GIT-L02-Hemorrhoidal Disease

What is the annual incidence of symptomatic hemorrhoids in the Western world

>1 million individuals per year.

Is hemorrhoidal disease selective for age or sex

No, but age is a known risk factor.

How does diet influence hemorrhoidal disease

A low-fiber, high-fat Western diet is associated with constipation, straining, and hemorrhoid development.

What is the function of hemorrhoidal cushions

They aid in continence by preventing damage to the sphincter muscle.

What are the three main hemorrhoidal complexes

Left lateral, right anterior, and right posterior.

What causes hemorrhoidal prolapse

Engorgement and straining weaken the support system, leading to prolapse.

Where do external hemorrhoids originate

Below the dentate line, covered with squamous epithelium.

What is a key characteristic of thrombosed external hemorrhoids

They are painful.

Where do internal hemorrhoids originate

Above the dentate line, covered with mucosa and transitional zone epithelium.

What is the most common type of hemorrhoid

Internal hemorrhoids.

What are the main reasons patients seek medical attention for hemorrhoids

Bleeding and protrusion.

How is hemorrhoidal bleeding typically described

Painless bright red blood seen in the toilet or on wiping.

Why must a colonic neoplasm be ruled out in anemic patients with hemorrhoidal bleeding

To exclude a more serious underlying cause of anemia.

What type of pain is associated with hemorrhoids

A dull ache from engorgement; severe pain may indicate thrombosis.

How is hemorrhoidal disease diagnosed

Physical examination, digital rectal exam, and anoscopy.

What should be inspected in the perianal region during examination

Thrombosis and excoriation.

How is hemorrhoidal prolapse assessed during anoscopy

The patient strains, and the physician observes prolapse.

What is an important distinction between rectal prolapse and prolapsing hemorrhoids

Rectal prolapse is circumferential, while hemorrhoidal prolapse is radial.

When should a colonoscopy be performed in young patients with bleeding hemorrhoids

If bleeding continues after initial treatment.

What screening is recommended for older patients with hemorrhoidal bleeding

Colonoscopy or flexible sigmoidoscopy.

What is the treatment for an acutely thrombosed hemorrhoid within the first 72 hours

Elliptical excision.

What conservative treatments are recommended for hemorrhoids

Sitz baths, fiber, and stool softeners.

What office-based procedures are available for bleeding hemorrhoids

Rubber band ligation, infrared coagulation, and sclerotherapy.

Why can hemorrhoid procedures be performed without discomfort

Sensation begins at the dentate line.

How does rubber band ligation work

Bands cause ischemia and fibrosis, fixing the tissue proximally.

What is a common complaint after rubber band ligation

A dull ache for 24 hours.

What is injected during sclerotherapy for hemorrhoids

1–2 mL of a sclerosant, usually sodium tetradecyl sulfate.

What precaution must be taken during sclerotherapy

Avoid circumferential injection to prevent stenosis.

What are the surgical treatment options for hemorrhoids

Excisional hemorrhoidectomy, transhemorrhoidal dearterialization (THD), and stapled hemorrhoidectomy (PPH).

What is a benefit of sutured hemorrhoidectomy

Removal of redundant tissue and anal skin tags.

Why is stapled hemorrhoidectomy associated with less discomfort

It does not remove anal skin tags.

What is a disadvantage of stapled hemorrhoidectomy

Increased number of complications with the stapling device.

How does transhemorrhoidal dearterialization (THD) work

Uses ultrasound guidance to ligate blood supply, reducing engorgement.

Who should not undergo hemorrhoid procedures

Immunocompromised patients or those with active proctitis.

Why is emergent hemorrhoidectomy for bleeding hemorrhoids avoided

It is associated with a higher complication rate.