GASTROENTEROLOGY ARTICLE OF THE MONTH
August 12, 2004
AGA. American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Hemorrhoids. Gastroenterology 2004;126:1463-73
1. Hemorrhoids
a. Are arteriovenous communications
b. Are always abnormal, they serve no function in the anal canal
c. Most people have 3 or 4 hemorrhoid cushions
d. Skin tags represented previously thrombosed external hemorrhoids
2. Clinical features of hemorrhoids
a. Are a frequent cause of heme positive stools
b. Never cause anemia
c. Are increased in frequency in patients with portal hypertension
d. Usually present with post-defecatory pain
e. Bleeding is typically bright-red
True or False
3. Most symptoms develop from external hemorrhoids rather than internal hemorrhoids.
4. When patients complain that they have “hemorrhoid problems” they are usually correct.
5. A person that has hemorrhoids that prolapse after defecation and has to “push them back inside each time” is considered to have 3rd degree hemorrhoids
6. Hemorrhoids are classified as internal or external depending on whether you can see them when visually inspecting the anus or not.
7. Thrombosis of hemorrhoids occurs more frequently in external rather than internal hemorrhoids.
8. Severe pain, high fever and urinary retention suggest a diagnosis of necrotizing pelvic infection, a possible complication of hemorrhoidal band ligation.
9. Corticosteroid creams have been shown to acutely reduce perianal inflammation and bleeding.
10. Nonoperative therapy of hemorrhoids usually does not address external hemorrhoid problems.
11. Band ligation is the most effective non-operative intervention, but also the most likely to be a pain in the butt.
12. Anorectal Crohn’s disease is a contraindication for hemorrhoidectomy, but Crohn’s disease not involving the rectum or anus is not a contraindication.
13. Operative management of hemorrhoids
a. Reserved for extensive third or fourth degree hemorrhoids
b. Post operative pain is short-lived
c. It takes 2-4 weeks for patients to return to work (anything for a vacation!)
d. Anal stenosis may develop in up to 6% of patients
e. Incontinence develops in 2% to 12%