Heammorhoids
Dilated veins occurring in relation to anus
TypesA-Internal hemorrhoids
B- external hemorrhoides
Hemorrhoides may be symptomatic with other diseases
1-carcinoma of rectum
2-pregnancy
3-straining at micturition
4-constpation
aetiology1-herdittary
2-morphological
3-anatomical
Excerbating factors
pathologyThey are arrange in three groups at 3 ,7 ,11, o’clock site while patient in lithotomy position
These are related to the superior rectal artery branches
A-pedicle
b-internal hemorrhoid
c- external hemorrhoides
Clinical featuresA-bleeding
B-prolapse
C-discharge
D-pain
E-anemia
On examination
Inspection
Digital examination
Proctoscopy
segmoidoscopy
complications
1-strangulation
2-thrombosis
3-ulceraion
4-gangren
5-fibrosis
6-suppuration
7-pyophlebitis (portal pyaemia )
Treatment
Symptomatic treatment ,Active treatment
1-injection
2-banding
3-cryosurgery
4-photocoagulation
5-surgery (transfixation and excision)
Anorectal abscess1-perianal 60 %
2-ischiorectal 30%
3-submucous
4-pelvirectal
Fistula in anoIt is a track connecting two epithelial surface (skin and anal or rectal mucosa )
Classifications
Low or high fistula according to the internal opening wither below or above the ano rectal ring .
1-anatomical ,subcutaneous ,submucous, low anal ,high anal . Pelvirectal
2-park classification; a-intersphincteric, b-transsphenctric(low or high ), c- supralevator
Clinical feature
-continuous seroperulent discharg
-attack of pain followed by discharge of pus
-orifice usually small, 3-4 cm from anus
-Goodsall’s rule; orifece at the anterior half are direct while that at posterior half have curved track
-PR Examination
-proctoscopy
Treatment 1-low type lay open
2-high type staged operation, seton ,colostomy