Haemorrhoi

ds
Helsi Yuniarti
Yudhan Triyana

Pembimbing :
Dr. Hans Marpaung M.M Sp.B FICS

Hemoroid is the varcious vein dilataion from

hemmorhoidal inferior and superior plexus
To the proximal, rectum connected with
sigmoideal colon, and to the distal connected
with analis canalis
Half of the rectum to the proximal, have
ventrikular, named lumnae analis, there are the
blood supply from arteri arectalis superior and
plexus venosus.

Tunica Muscularis, from the out side is

stratum longitudinale, and from the in
side is stratum cirrculare,
Stratum circulare build musculus
spinter ani internus,
Half of Stratum longitudinale go to the
distal and fused with puborectalis and
continue to the distal between m.
spinter ani ext, int.

ANATOMI ANOREKTUM

 Blood Supply for Canalis Analis and

Rectum are
A. Rectalis Superior, from A. Mesenterica
Inferior (Most Supplyer from rectum and
canalis analis)
A. Rectalis Media, from A. Iliaca Interna,
(under rectum, and some of canalis
analis
A.Rectalis Inferior, from A. Pudenda
Interna (canalis analis and skin around
that)

 Vein System
Rectalis Superior Vein, Rectalis Media
Vein, Rectalis Inferior Vein
Located at submucosa flow the blood
reverse, lot of those veins located above
the pectinata line.

Arterial
supply

line
superior rectal
A.
below dentate
line
inferior rectal
A.

Potential sites for

Primary Haemorrhoids

11 oclock
3 oclock

7 oclock

Etiologi
Massive Exercise

Obstipasi / konstipasi
Defecation POsision
Trauma
Age
Diarrhoea
Less Fiber Diet

Family Historys

Comorbid Cases
Local
Abdominal
Pelvic
Pregnancy

Anorectal Deformity,
Weakness of Spinter
Ascites
gravid uterus,
uterine neoplasm,
ovarian neoplasm,

Hipertensi Portal
Neurological

paraplegia,
multiple sclerosis

KLASIFIKASI

Interna

Proximal from
the linea
dentata
Lined by
anorectal
muccose
Grade I,II,III,IV

Ekstern
a

Located distal
from linea
dentata
Lined by
anoderm

Combination from
Internal and
external
Combina
hemmoroidh
tionn
Border of linea
dentata

Klasifikasi Hemoroid Interna

Hemoroid Interna
Derajat

Berdarah

Prolaps

Reposisi

II

Spontan

III

Manual

IV

Tetap

Irreponibel

Prolapsed
Internal haemorhoids

Hemoroid Eksterna
3 form for Hemmoroid
Externa
Hemmoroid ordinary,
located at Distal
Muccutaneal Junction
Buldge Hemmoroid
with acute Thrombosis
form
Skin Tags Form

Thrombosed
External haemorrhoids

1. Acute
2.Chronic

Hemoroid Gabungan
(Interna dan Eksterna)

Patogenesis
Raised Intraabdomkinal Preassure

venous return barrier

Dilatation and buldging of pleksus
venosus
Mukosa pushed to distal by strict
feses
straining

Pelvic floor pushed to distal ani

muccous prolaps

First sign

Anemia

Bleeding {defekasi}
Bleeding

Prolaps
buldge

Haemorrhoids

Discharge
pruritus
& Pruritus

Iritasi

Throm
bosis

Pain
paini

( Komplikasi)

Sign and symptom

 Classification of Pain Location

above or under dentate line?

External or Internal

External hemorrhoid Internal hemorrhoid

Under Dentate Line

Above Dentate LIne

Varicosities of veins
draining
inferior rectal artery

Varicosities of veins
draining
superior rectal artery

Lined by
squamous epithelium

Painful
Prone to thrombosis if
vein ruptures
(Thrombosed pile)

Lined by
columnar epithelium
Pain insensitive
May prolapse outside
anal canal
(prolapsed hemorrhoid)

Gr I

not prolapse

Gr II

returns spontaneously

Gr III

Gr IV

manually returned

remains prolapsed

Grading of hemorrhoids (on history)