5-Minute Clinical Consult : Hemorrhoids

5-Minute Clinical Consult

Hemorrhoids

Description

Varicosities of the hemorrhoidal venous plexus
External hemorrhoids are located below the dentate line and covered by squamous epithelium.
Internal hemorrhoids are located above the dentate line.
Both types of hemorrhoids often coexist.
Classification of internal hemorrhoids:
- First degree: Hemorrhoids do not prolapse.
- Second degree: Prolapse through the anus on straining but reduce spontaneously
- Third degree: Protrude and require digital reduction
- Fourth degree: Cannot be reduced
Hemorrhoids often progress from itching, bleeding stage to protrusion with easy reduction, then difficult reduction, and finally rectal prolapse. Thrombosis may occur at any protrusion stage.

ALERT
Geriatric Considerations
Common in elderly along with rectal prolapse

Pediatric Considerations

Uncommon in infants and children. Look for underlying cause (e.g., venacaval or mesenteric obstruction, cirrhosis, portal HTN).
Occasionally, as in adults, hemorrhoids may result from chronic constipation, fecal impaction, and straining at stool. Surgery is rarely required in children.

Pregnancy Considerations

Common in pregnancy
Usually resolves after pregnancy
No treatment required, unless extremely painful

Hemorrhoids has been found in 5-Minute Clinical Consult

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5-Minute Clinical Consult (5MCC) for Mobile + Web helps you diagnose, treat, and follow up on over 900 medical conditions. The 2013 edition also includes Diagnosaurus, 200 pediatrics topics, and medical RSS feeds.

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