True about Haemorrhoid :
Ans: D (Internal...) "Portal hypertension was long thought to increase the risk of hemorrhoidal bleeding because of the anastomoses between the portal venous system (middle and upper hemorrhoidal plexuses) and the systemic venous system (inferior rectal plexuses). It is now understood that hemorrhoidal disease is no more common in patients with portal hypertension than in the normal population. Rectal varices, however, may occur and may cause hemorrhage in these patients, in general, rectal varices are best treated by lowering portal venous pressure. Rarely, suture ligation may be necessary if massive bleeding persists. Surgical hemorrhoidectomy should be avoided in these patients because of the'risk of massive, difficuit-to-control variceal bleeding.'- Sabiston 18th/ 1440"Internal hemorrhoid pathology has no correlation with constipation (infrequent passage of stool) or portal hypertension.Pathologic hemorrhoids are not dilated vascular channels, varices, or vascular hyperplasias. The principal mechanism in younger men is increased resting pressure within the anal canal, leading to decreased venous return, venous engorgement, and disruption of the supporting tissues. The cause of external hemorrhoidal disease is unknown but is associated with straining such as that which occurs with constipation or d iarrbea *-CSDT 11 th/766"Occasionally, patients with portal hypertension develop rectai varices, but these should not be confused with haemorrhoids as the consquences may he disastrous. External haemorrhoids relate to venous channels of the inferior haemorrhoidal plexus deep in the skin surrounding the anal verge L&B25th/1254"Occasionally,; patients with porta! hypertension develop recta! varices, but these should not be confused with haemorrhoids as the consquences may be disastrous. Externa! haemorrhoids relate to venous channels of the inferior haemorrhoidal plexus deep in the skin surrounding the anal verge L & B25th/1254PORTAL HYPERTENSION AND VARICOSE VEINS L&B 25th/1254"Misconceptions concerning the vascular anatomy of the anal canal (specifically the lack of appreciation of communications between portal and systemic systems and the 'normality' of venous dilatations) ted to theories of development of primary internal haemorrhoids that lasted for several centuries. Man's upright posture (we know little about haemorrhoidal problems in animals), lack of valves in the portal venous system and raised abdominal pressure were thought to contribute to the development ofanal varicosities. If raised portal venous pressure were indeed the cause, one would expect a high incidence in subjects suffering from portal hypertension; however, although such patients have a higher incidence of anorectal varices, these are a separate anatomical and clinical entity from haemorrhoids, which are seen no more frequently than in those without cirrhosis, portal hypertension and oesophageal varicesInternal piles ortrue piles are sacculardilations of internal rectal venous plexus. They occur above pectinate line & are therefore painless"- BDC II 4th/384Internal piles or true piles is covered by upper mucous part of a nal canalfAs internal piles lies above pectinaie line-pectinate line is lower part of upper mucous layer)- BDC II 4th/384Internal piles is covered by transitional zonefstratified squamous epithelium) &!ower cutaneous part of anal canal- BDC II 4th/384HEMORRHOIDExternal Hemorrhoids# These are located distal to the dentate line and are covered with anoderm. Because the anoderm is richly innervated, thrombosis of an external hemorrhoid may cause significant pain.it is for this reason that external hemorrhoids should not be ligated or excised without adequate local anesthetic. A skin tag is redundant fibrotic skin at the anal verge, often persisting as the residual of a thrombosed external hemorrhoid.Treatment of external hemorrhoids and skin tags are only indicated for symptomatic relief.Internal HemorrhoidsThese are located proximal to the dentate line and covered by insensate anorectal mucosa, internal hemorrhoids may prolapse or bleed, but rarely become painful unless they develop thrombosis and necrosis (usually related to severe prolapse, incarceration, and/or strangulation). Internal hemorrhoids are graded according to the extentof prolapse.First-degree hemorrhoids bulge into the anal canal and may prolapse beyond the dentate line on straining.Second-degree hemorrhoids prolapse through the anus but reduce spontaneously. Third-degree hemorrhoids prolapse through the anal canal and require manual reduction. Fourth-degree hemorrhoids prolapse but cannot be reduced and are at risk for strangulation.Table (Sabiston 18th/1440).Internal Hemorrhoids: Grading and ManagementGradeSymptoms And SignsManagementFirst degreeBleeding; no prolapseDietary modificationsSecond degreeProlapse with spontaneous reductionRubber band ligation Bleeding, seepageCoagulation Dietary modificationsThird degreeProlapse requiring digital reductionBleeding, seepageSurgical hemorrhoidectomyRubber band ligationDietary modificationsFourth degreeProlapsed, cannot be reducedStrangulatedSurgical hemorrhoidectomyUrgent hemorrhoidectomyDietary modifications
Internal haemorrhoid is dilation of superior rectal artery
Interna] haemorrhoid lined by - Squamous & transitional epithelium
External haemorrhoid lined by - Squamous & transitional epithelium
Internal haemorrhoid is classified on basis of prolapse
Disorders of the Anal Canal