HemorrhoidHemorrhoidss

( piles )( piles )Presented by group IPresented by group I

DR . Amany GamalDR . Amany Gamal

Objectives :-Objectives :-1)1) Definition of Hemorrhoids .Definition of Hemorrhoids .

2)2) Anatomy .Anatomy .

3)3) Types .Types .

4)4) Pathophysiology .Pathophysiology .

5)5) Symptoms .Symptoms .

6)6) Causes .Causes .

7)7) Signs and Tests .Signs and Tests .

8)8) Complications .Complications .

9)9) Treatment .Treatment .

10)10) Hemorrhoid Surgery .Hemorrhoid Surgery .

11)11) Prevention .Prevention .

What Are What Are Hemorrhoids?Hemorrhoids?

Alternative NamesAlternative Names Rectal LumpRectal Lump PilesPiles Lump in the RectumLump in the Rectum

DefinitionDefinition

Dilated or enlarged veins in the Dilated or enlarged veins in the lower portion of the rectum or anus.lower portion of the rectum or anus.

Hemorrhoids (Piles) are blood vessels Hemorrhoids (Piles) are blood vessels located in the smooth muscles of the located in the smooth muscles of the walls of the rectum and anus.walls of the rectum and anus.

ANATOMYANATOMY right anterior, right posterior and left right anterior, right posterior and left

lateral positions .lateral positions . those originating above the dentate those originating above the dentate

line which are termed internal .line which are termed internal . those originating below the dentate those originating below the dentate

line which are termed external . line which are termed external .

Types of HemorrhoidsTypes of Hemorrhoids

Two Types:Two Types: Internal- Under the skinInternal- Under the skin External- Around the anusExternal- Around the anus

Grades:Grades:I- Hemorrhoids only bleedI- Hemorrhoids only bleedII- Prolapse and reduce spontaneouslyII- Prolapse and reduce spontaneouslyIII- Require replacementIII- Require replacement!V- Permanently Prolapsed!V- Permanently Prolapsed

PathophysiologyPathophysiology

represent engorgement or enlargement represent engorgement or enlargement of the normal fibro vascular cushions of the normal fibro vascular cushions lining the anal canal. lining the anal canal.

chronic straining secondary to chronic straining secondary to constipation or occasionally diarrhea constipation or occasionally diarrhea

fibro vascular cushions lose their fibro vascular cushions lose their attachment to the underlying rectal wall. attachment to the underlying rectal wall.

Cont.Cont.

prolapse of internal hemorrhoidal prolapse of internal hemorrhoidal tissue through the anal canal. tissue through the anal canal.

the overlying mucosa becomes more the overlying mucosa becomes more friable and the vasculature increases. friable and the vasculature increases.

With overlying thinning of the mucosa With overlying thinning of the mucosa and vascular engorgement, and vascular engorgement, subsequent rectal bleeding occurs. subsequent rectal bleeding occurs.

SymptomsSymptoms

Rectal BleedingRectal Bleeding Bright red blood in stoolBright red blood in stool Pain during bowel movementsPain during bowel movements Anal ItchingAnal Itching Rectal ProlapseRectal Prolapse ThrombusThrombus

CausesCauses

PressurePressure Constipation Constipation DiarrheaDiarrhea Sitting or standing for long periods of timeSitting or standing for long periods of time ObesityObesity Heavy LiftingHeavy Lifting PregnancyPregnancy

Signs and TestsSigns and Tests

Rectal ExaminationRectal Examination VisualVisual DigitalDigital

TestsTests Stool Guaiac (FOBT)Stool Guaiac (FOBT) SigmoidoscopySigmoidoscopy AnaoscopyAnaoscopy ProctoscopyProctoscopy

ComplicationsComplications

The blood in the enlarged veins may form The blood in the enlarged veins may form clots and the tissue surrounding the clots and the tissue surrounding the hemorrhoids can die (Necrosis)hemorrhoids can die (Necrosis)

This causes painful lumps in the anal area.This causes painful lumps in the anal area. Severe bleeding can occur causing iron Severe bleeding can occur causing iron

deficiency anemia.deficiency anemia.

