chart of important info about hemorrhoid

1. Hemorrhoid
Prepared by : Dr Abdullah ihsaas
General Surgery trainee specialist
Nangarhar University Teaching Hospital
General Surgery Word

2. Surgical anatomy of anal canal
Length of anal canal 8 – 20 cm.
Surgical is 2 – 4 cm
There are three curvatures at anal canal :-
1. Sup – curvature  To right side
2. Middle – curvature  Left side
3. Inf – curvature  To right side

4. Blood supply of anal canal :-
• Sup rectal artery  inf mesenteric art
• Middle rectal artery  internal iliac artery
• Inf rectal artery  internal pudendal artery
Venous drainage :-
• Sup – rectal vein
• Middle rectal vein ________ internal iliac vein ___portal vein
• Inf rectal vein
Lymphatic drainage :-
• Inf mesenteric nodes
• Internal iliac nodes

5. Hemorrhoid

6. Definition :-
• Abnormal dilatation of hemorrhoidal plexus due to Vinous stasis is
called hemorrhoid.
• Varicose of hemorrhoidal plexus is called hemorrhoid.

7. Incidence of hemorrhoid
• Age 45 – 65
• Illness 4%
• Sex Male = Female

8. Etiology of hemorrhoid
• Low fiber diet using
• Constipation
• Diarrhea
• Obesity
• Cachexia
• CVD
• Ascites
• Liver cirrhosis
• BPH
• Harvey weight lifting
• Intra abdominal tumors
• Pregnancy
• Site on feet for long time
• Standing for long time
• Old age
• Muscle weakness

9. Classification:-
1. External hemorrhoid  lower from pectin line
2. Internal hemorrhoid  upper from pectin line
3. Mixed hemorrhoid  upper and lower ( mixed )

10. Calcification of internal hemorrhoids
1. First degree ( I ) :-
Fullness of anal canal + blood + No prolapse.
1. Second degree ( 2 ) :-
Fullness of anal canal + blood + prolapse spontaneously reducible.
1. Third degree ( 3 ) :-
Fullness of anal canal + blood + prolapse reducible with manure.
1. Fourth degree ( 4 ) :-
Fullness of anal canal + blood + prolapse (incarcerated) Non reducible.

13. Graham sten warts classification:-
1. Vascular internal hemorrhoid  involved just veins, mostly at
young age.
2. Mucosal internal hemorrhoid  involved mucosal membrane,
mostly at old age.

14. Pathophysiology of hemorrhoid
• While Risk factors found ( constipation, BPH ..ETC) Pressure at
defecation  Supportive tissue of anal canal are weak Or damages 
then prolapse occurs.
• After that strangulation  ischemia  thrombosis, Gangrene,
fibrosis

15. Clinical feature :-
• Pain ( fullness )  Sever at External Hemorrhoid and
Developed gangrenous internal hemorrhoid.
• Bleeding
• Anemia
• Constipation
• Mucosal discharge

16. Investigation
1. Blood Exam  HB - BT - CT - HBS – HCV - HIV
2. Stool Exam  DDX with Intestinal parasites
3. Ano scopy
4. Rectal digital examination

17. Diagnosis of Hemorrhoid
• Complete detailed History taking
• Physical Examination
• Lab Exam

18. DDX of Hemorrhoid
• Ulcerative colitis
• Irritable bowel disease
• Dysentery
• Rectal prolapse
• Rectal CA
• Anal fissure
• Anal fistula
• Intussusception

19. Complication
1. Hypovolemic shock
2. Anemia
3. Thrombosis
4. Ulceration
5. Suppuration
6. Fibrosis
7. Calcification
8. Gangrene
9. Anal fistula
10. Anal stenosis

20. Treatment
1. Conservative treatment
2. Non surgical treatment
3. Surgical treatment

21. Conservative treatment
• High fiber diet
• Adequate fluid intake
• Stool soft near drugs
• Anti biotic
• Analgesics
• Poyidon bath BID TID
• Eradication of cause
• Local pomade in grade (1) and non thrombotic external
• Proper anal hygiene

22. Non surgical treatment
1. Elastic band ligation  hemorrhoidal pile attracted and ligate at
base after that it will be necrotic and removed.
2. Sclerotherapy  Phenol 5% or almond oil injected at pile
3. Cryo surgery  CO and N injected to pile after 10 min
coagulation occur and after that removed

23. Surgical treatment :-
 Excisional Hemorrhoedectomy
Done while :-
• 3rd and 4th grade hemorrhoid
• First and 2nd grade hemorrhoid which is not cure with medical
treatment
• External mixed hemorrhoid

24. Excisional haemorrhoidectomy procedure :-
• Hemorrhoid piles ligated
• And removed
If there is more hemorrhoid piles at anal canal then :-
• Large piles are ligated and removed
• Small piles are sutures circularly

25. Post operative complication :-
• Infection
• Anal stenosis
• Bleeding
• Recurrence

26. Prevention:-
Reduce risk factors

27. Reference :-
• Baily & loves practice of surgery
• Grays anatomy 3rd edition
• Respected teachers Lecture Notes.