SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : HEMORRHOIDS (VARICES HAEMORRHOIDALES) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology primary (more frequent) hemorrhoids is blood stagnation due to a sedentary lifestyle, alcoholism, hard work, constipation, change in venous wall due to the weakness of mesenchymal apparatus or inflammation of the vein wall under the influence of local processes (proctitis). Contributing issues, the absence of valves in the hemorrhoidal veins and obstruction of outflow of blood due to the low location of the hemorrhoidal veins in the body that promotes stagnation. The cause of secondary hemorrhoids - compression of the veins and stagnation in their blood due to compression by a tumor or pregnant uterus.
The pathogenesis. There are external hemorrhoids in the anal area under the skin around the anus (an extension of v.haemorrhoidalis inferior system v. cavae) and internal submucosal nodes (an extension of v.haemorrhoidalis superior system v. mesentericae inferioris). Hemorrhoids is varicose venous trunks naturalno inflamed hyperemic, thickened mucosa over them with advanced, easy-to-injure capillaries.
The symptoms until complications often very small: the feeling of fullness, tension, sometimes itching, swelling of the external and wygodnie inner cones when urinating, pain during bowel movements and bleeding after bowel movements, constipation.
Course and complications. Trauma inflamed mucous when urinating causes rupture of dilated capillaries and re - bleeding from minor impurities in the blood to release it in large quantities (up to 1 Cup or more), which leads to anemizatsii patient (paleness, headaches, weakness, decrease of the percentage of hemoglobin). Infection, penetrating from the side of mucous membrane, can cause thrombophlebitis (inflammation of hemorrhoids): pain, worse when urinating swelling of the nodes, fever, thick, when feeling a painful knots. Loss of internal nodes when they napravlenii causes serious thrombosis with subsequent gangrenosa: wygodnie site immediately after defecation, neupravlyaemoj it, the presence of mucous covered thrombosed, and then Gangreserve site.
Other complications: paroproktitu (see), ascending thrombophlebitis, sepsis.
Recognition in most cases is not difficult when you look at the anal area, matogianni patient are visible through the translucent skin and mucous bluish, spodumene with pressure nodes. Absolutely necessary in all cases, a rectal examination to exclude cancer of the rectum.
Eliminate the cause of the stagnation of blood in the rectal area (treatment of constipation, the purpose of the mode of movements in sedentary way of life, limitation of heavy physical activity and other). Good results are obtained by adjustment of the chair, a diet rich slags, laxative candles with belladonna. Local good cold perfusion, local cold baths and darsonvalization. When bleeding a positive result gives daily appointment laxative (rhubarb 0,3 - 0,6, licorice powder 1 teaspoon, purge 1 - 3 tablets, vaseline oil 3 tablespoons at night). With frequent bleeding, driving enemizati, repeated inflammation and entrapment sites, as well as failure of conservative treatment methods shown operation. Contraindications to it - thrombosis and infringement of nodes before the expiration of 3 to 4 weeks after thrombosis.
Thrombosis of nodes are shown resting (supine position), laxatives, cold lotions from Borovskoy liquid or lead lotion or bubble with ice, streptocid 5,0 - 8,0 per day. After 3 to 4 days when the pain subsided warmers to accelerate the resorption of blood clots. At the expense of the nodes in the fresh cases it is possible to reposition. When the coagulation of a node is the rest, the local circular block with 0.5% solution of novocaine anesthesia sphincter, the bladder with ice, laxative, drugs, penicillinate, sulfanilamide, blood transfusion small doses.