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haemorrhoids.pptx
Haemorrhoidal disease, also known as piles, is caused by the distal displacement of normal anal cushions which causes venous dilatation. It is classified into internal or external types depending on whether they are above or below the dentate line. The most common symptom is bleeding. Treatment options include lifestyle changes, medications, injections, rubber banding, surgery, and ablations depending on the grade of haemorrhoids. Proper medical evaluation is important to identify any underlying conditions like cancer that may be causing the symptoms.
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haemorrhoids.pptx
- 1. The Bottom Line: HaemorrhoidalDisease Chea Chan Hooi MD General & Laparoscopic Surgeon Borneo Medical Centre (Miri) cheachanhooi@yahoo.com 0149972321
- 2. Disclosure • Perform surgeriesand clinic procedures for haemorrhoids and varicose veins • Use Daflon extensively • No monetary incentive from Servier • No shares in Servier
- 3. Content • Definition • Anatomy •Etiology • Grades • Differential diagnoses • Symptoms • Investigations • Treatment • Conclusion • Q&A
- 4. Definition • Haemorrhoids – Distaldisplacement of normal anal cushions causing venous dilatation – 痔疮, piles, buasir – Anal cushions • Sensory input to differentiate luminal content • Provides 15 – 20% of resting anal pressure • Arterio-venous anastomoses
- 5. Types • Anatomy – Internal •Anal cushion • Superior to dentate line • Columnar epithelium • Grade 1 – 4 – External • Perianal blood vessels • Inferior to dentate line • Anoderm & skin cover
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- 7. Etiology Constant straining Prolonged sittingon toilet bowl Pathological Iatrogenic
- 8. Grades of internalhaemorrhoids
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- 17. Tests • Colonoscopy – Over40 y/o – Red flags – Younger patients not improving with phlebotonic drugs
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- 24. Treatment options • Lifestylechanges – Avoid constipation – Physical activities – Reduce weight – Reading in toilet • Medications • Interventions
- 25. Medications • Symptomatic relief –Sitz bath – Topical analgesics – Systemic analgesics, anti-inflammatory – Stool softeners • Phlebotonics – Flavonoids – Calcium dobesilate – Nano-emulsions (diosmin & hesperidin too) • Osmotics – Plant-based – Sugar Ratto C, Orefice R, Tiso D, Martinisi GB, Pietroletti R. Management of hemorrhoidal disease: new generation of oral and topical treatments. Eur Rev Med Pharmacol Sci 2020;24:9645-9
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- 46. Conclusion • Haemorrhoids arevery common • Most common symptom is bleeding • Can mask a cancer • Proper medical evaluation is important • The bottom line – vigilant evaluation so as not to miss other significant diseases
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