Hemorrhoids

Hemorrhoids are outlined tooth line on both sides of the rectum and lower venous plexus caused by the varicose blob that could cause bleeding, embolism, emerge. Divided into internal hemorrhoids, and mixed hemorrhoids external hemorrhoids (Figure 2 -108), occurred in adults, affecting life and work. Figure 2 -108 hemorrhoid dentate line with the types of pathology Disease (1) varices doctrine : anatomical factors portal vein and its branches without valve, blood easy pregnancy, rectosubmucous organizations osteoporosis, favorable vein expand. habitual constipation prolonged use defecation, venous plexus prolonged internal pressure increased, undermining the smooth muscle fibers and elastic connective tissue, varices. ۠increased intra-abdominal pressure such as pregnancy, pelvic tumor, benign prostatic hypertrophy dysuria, so that venous obstruction. (2) Pad hyperplasia spondylolisthesis theory : that hemorrhoid by Thomson Pad depression formed. Pad is anal upper submucosa with sponge-like erectile tissues, which have small arteries and veins. Arterial and venous shorted traffic and smooth muscle and connective tissue, muscle fiber and connective tissue so that the fixed pad. As local tissue degeneration, such as increased intra-abdominal pressure, Pad spondylolisthesis, within the next shift into hemorrhoids. 2. Classification and pathology (1) internal hemorrhoids is rectal venous plexus of varicose veins blob at the tooth above the surface mucosa coverage, Common to the left and right anterior and right after three. (2) external hemorrhoids is rectal venous plexus of varicose veins blob at the tooth below the surface of the anal skin covered, often vein thrombosis and prominent in the mouth or anus outside the anus. (3) mixed hemorrhoids from the rectum, under venous plexus each other and influence each other. Hemorrhoid block-line gear, Meanwhile the surface of anal mucosa and skin covered. China currently divided into three internal hemorrhoids : the first period when they shocked, hemorrhoids block not discredit the anus, anus microscopic examination only can be seen; the second period when they stepped out of anal hemorrhoids block, and after he returned; ۠the third period when they stepped out of anal hemorrhoids block, not required to reply and gracefully back to the second period of internal hemorrhoids often become mixed hemorrhoids that bulbs constantly rising. all get out of the external anal called "Ring hemorrhoid." Sometimes hemorrhoids block emerge again for the external anal sphincter spasm by the incarcerated, resulting in bleeding edema, dark purple or necrosis, This is a very serious complication. Clinical manifestations (1) an internal hemorrhoids. Bleeding when it is a common symptom of internal hemorrhoids, was bright red, painless and generally small amount of bleeding, sometimes more, were spray-like racks can cause severe anemia. 2. Block stepped out of hemorrhoids, internal hemorrhoids second, the three could get out of the anus, from the back into their own hands must be pushed back to the anus. Otherwise easily incarcerated and necrosis. 3. Pain purely internal hemorrhoids without pain. When the internal hemorrhoids mucosal erosion, edema, infection can be painful, such as occurrence of Incarcerated strangulated, necrosis infection, it will be pain. 4. Pruritus Rectal Prolapse due to stimulate the secretion increased sphincter relaxation, secretions drain, make perianal itching, skin or even eczema. Check internal hemorrhoids and the internal hemorrhoids mixed hemorrhoids part unless emerge, not generally seen. Hemorrhoids block off of the best immediately after defecation observation, we can see that piece of hemorrhoids dark purple, sometimes visible mucosal erosion or bleeding. And the problem can not extricate himself from the need to block anal microscope to see that the seizure can not be palpable hemorrhoid block, but may exclude other diseases. (2) thrombotic external hemorrhoids caused by defecating or forceful, anus marginal vein rupture, blood and tissue infiltration, as hematoma, Pain tumor formation. Defecography and activities aggravated anal examination see the edge of a prominent dark purple long-mass Park, the surface skin edema, quality hardware, obvious tenderness, inactive. (3) external hemorrhoids is the connective tissue anal margin of the skin wrinkles in turn, are connective tissue, vascular little that varicose veins widens long and pointed, size ranging from forming a single, more fat. Local difficult to keep clean, inflammatory pain can be. Diagnosis based on the typical symptoms of hemorrhoids, digital rectal examination and anal endoscopic examination, the general diagnosis is not difficult, but with the following disease. (1) rectal polyps painless rectal bleeding is a common symptom, low pedicle polyps can discredit the anus, with Prolapse confused, referring to the seizure could palpable, most pedunculated. (2) cancer Strictly speaking it is not difficult to identify the two, as