Presented by group I DR . Amany Gamal Hemorrhoids ( piles ) Presented by group I DR . Amany Gamal

Objectives :- Definition of Hemorrhoids . Anatomy . Types . Pathophysiology . Symptoms . Causes . Signs and Tests . Complications . Treatment . Hemorrhoid Surgery . Prevention .

What Are Hemorrhoids? Alternative Names Rectal Lump Piles Lump in the Rectum

Definition Dilated or enlarged veins in the lower portion of the rectum or anus. Hemorrhoids (Piles) are blood vessels located in the smooth muscles of the walls of the rectum and anus.

ANATOMY right anterior, right posterior and left lateral positions . those originating above the dentate line which are termed internal . those originating below the dentate line which are termed external .

Types of Hemorrhoids Two Types: Grades: Internal- Under the skin External- Around the anus Grades: I- Hemorrhoids only bleed II- Prolapse and reduce spontaneously III- Require replacement !V- Permanently Prolapsed

Pathophysiology represent engorgement or enlargement of the normal fibro vascular cushions lining the anal canal. chronic straining secondary to constipation or occasionally diarrhea fibro vascular cushions lose their attachment to the underlying rectal wall.

Cont. prolapse of internal hemorrhoidal tissue through the anal canal. the overlying mucosa becomes more friable and the vasculature increases. With overlying thinning of the mucosa and vascular engorgement, subsequent rectal bleeding occurs.

Symptoms Rectal Bleeding Bright red blood in stool Pain during bowel movements Anal Itching Rectal Prolapse Thrombus

Causes Pressure Constipation Diarrhea Sitting or standing for long periods of time Obesity Heavy Lifting Pregnancy

Signs and Tests Rectal Examination Tests Visual Digital Stool Guaiac (FOBT) Sigmoidoscopy Anaoscopy Proctoscopy

Complications The blood in the enlarged veins may form clots and the tissue surrounding the hemorrhoids can die (Necrosis) This causes painful lumps in the anal area. Severe bleeding can occur causing iron deficiency anemia.

Treatment Non-surgical Mild cases are controlled by: Preventing constipation Drinking Fluids High-fiber diet Use of Fiber supplements Stool softeners

Cont. Apply and OTC cream or suppository containing hydrocortisone Keep anal area clean Soak in a warm bath Apply ice packs or compresses x 10min

Cont. If prolapses, gently push back into anal canal Use a sitz bath with warm water Use moist towelettes or wet toilet paper instead of dry toilet paper.

Treatments For painful or persistent hemorrhoids: Tying off a hemorrhoid Sclerotherapy Infrared Light Laser Therapy Freezing Electrical Current Surgery

Hemorrhoid Surgery Alternative Name: Hemorrhoidectomy Hemorrhoid surgery is the removal of enlarged veins around the anus

Surgical Treatment of Hemorrhoids The triangular shaped hemorrhoid is excised down to the underlying sphincter muscle. Wound can be closed or left open stapled hemorrhoidectomy has been developed as an alternative to standard hemorrhoidectomy

Cont. Indications Persistent itching Anal bleeding Pain Blood clots Infection

Cont. Risks Reactions to medications of anestesia Bleeding Infection Narrowing of the anus *The outcome is usually very good in the majority of cases.

Prevention Eat high fiber diet Drink Plenty of Liquids Fiber Supplements Exercise Avoid long periods of standing or sitting Don’t Strain Go as soon as you feel the urge

We hope that you will have benefited Best wishes Group ( 1 )

آية المغاورى أحمد حسني إبراهيم رمضان أماني زاهر أحمد عاشور Group ( 1 ) أسماء رخا أحمد الجمل أحمد إسماعيل آية نجيب أنغام أحمد الشربيني آيات راغب إبراهيم الأشرم أبانوب عماد