hemorrhoids (piles)
TRANSCRIPT
Hemorrhoids (Piles)
S.S Hotchandani4th year BDS Student at Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, Pakistan.
Introduction
Greek word..Haim; Blood Rhoos; Flowing
Latin Word
Pila; Ball
Introduction
Prevalence of Asymptomatic Piles is greater
than Symptomatic
Piles.
Piles
Internal
Primary
Secondary
External
Internal Hemorrhoids Piles inside Anus…
Occur in Anal Cushions, usually at 3, 7 & 11 o'clock Position.
AKA, Symptomatic Anal Cushions
Called as Secondary if they occur in b/w Primary masses…
Causes of PRIMARY Internal Hemorrhoids
There are some misconceptions about the anatomy of vascular system of anal canal and these misconceptions has led to give many theories about the Development of Primary Internal Hemorrhoids…
PORTAL HYPERTENSION & VERICOSE VEINS
Man’s upright or standing posture contribute to hemorrhoids formation, though there are no any cases of hemorrhoids in Animals!!
Portal venous system does not contain any valves and this causes backward flow and dilate Anal cushions’ blood vessels & cause piles.
Increased abdominal pressure contribute to formation of anal varicosity resulting piles.
Note; Prevalence of Ano rectal varices is greater than Piles in Patients of Portal Hypertension..
Other Theories or Causes told by Some Scholars!!
Hemangioma
Infection
Diet & Stool
Anal Hypertonia
Ageing
New Concept about Development of Piles.
Shearing forces which act on anus causes displacement of anal cushions caudally and also mucosal trauma..
With time, fragmentation of supporting structures causes loss of elasticity of cushion and they do not retract back after defecation
Causes of Secondary Internal Hemorrhoids (LOCAL)
Anorectal Deformity
Hypotonic Anal Sphincter
Causes of Secondary Internal Hemorrhoids (Abdominal)
ASCITES
Causes of Secondary Internal Hemorrhoids (Neurological)
Paraplegia
Multiple Sclerosis
Causes of Secondary Internal Hemorrhoids (Pelvic)
Gravid Uterus Uterine Neoplasm
Ovarian Neoplasm
Bladder Carcinoma
ClinicalFeatures
Bleeding
Pain
Anal irritation
Constipation
Mucous Discharge
Prolapse
• Permanently Prolapsed
4t
h Degree
• Prolapse but goes bac k ma nua lly
3r
d Degree
• Prola pse but g oes ba ck spontaneous ly
2n
d Degree
• Bleed only, no Prolapse
1s
t Degree
Degrees of Hemorrhoids
Ulceration
Gangrene
Portal Pyaemia
Fibrosis
Strangulation &
Thrombosis
Complications
MANAGEMENT
Medical & Surgical
Conservative Treatment
Exclude other cause of bleeding from anusNormalize bowel and defecation habits.
Only evacuating stool when natural desire appears
Adopting defecation position so that minimal straining occur during defecation
Use of stool softener and bulking agents.
Surgical ManagementInjection
Sclerotherapy
HaemorrhoidectomyBanding
THANKS!
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