long as seriously do digital rectal examination and microscopic examination anus and rectum block can be found. (3) rectal prolapse defecation when emerge, the general level of the entire rectum, mucosa of concentric annular plica. Hemorrhoid treatment in the majority of static, silent, simply pay attention to diet, feces smoother and prevent complications such as : (1) applicable to the general treatment of hemorrhoids initially, occasionally Dabiandaixie. Defecography mainly to adjust and maintain patency stool, after bath with hot water, available for anal suppositories, hemorrhoids suppository, indomethacin, lubricants, Convergence role. Local thrombotic external hemorrhoids ointment topical analgesics or physiotherapy, if the initial internal hemorrhoids discredit incarcerated, they can promptly hemorrhoid group back anus. (2) sclerotherapy treatment of internal hemorrhoids applicable 12, the drug was injected into the base of the mother hemorrhoid submucosa. aseptic inflammatory reaction occurred, a small vascular occlusion and hemorrhoids within the fiber hyperplasia, sclerosing shrinking. The hardening agent used a 5% sodium morrhuate, compound alum injection, 5% glycerol solution such as phenol. The methods of operation patients emptying stool, chest knee-anal microscope revealed hemorrhoid block, After disinfection guidelines in the first tooth Buy piercing submucosal injection, each injecting a hemorrhoid block ~ 2 ml (Figure 2-109). Figure 2 -109 internal hemorrhoids injection therapy (c) Cryotherapy applied to stop the bleeding hemorrhoids, recurrence, associated with the elderly, the infirm or the heart, lung, liver, kidney, etc., and not surgery, Application of liquid nitrogen (-196 ° C) with the probe through frozen hemorrhoid block contacts to organizations necrosis. Operation of preoperative preparation and injection therapy posture and the same, anal probe microscopy will be frozen directly with the center block access to hemorrhoids, sustained two minutes into the entire hemorrhoid white ice hockey, with no special treatment, 5 ~ 7 days hemorrhoid tissue necrosis. 10 ~ 14 days from necrosis rot, while epithelial growth, healing after partial stay low white scar. According to the internal and external hemorrhoid has frozen more than 10,000 cases, up to 70% cure rate, I used hospital treatment of hemorrhoid ligation frozen more than 3,000 cases, a cure rate of 82%, the total efficiency of 95%. (4) Kuzhi therapy applicable to the small internal hemorrhoids or from bleeding. with two cusps spindle as the size of a match stick inserted hemorrhoid medicine spindles, so that hemorrhoid acute inflammatory response, necrosis corrosion, Finally fibrosis. Kuzhi small litter containing alum, gallnut, berberine, March 7, borneol drugs. Chap D-ready with injection therapy, Chap requirements under direct vision small, not too deep, was so shallow. Too deep into muscle or can penetrate the wall will cause infection around the rectum. Too shallow can cause hemorrhagic mucosal necrosis. (5) applicable to infrared coagulation one, two small internal hemorrhoids, it can harden the protein coagulation therapy. Probe focus block facing hemorrhoid upper base anal mucosa, solidification 15 seconds, each block hemorrhoid solidification six small, often after a small amount of bleeding, but need another surgery are more used. (6) applies to surgical therapy Prolapse heavier or ring mixed hemorrhoids prolapse surgery better. Methods commonly used are : 1. Hemorrhoid ligation in the roots with thick silk ligation, hemorrhoids ischemia, necrosis. Attention to postoperative hemorrhage secondary. 2. Aprons Ligation of a special 0.2-0.3cm wide hemorrhoid latex trap in the roots, so that hemorrhoid ischemic necrosis. postoperative hemorrhage secondary to the possibility. If no ligation device that can also be used to replace two hemostatic forceps. 3. Hemorrhoids resection applicable isolated discredit Hemorrhoids, Anal expansion under anesthesia revealed hemorrhoid corporations, open the skin and mucous membranes. Mission to varicose vein stripping out that the ligation of excision, teeth can suture line mucosa, skin incision open drainage. 4. Hemorrhoids resection of the cricoid serious ring can be a hemorrhoid removal surgery using 8-12cm long is Bing cork Park column will be inserted into the anus hemorrhoid removal tow, interrupted suture and outside the margins. Due to trauma, it can be easily infected, it can cause anal stenosis, postoperative be periodically expanded anus. Prevention (1) adopt a daily regular bowel habits to prevent constipation and bowel long time. (2) attention to food hygiene, eat more vegetables, and eat hot peppers and other big irritant to the Food and avoid drinking heavily. (3) regular physical activity, persist in sports, right or standing for long periods of sedentary elderly and the infirm, people should adhere to the intergovernmental parade. (4) to maintain the anus of clean, timely treatment Proctitis anal sexual disorders.