - 2 The needle (strong curved with forceps) is inserted into the HAL Doppler. The needle passes beneath the artery and is withdrawn. STEP - 3 A knot is tied externally, which is then pushed down into the mucosa with the knot pusher, thus ligating the artery. The Doppler sound disappears as soon as the ligation is successfully performed. The suture is cut with scissors inside of the instrument. After completion of the ligation, a second assessment with the HAL Doppler system should confirm disappearance of sound. AUTHOR STREAM 6/14/2012 17

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Other Management Local application of a bland and zinc salt containing ointment relieves these local symptoms. Application of an ointment containing a local anesthetic such as nupercaine before passing a stool help to relieves the local pain and ease the sphincter spasm. Relaxation of anal sphincter is mediated by nitric oxide. Nitroglycerine ointment ( myovin ) or isosorbide dinitrate 1% ointment is used for anal fissure for healing with relief spasm and pain. Botulinum toxin by local injection into the anal sphincter has been used in resistant cases, it act by preventing the release of Ach locally. Avoidance of hard stool by the use of bulk laxatives or stool softener. SATOSKAR 6/14/2012 18

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PREVENTION Eat high fiber diet. Drink Plenty of Liquids. Fiber Supplements. Exercise. Avoid long periods of standing or sitting. Don’t Strain. Go as soon as you feel the urge. SATOSKAR 6/14/2012 19

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REFERENCE Harsh Mohan , “Textbook of Pathology”, sixth edition, Jaypee publishers, 581. Satoskar R.S .,“Pharmacology And Pharmacotherapeutics ”, revised 20 th edition, 608. Tortora Gerard J , “Principles Of Anatomy & Physiology”, 12 th edition, 970. www.authorstream.com www.wikipedia.org www.medicinenet.com 6/14/2012 20

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THANKS FOR YOUR ATTENTION 6/14/2012 21