1. Apakah hemorrhoid externa berasal dari squamous sel?2.
Hubungan anatomi terhadap faktor risiko terjadi
hemorrhoid?Hemorrhoids are not varicosities; they are clusters of
vascular tissue (eg, arterioles, venules, arteriolar-venular
connections), smooth muscle (eg, Treitz muscle), and connective
tissue lined by the normal epithelium of the anal canal.
Hemorrhoids are present in utero and persist through normal adult
life. Evidence indicates that hemorrhoidal bleeding is arterial and
not venous. This evidence is supported by the bright red color and
arterial pH of the blood.Hemorrhoids are classified by their
anatomic origin within the anal canal and by their position
relative to the dentate line; thus, they are categorized into
internal and external hemorrhoids.External hemorrhoids develop from
ectoderm and are covered by squamous epithelium, whereas internal
hemorrhoids are derived from embryonic endoderm and lined with the
columnar epithelium of anal mucosa. Similarly, external hemorrhoids
are innervated by cutaneous nerves that supply the perianal area.
These nerves include the pudendal nerve and the sacral plexus.
Internal hemorrhoids are not supplied by somatic sensory nerves and
therefore cannot cause pain. At the level of the dentate line,
internal hemorrhoids are anchored to the underlying muscle by the
mucosal suspensory ligament. External hemorrhoidal veins are found
circumferentially under the anoderm; they can cause trouble
anywhere around the circumference of the anus.
3. Mengapa terjadi retensio urin pada post hemorrhoidectomy?
Urinary retentionUrinary retention can occur in up to 15% of
patients posthemorrhoidectomy. Many factors are thought to
contribute to urinary retention following hemorrhoidectomy, with
pain being a major contributor. Perioperative restriction of fluid
intake has been shown to reduce the need for catheterization. In
general, most patients have no further issues after 1
catheterization. Men with enlarged prostates may require an
indwelling Foley catheter for up to 72 hours.Urinary retention,
which is the most common complication following hemorrhoidectomy,
occurs is as many as 20% of patients. Factors often held
responsible include the following : Spinal anesthesia Rectal pain
and spasm High ligation of the hemorrhoidal pedicle Rough handling
of tissue Heavy suture material Numerous sutures Fluid overload
Rectal packing Tight, bulky dressings Anticholinergics
NarcoticsGenerally, the incidence of urinary retention is not felt
to be altered by the prophylacticadministration of Urecholic
(bethanechol chloride). Prophylactic alfa adrenergic blockade has
failed to prevent this complication, as has the administration of
an anxiolytic agent.
Rubber Band Ligation. Persistent bleeding from first-, second-,
and selected third-degree hemorrhoids may be treated by rubber band
ligation.Mucosa located 1 to 2 cm proximal to the dentate line is
grasped and pulled into a rubber band applier. After firing the
ligator, the rubber band strangulates the underlying tissue,
causing scarring and preventing further bleeding or prolapse (Fig.
29-31). In general, only one or two quadrants are banded per visit.
Severe pain will occur if the rubber band is placed at or distal to
the dentate line where sensory nerves are located. Other
complications of rubber band ligation include urinary retention,
infection, and bleeding. Urinary retention occurs in approximately
1% of patients and is more likely if the ligation has inadvertently
included a portion of the internal sphincter. Necrotizing infection
is an uncommon, but life-threatening complication. Severe pain,
fever, and urinary retention are early signs of infection and
should prompt immediate evaluation of the patient usually with an
exam under anesthesia. Treatment includes dbridement of necrotic
tissue, drainage of associated abscesses, and broad-spectrum
antibiotics. Bleeding may occur approximately 7 to 10 days after
rubber band ligation, at the time when the ligated pedicle necroses
and sloughs. Bleeding is usually self-limited, but persistent
hemorrhage may require exam under anesthesia and suture ligation of
the pedicle.