Hemorrhoid is a topic covered in the 5-Minute Emergency Consult.

To view the entire topic, please or purchase a subscription.

Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:

Emergency Central

-- The first section of this topic is shown below --

Basics

Description

  • General:
    • Normal venous sinusoids of the distal rectum and proximal anal canal
    • Normal vascular cushions of anal canal that contribute to anal continence
    • Arteriovenous shunt system exists at the level of the internal hemorrhoids that accounts for the bright red blood per rectum
  • When the hemorrhoids become symptomatic, hemorrhoid disease develops.
  • Do not cause pain unless thrombosed or strangulated
  • Discrete masses of thick submucosa contain:
    • Blood vessels
    • Smooth muscle
    • Elastic and connective tissue
  • Sliding down of part of anal canal lining
  • External hemorrhoids:
    • Vessels situated below dentate line
    • Covered by skin/anoderm
    • Drain to internal iliac veins
  • Internal hemorrhoids:
    • Submucosal vessels above dentate lines
    • Drain to portal system
    • Usually at left lateral, right posterolateral, and right anterolateral positions
    • Grade 1: Painless, bleeding
    • Grade 2: Prolapse with bowel movement (BM), spontaneously reduce
    • Grade 3: Prolapse with BM, require manual reduction
    • Grade 4: Chronically prolapsed, not reducible

Etiology

  • Exact cause unknown
  • Gravitational forces and abdominal pressure cause distention of the sinusoids
  • Associated with straining and irregular bowel habits:
    • Hard, bulky stools or diarrhea cause tenesmus/straining.
    • Push anal cushions out of anal canal
    • Weaken submucosal tissue leading to prolapse
  • Higher resting anal pressures:
    • Erect posture
  • Heredity:
    • Absence of valves in veins
  • Increased intra-abdominal pressure:
    • Ascites
    • Pregnancy
  • Portal hypertension

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemorrhoid ID - 307226 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307226/all/Hemorrhoid ER -