PATHOPHYSIOLOGY OF HEMORRHOIDS Hemorrhoids are dilated portions of veins in the anal canal.

Brunner & Suddarths Textbook of Medical-Surgical Nursing, vol. 1, edition 12, pg. 1109

THE PATHOPHYSIOLOGY OF HEMORRHOIDS

Hemorrhoids usually manifests from excessive straining at defecation because of constipation or during pregnancy. At pregnancy, an increased pressure in the hemorrhoidal tissue occurs. This either initiates hemorrhoids or aggravates existing ones. Hemorrhoids is seen in individuals 30 years old and older. Upon defecation, the mucosa of the anal lining is sheared. The structures of the wall slide down the anal canal. Such structures include the hemorrhoidal and vascular tissues. There are two types of hemorrhoids: internal hemorrhoids and external hemorrhoids. In internal hemorrhoids, pain is not very much experienced until they enlarge. This causes the hemorrhoids to either bleed or prolapsed. In external hemorrhoids, a thrombosis within the hemorrhoid causes inflammation, then edema. The thrombosis then further causes ischemia. The lack of oxygen in the hemorrhoidal tissue then causes necrosis. The common signs of both internal and external hemorrhoids are pain and itching, which often causes the bright red bleeding upon defecation. Management first used is the non-surgical treatments. To relieve discomfort, nurses should emphasize on good personal hygiene, avoid excessive straining upon defecation. They should also encourage patients to have a high-residue diet (fruit & bran) as well as increasing their oral fluid intake. To reduce engorgement, patients can be given bulk-forming agents such as psyllium. Applying a warm compress; giving sitz baths; application of witch hazel, analgesic ointments and suppositories and reinforcing bed rest can also be applied. When such interventions dont work, and the hemorrhoids worsen, medical management performed initially is the non-surgical treatments. Such treatments are done to prevent prolapsed and they include infared photocoagulation, bipolar diathermy, laser therapy and injection of sclerosing agents. After other non-surgical treatments were deemed unsuccessful, surgery is the last resort to removing the hemorrhoids. Procedures include Nd: YAG laser, cryosurgical hemorrhoidectomy, rubber-band ligation procedure and stapled hemorrhoidopexy. The patient handled with the diagnosis underwent hemorrhoidectomy, where the external hemorrhoids were excised and the skin affected was cauterized.

HEMORRHOIDECTOMY
In the treatment of hemorrhoids, surgery is the last resort. Surgical hemorrhoidectomy is required for patients who do not respond to other forms of therapy. A hemorrhoidectomy is surgery to remove internal or external hemorrhoids that are extensive or severe. Surgical hemorrhoidectomy is the most effective treatment for hemorrhoids, though it is associated with the greatest rate of complications. Significant postoperative pain is common, as is urinary retention and constipation.

Closed Hemorrhoidectomy

Open Hemorrhoidectomy In an open hemorrhoidectomy, hemorrhoidal tissue is excised in the same manner as in a closed procedure, but here the incision is left open. Surgeons may opt for open hemorrhoidectomy when the location or amount of disease makes wound closure difficult or the likelihood of postoperative infection high. Often, a combination of open and closed technique is utilized.

FAR EASTERN UNIVERSITY INSTITUTE OF NURSING LEVEL IV

CASE STUDY THE MEDICAL CITY - SURGICAL SUITE November 24, 2012

SUBMITTED BY: GROUP 32A-BSN308 Reloj, Cecille P.

SUBMITTED TO: Erlinda Ramos, RN, MAN