Treatment Non-surgicalTreatment Non-surgical

Mild cases are controlled by:Mild cases are controlled by: Preventing constipationPreventing constipation Drinking FluidsDrinking Fluids High-fiber dietHigh-fiber diet Use of Fiber supplementsUse of Fiber supplements Stool softenersStool softeners

Cont.Cont.

Apply and OTC cream or suppository Apply and OTC cream or suppository containing hydrocortisonecontaining hydrocortisone

Keep anal area cleanKeep anal area clean Soak in a warm bathSoak in a warm bath Apply ice packs or compresses x 10minApply ice packs or compresses x 10min

Cont.Cont.

If prolapses, gently push back into anal If prolapses, gently push back into anal canalcanal

Use a sitz bath with warm waterUse a sitz bath with warm water Use moist towelettes or wet toilet paper Use moist towelettes or wet toilet paper

instead of dry toilet paper.instead of dry toilet paper.

TreatmentsTreatments

For painful or persistent hemorrhoids:For painful or persistent hemorrhoids: Tying off a hemorrhoidTying off a hemorrhoid SclerotherapySclerotherapy Infrared LightInfrared Light Laser TherapyLaser Therapy FreezingFreezing Electrical CurrentElectrical Current SurgerySurgery

Hemorrhoid SurgeryHemorrhoid Surgery

Alternative Name: HemorrhoidectomyAlternative Name: Hemorrhoidectomy

Hemorrhoid surgery is the removal of Hemorrhoid surgery is the removal of enlarged veins around the anusenlarged veins around the anus

Surgical Treatment of Surgical Treatment of Hemorrhoids Hemorrhoids

The triangular shaped hemorrhoid is The triangular shaped hemorrhoid is excised down to the underlying excised down to the underlying sphincter muscle. sphincter muscle.

Wound can be closed or left openWound can be closed or left open stapled hemorrhoidectomy has been stapled hemorrhoidectomy has been

developed as an alternative to developed as an alternative to standard hemorrhoidectomystandard hemorrhoidectomy

Cont.Cont.

IndicationsIndications Persistent itchingPersistent itching Anal bleedingAnal bleeding PainPain Blood clotsBlood clots InfectionInfection

ContCont..

RisksRisks Reactions to medications of anestesiaReactions to medications of anestesia BleedingBleeding InfectionInfection Narrowing of the anusNarrowing of the anus

*The outcome is usually very good in the *The outcome is usually very good in the majority of cases.majority of cases.

PreventionPrevention

Eat high fiber dietEat high fiber diet Drink Plenty of LiquidsDrink Plenty of Liquids Fiber SupplementsFiber Supplements ExerciseExercise Avoid long periods of standing or sittingAvoid long periods of standing or sitting Don’t StrainDon’t Strain Go as soon as you feel the urgeGo as soon as you feel the urge

We hope that you We hope that you will have benefitedwill have benefited

Best wishesBest wishes Group ( 1 )Group ( 1 )

Group Group ( 1 )( 1 )

أحمدأحمدحسنيحسني أحمدأحمد

حسنيحسني أحمدأحمد

عاشورعاشور أحمدأحمد

عاشورعاشور

أبانوب أبانوب عمادعماد

أبانوب أبانوب عمادعماد

أحمدأحمدالجملالجمل أحمدأحمدالجملالجمل

أحمدأحمدالشربينالشربين

يي

أحمدأحمدالشربينالشربين

يي

أحمدأحمدإسماعيإسماعي

لل

أحمدأحمدإسماعيإسماعي

لل

إبراهيم إبراهيم رمضانرمضان

إبراهيم إبراهيم رمضانرمضان

إبراهيم إبراهيم األشرماألشرم

إبراهيم إبراهيم األشرماألشرم

آيات آيات راغبراغبآيات آيات راغبراغب

أسماء أسماء رخارخا

أسماء أسماء رخارخا

آية آية المغاورالمغاور

ىى

آية آية المغاورالمغاور

ىىأماني أماني زاهرزاهر

أماني أماني زاهرزاهر

آية آية نجيبنجيبآية آية نجيبنجيبأنغامأنغامأنغامأنغام