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1. Solve the food particles into the molecular shape to digest.
2. Absorb the products of digestion in the form of small molecules
into the bloodstream.
3. Elimination of undigested food and other absorbed and waste
products from the body (Smeltzer, 2002; 984).
The composition of the digestive tract consists of: oris (mouth), pharynx
(throat), esophagus (throat), ventrikulus (stomach), intestinum minor (small
intestine) consists of duodenal (intestinal 12 fingers), yeyenum and ileum,
intestinum major (large intestine ) consists of the cecum, ascending colon,
transverse colon, descending colon and sigmoid colon, rectum and anus.
(Syaifuddin, 1997; 75)
a) colon
The large intestine or colon-shaped hollow muscular tube with a length
of about 1.5 m which extends from the cecum to anus canal with a
diameter of 6.5 cm. The large intestine has no villi, no circular folds,and its diameter is wider, shorter length, and power regangnya larger
than the small intestine. (Sloane, 2004; 294) Bowel function is:
1. Absorb 80% - 90% of water and electrolytes from the
remaining kimus kimus and change from a liquid to
semi-solid mass.
2. The large intestine produces only mucus. Secretions do
not contain digestive enzymes or hormones.
3. A number of bacteria in the colon can digest cellulose
and produce small amounts of nutrients for the body
fewer calories every day.
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4. Large intestine to excrete the waste in the form of
feces.
(Sloane, 2004; 295).
The parts of the colon is as follows:
1. cecum
In the cecum and appendix are ileoseikal valve attached
to the tip of the cecum. Cecum occupies approximately
the first 2-3 inches of the colon. Flow control valve
ileoseikal kimus and ileum to the cecum and prevent
backflow of faecal material from the colon into the
small intestine. (Price, 2006; 456)
2. Kolon
The colon is the large intestine from the cecum to the
rectum. The colon has three divisions:
a. ascending colon
Ascending colon extends from the cecum to the
lower edge of the liver on the right and flipped
horizontally to the hepatic flexure.
b. Kolon Tranversum
Tranversum colon crosses the abdomen stretches
under the liver and stomach until ketepi lateral left
kidney, where he turned down the flexure splenik.
c. descending colon
Extending down the left side of the abdomen
(Sloane, 2004; 294)
d. Sigmoid Colon
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Krista started as high as the sigmoid colon and form
a curve-shaped iliac S. curve of the bottom turn left
when united with the rectal sigmoid colon (Price,
2006; 456).
Picture 1.2Colon
b)The rectum
Extending from the sigmoid colon to the anus (the mouth to the outside
of the body). Last 1 inch of the rectum called the anal canal and is
protected by a muscular sphincter ani externus and internus spingter.
The length of the rectum and anus canal is about 15 cm. (Price, 2006;
456).
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Picture 1.3Rectum
c) Anus
Is part of the digestive tract that connects the rectum to the outside
world. Located in the pelvic floor, the walls are reinforced by two
sphincters:
1. the internal sphincter ani, is controlled by the
autonomic nervous
2. the external sphincter ani, is controlled by the nervous
system of voluntary.
Defecation is controlled by external and internal anal sphincter.
Defecation reflex integrated in the sacral spinal cord segments of the
second and fourth. External and internal sphincter muscle relaxes at the
anus up over the masses interested in the stool. Defecation can be
inhibited by the contraction of the external sphincter muscle voluntar
and levator ani. If defecation is not perfect, the rectum to relax and
defecation desire disappears. The water still continues to be absorbed
from the mass of feces, so the stools become hard and cause more
difficulty defecation. Excessive pressure on the stool causing venous
congestion hemoroidalis causing internal and external hemorrhoids
(varicose veins rectum). (Price, 2006: 458-459).
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B. Basic Concept of Haemorrhoids
Hemorrhoid is the swelling or distention of the veins in the anorectal area.
Common but less attention except when it causes pain and bleeding. Other
literature states that the external hemorrhoids are the venous varices and / or of the
internal anal canal is caused by the pressure on the rectal veins.
"Hemorrhoid are dilated, engorged veins in the lining of the rectum".
Hemorrhoids are enlarged veins around the rectum and protrusion. (Potter, 1997;
1374). "Hemorrhoid are dilated varicose veins of the anus and rectum".
Hemorrhoids are dilated varicose veins in the anus and rectum. (Reeves, 1999;
162). Hemorrhoidal plexus is dilated (veins webbing) veins around the rectal and
anal. (Jackson, 2000; 142).
Picture 2.1 haemorrhoids
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CHAPTER II
PATOPHYSIOLOGY AND CLASSIFICATION
A. Pathophysiology
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Venous distension was initially normal structures in the anal region, because
the veins are functioning as a valve that can help support the weight, but when
distended persistent disruption will occur.
