Haemorrhoids
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Clinically Relevant Anatomy[edit | edit source]
Anal canal is the end part of the gastrointestinal tract (GIT), it is about 4cm in length in women and more longer in men to be about 4.4 cm in length, passes downwards and backwards forming the anorectal angle. The internal lining mucousa membrane of anal canal divided by the pectinate line into two portions: the upper one the vertical anal columns (8-10 anal fold), at there ends there are valves (anal valves), above each one of these anal valves there is a shallow mucosal pocket called the anal sinus. the lower part below the line is formed of nonkeratinized squamous epithelium with no ducts it is sensitive to pain and provides an internal moisturizing to the canal[1]. The upper anal canal lined by three main anal cushions that lies contribute with its anatomy to help with continence, the first one located in the right anterior at 11 o'clock, the second at right posterior at 7 o'clock and the last one on the left lateral aspect at 3 o'clock of the anal canal, they consist of connective tissues and blood vessels in addition there are minor cushions between them.
The anal canal is described into anatomical and surgical anal canal. The anatomical anal canal starts from the dentate line and ending at the anal verge, while the surgical anal canal extends from the anorectal ring (junction between the anal canal and rectum) to the anal verge[2].
Mechanism of Injury / Pathological Process[edit | edit source]
Hemorrhoids is defined as a swollen/ enlargement/ or displacement of vascular anal cushions, it may be symptomatic condition or a symptomatic condition in others that affecting millions of people. The exact pathophysiology is still unclear but there are many theories.
Sliding of lining anal cushions theory, that was described in 1975, it suggested that the hemorrhoids happens when there is break down and downward displacement of structures of internal anal cushions, theses changes displacement are associated with inflammatory process of internal canal, venous dilatation, process of degeneration of the fibroelastic and collagen tissues, vascular thrombosis and/ or anal sub-epithelial muscle this theory still accepted.
Clinical Presentation[edit | edit source]
Diagnostic Procedures[edit | edit source]
Management / Interventions[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Resources[edit | edit source]
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References[edit | edit source]
- ↑ Bazira PJ. Anatomy of the rectum and anal canal. Surgery (Oxford). 2022 Dec 7.
- ↑ Lee JM, Kim NK. Essential anatomy of the anorectum for colorectal surgeons focused on the gross anatomy and histologic findings. Annals of Coloproctology. 2018 Apr;34(2):59.
