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Case Study of

INTERNAL HEMORRHOIDS

In Partial Fulfillment of The Requirement for the Subject: Related Learning Experience

Submitted to:

February 11, 2012


Introduction:

Hemorrhoids or haemorrhoids are perianal varicose veins .it is a vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of stool. Haemorrhoids are enlarged veins just under the surface tissue of your rectum (the last part of your bowel) or your anus (the opening of your bowel). Haemorrhoids usually caused by increased pressure on the veins in the pelvic and rectal area. As pressure increases, blood pools in veins and causes them to swell. Eventually, the swollen veins stretch the surrounding tissue, and hemorrhoids develop. This common problem can be painful, but its usually not serious. Veins can swell inside the anal canal to form internal hemorrhoids. Or they can swell near the opening of the anus to form external hemorrhoids. It is possible to have both types at the same time. The symptoms and treatment depend on which type is existent. The symptoms of pathological hemorrhoids depend on the type present. Internal hemorrhoids usually present with painless rectal bleeding while external hemorrhoids present with pain in the area of the anus . With internal hemorrhoids, there is a visible bright red streak of blood on toilet paper or bright red blood in the toilet bowl after a normal bowel movement. Blood is also visible on the surface of the stool. Internal hemorrhoids often are small, swollen veins in the wall of the anal canal. But they can be large, sagging veins that bulge out of the anus all the time. They can be painful if they bulge out and are squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off. If hemorrhoids bulge out, mucus may also be seen on the toilet paper or stool. External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum. Internal hemorrhoids may protrude, or prolapsed, through the anus. Most prolapsed hemorrhoids shrink back inside the rectum on their own. Severely prolapsed hemorrhoids may protrude permanently and require treatment. Internal hemorrhoids usually are first noticed when minor bleeding occurs with defecation. Pain occurs rarely, unless there is an associated disorder such as an anal fissure, thrombosis, or strangulation of the affected vein. External hemorrhoids produce

varying degrees of pain, feelings of pressure, itching, irritation, and a palpable mass. Bleeding occurs only if the external hemorrhoid is injured or ulcerated and begins to break down. Most clinicians use the grading system proposed by Banov et al in 1985, which classifies internal hemorrhoids by their degree of prolapse into the anal canal. This system both correlates with symptoms and guides therapeutic approaches.
y

Grade I hemorrhoids project into the anal canal and often bleed but do not prolapse.

Grade II hemorrhoids may protrude beyond the anal verge with straining or defecating but reduce spontaneously when straining ceases.

Grade III hemorrhoids protrude spontaneously or with straining and require manual reduction.

Grade IV hemorrhoids chronically prolapse and cannot be reduced. They usually contain both internal and external components and may present with acute thrombosis or strangulation. We choose this topic because we find it interesting. Aside from that we want to

know further on how the said condition could really affect the self-esteem of an individual.

PATIENT X Age Birthday Address Religion Diagnosis: y Internal hemorrhoids : 64 : : : Roman Catholic

Operation performed: y Colonoscopy

Anatomy and physiology

The colon is the last part of the digestive system in most vertebrates; it extracts water andsalt from solid wastes before they are eliminated from the body, and is the site in which flora-aided (largely bacterial) fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a major role in absorption of foods and nutrients. However, the colon does absorb water, sodium and some fat [1] soluble vitamins. In mammals, the colon consists of four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon (the proximal colon usually refers to the ascending colon [2] and transverse colon). The colon, cecum, and rectum make up the large intestine.

Pathophysiology

Non- modifiable factors -Age (20-50 years old) -Gender -Family history -Pregnancy

Modifiable factors Obesity Sedentary lifestyle Constipation Chronic Diarrhea Poor bathroom habits Postponing bowel movement Intake of fiber-deprived diet Cirrhosis of the liver Prolonged sitting or standing

Tenesmus

Increases intra-abdominal pressure

Increases hemorrhoidal venous pressure

Distention of the hemorrhoidal veins

Rectal ampulla is filled with formed stool Venous obstruction

Result of repeated and prolonged increase in the pressure and the obstruction

Permanently dilation of hemorrhoidal veins

Severe bleeding

Thrombosis Intense pain

Hemorrhoidal strangulation

Iron deficiency anemia

Cut of blood supply by anal sphincter Severe pain Extreme edema

Inflammation

Reference:

Baker H. Hemorrhoids. In: Longe JL, ed. Gale Encyclopedia of Medicine. 3rd ed. Detroit: Gale; 2006: 17661769. Chong PS, Bartolo DCC. Hemorrhoids and fissure in ano. Gastroenterology Clinics of North America. 2008;37:627644.