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.
 line
Arterial superior rectal
A.
supply 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 Anorectal Deformity,
Weakness of Spinter

Abdominal Ascites

gravid uterus,
Pelvic uterine neoplasm,
ovarian neoplasm,
Pregnancy
Hipertensi Portal

paraplegia,
Neurological multiple sclerosis
KLASIFIKASI
Proximal from
the linea
dentata
Interna Lined by
anorectal
muccose
Grade I,II,III,IV
Located distal
from linea
Ekstern dentata
a
Lined by
anoderm

Combination from
Internal and
Combina external
tionn hemmoroidh
Border of linea
dentata
Klasifikasi Hemoroid Interna
Hemoroid Interna
Derajat Berdarah Prolaps Reposisi
I + - -
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
Bleeding {defekasi}
Bleeding

Anemia Discharge
Prolaps
buldge H
Haemorrhoids pruritus
& Pruritus

Iritasi

Throm
Pain
paini
bosis
( 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 Varicosities of veins
draining draining
inferior rectal artery superior rectal artery
Lined by Lined by
squamous epithelium columnar epithelium
Painful Pain insensitive

Prone to thrombosis if May prolapse outside

vein ruptures anal canal
(Thrombosed pile) (prolapsed hemorrhoid)
 Gr I Gr II Gr III Gr IV
not prolapse returns spontaneously manually returned remains prolapsed

Grading of hemorrhoids (on history)