Disease anatomy some colon lesions

2021-05-12 03:59 PM

Haemorrhoids are varicose veins in the vesicles of the anus and around the anus

Colonic diverticulosis

The colon has many diverticula, especially in the sigmoid and rectum. The older the disease, the higher the incidence and rare in people under 30 years of age.

The disease is caused by the lining of the intestine and the lining of the intestine protruding through the weak points of the muscle layer.

95% of the diverticula are present in the sigmoid colon. The diseased intestines are prone to hypertrophy of the muscle layer (50-70% of cases). The diverticula are usually about 0.5-1 cm in diameter along the edge of the longitudinal muscle layer. Without inflammation, the sac can usually be stretched and filled with faeces. The diverticula can become inflamed and can cause inflammation around the diverticula and then spread inflammation around the colon, causing thick fibres to thicken the colon wall, narrowing the colon wall (easily confusing with cancer), progression. abscess wall around the large intestine, and can cause peritonitis.

Under the microscope, the diverticula have a thin wall with atrophic mucosa, under the pressed mucosa, the smooth or thin muscle layer is lost. In the presence of inflammation, it is nonspecific inflammation with strong fibrosis of the diverticular wall. Bacterial cultures revealed many types, of which E. coli predominated.

Haemorrhoids

Haemorrhoids are varicose veins in the vesicles of the anus and around the anus. This is a very common disease, accounting for 5% of the population. The disease is rare in people under 30 years old, except in pregnant women. An overseas statistic shows that more than 50% of people over the age of 50 suffer from haemorrhoids. In our country, there is no epidemiological investigation on this disease, but clinicians feel it is a common disease and different rates of sex, age, occupation, as well as way living activities, eating and working regime of the patient.

The disease is caused by a long-lasting increase in venous pressure in the hemorrhoidal network of the anus. There are many causes of this increased pressure, of which the 2 most common are constipation and stagnation of venous blood during pregnancy (in pregnancy there is congestion in the pelvis and there is the pressure of the uterus to the blood vessels in this area). Rarer is portal hypertension and then haemorrhoids are part of collateral circulation.

Classify

Haemorrhoids lesions have 2 types:

External haemorrhoids: Immediately close to the edge of the anus in the form of bulges that cause the skin of these places to lose their folds become shiny, usually have 3 blisters (2 on the right and 1 on the left)

Internal haemorrhoids: You may not see anything out of the ordinary, then you may ask the patient to go to the toilet and squeeze as hard as when they go to the toilet, the haemorrhoids will fall out of the anus if they are big enough and many times. sa out. In the majority of cases, internal haemorrhoids have 3 tufts, also in the position of the external haemorrhoids (the right front one corresponds to 11 o'clock, the right-back one corresponds to the 7 o'clock position, the left one corresponds to the 7 o'clock position. 4 o'clock position).

These tufts may be equal but are often of a small size. Covering the internal haemorrhoids is the pink-purple mucosa. Black spots can be seen, hard to the touch, they are blood clots. If the haemorrhoids come out frequently, there are sores on the mucosa.

If the patient comes to the examination relatively early, the three haemorrhoids are clearly separated from each other. Later, in the middle of the 3 main tufts, there are a few smaller sub-tufts. It is also possible that all the main and secondary tufts have joined together to form a circle (ring haemorrhoids).

In the case of both internal haemorrhoids, at first internal and external haemorrhoids are separated by the comb area because the skin of this area sticks to the inner sphincter, separating the two veins of the upper and lower haemorrhoids. But later on, Parks ligament became loose, the comb region no longer stuck to the inner sphincter and internal haemorrhoids with external haemorrhoids formed mixed haemorrhoids.

Most patients come to the hospital when their condition is much worse with haemorrhoids or mixed haemorrhoids. It is necessary to accurately determine the extent of haemorrhoids in order to choose the appropriate treatment. It is divided into 4 degrees of disease:

Haemorrhoids 1: Haemorrhoids in the first stage, the veins are slightly dilated, the mucosal team is bulging but lying neatly in the rectum.

Haemorrhoids 2: The more hemorrhoidal veins form more pronounced tufts. When going to the toilet, squeezing a lot, tufts stick up in the anal hole. When the toilet is finished, stood up, the haemorrhoids fell back in and could not see anything.

Haemorrhoids 3: Every time you go to the toilet or walk a lot, when you squat or do heavy work, the haemorrhoids fall out. At that time, you must use your hands to gently press or lie down for a while before the haemorrhoids fall in

Haemorrhoid’s grade 4: The haemorrhoids are quite large, usually are circular haemorrhoids, easy to come out, even though you press on them with your hands. The patient feels that the haemorrhoids are frequently out of the anal canal.

Pathogenesis of haemorrhoids

Relatively clear. Currently, people mention the following reasons:

Standing posture: Haemorrhoids are more common in people who have to stand for a long time, have to sit a lot like desk clerk, shopkeeper ... Another remark is that haemorrhoids never appear in four-legged animals. When studying haemorrhoids venous pressure, people found that in a sitting posture pressure is 25 cm of water, in this standing posture this pressure rises to 75 cm water.

Illness and constipation: When the bowel movement requires a lot of pressure, then the pressure in the anal canal has increased 10 times.

Increased pressure in the abdominal sinuses: In those who do hard manual labour, in people with chronic bronchitis, bronchiectasis, heart failure ... pressure in the abdominal sinus often increases and haemorrhoids easily develop. show more than others.

Anal and pelvic tumours: Cancers of the rectum, uterine fibroids, large fetuses, and other tumours in the anorectal or pelvic area can prevent the return of blood from the anorectal to haemorrhoids. These are the specific and specific causes, so the haemorrhoids here are symptomatic haemorrhoids, not sick ones.