One of the predisposing factors that may cause venous distension is increased
intra-abdominal pressure. This condition leads to an increase in portal venous
pressure and systemic venous pressure, which will then be transmitted to the
anorectal area. Elevation of repeated pressure will push the vein separated from
the surrounding muscles so that the veins have prolapse. Circumstances that can
cause repetitive elevations include obstipasi / constipation, pregnancy and portal
hypertension. Could be a prolapsed hemorrhoids, developed into a thrombus or
hemorrhage.
Hemorrhoids result from venous congestion caused by the backflow of venous
disorders hemoroidalis. Chronic liver disease accompanied by portal hypertension
often lead to hemorrhoids because of the superior vena hemoroidalis drain blood
into the portal system. In addition the portal system has no valves, so easy going
back flow.
B. Classification
1. Based on the origin / point of cause:
a) Internal Hemorrhoids
Hemorrhoids are derived from the superior and medial veins
hemoroidales, located above the anorectal line and covered by anal
mucosa. These hemorrhoids remain inside the anus.
b) External Hemorrhoids
Hemorrhoids are due to the dilatation (widening of blood vessels)
inferior vena hemoroidales, located below the anorectal line and
covered by the intestinal mucosa. These hemorrhoids from the anus
(external hemorrhoids).
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Picture 3.1 Internal and Eksternal Haemorrhoids
2. Internal hemorrhoids are classified again according to its development:
a. Level 1: usually asymptomatic and not visible, less bleeding, bruising
can go back spontaneously.
b. Level 2: fresh red bleeding symptoms during defecation (bowel
movements) a lump can be seen around the edge of the anus and can
return spontaneously.
c. Level 3: The hemorrhoids prolapse, occurs after defecation and
infrequent bleeding, prolapse can come back with help.
d. Level 4: prolapse and difficult to re-occur spontaneously.
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CHAPTER III
ETIOLOGY AND CLINICAL APPEARANCES
A. Etiology
Hemorrhoids can occur due to dilatation (widening), inflammation
(inflammation) or swelling of the veins caused hemoroidalis:
1. Chronic Constipation: hard bowel movements, so it should be
pushing.
2. Pregnancy: due to suppression of the fetus on the abdomen.
3. Chronic diarrhea.
4. Old age.
5. Sitting for too long
6. Sexual intercourse peranal.
7. In some individuals the sphincter ani hypertrophy (swelling of the
muscle / valve rectum), obstruction (blockage) functional due to
spasm (cramps), and narrowing of the anorectal canal (the anal
canal, the tip end of the colon).
B. Clinical appearances of hemoroids
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1. Painless bleeding during bowel movements you might notice
small amounts of bright red blood on your toilet tissue or in the
toilet bowl
2. Itching or irritation in your anal region
3. Pain or discomfort
4. Swelling around your anus
5. A lump near your anus, which may be sensitive or painful
6. Leakage of feces
Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids
lie inside the rectum. You usually can't see or feel these hemorrhoids, and they
usually don't cause discomfort. But straining or irritation when passing stool can
damage a hemorrhoid's delicate surface and cause it to bleed. Occasionally,
straining can push an internal hemorrhoid through the anal opening. This is
known as a protruding or prolapsed hemorrhoid and can cause pain and irritation.
External hemorrhoids are under the skin around your anus. When irritated,
external hemorrhoids can itch or bleed. Sometimes blood may pool in an external
hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and
inflammation.
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CHAPTER IV
NURSING PROCESS
1. Assessment
a. The identity of patients
b. The main complaint
Patients present with complaints of continuous bleeding during
defecation. There are bumps on the anus or pain during defikasi.
c. history of disease
d. History of present illness
Patients found to have only a few weeks the lumps out and a few daysafter the Chapter there is blood dripping out.
e. Past medical history
Have never previously suffered from hemorrhoids, heal / repeat. In
patients with hemorrhoids when not in doing the surgery will return
RPD, can also connect with other illnesses such as liver cirrhosis.
f. Family history of disease
Are there any members who suffer from the disease keluaga
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g. social history
Disease in question to be asked.
h. physical examination
Activity / rest
Symptoms: weakness, fatigue
Signs: tachycardia, tachypnea / hyperventilation (in response to
activity)
i. circulation
Symptoms: weakness / weak pulse periver
Symptoms: Skin color is pale, cyanosis (depending on the amount of
blood loss) skin membrane
j. elimination
Symptoms: change in bowel habit
k. characteristic changes
Symptoms: abdominal tenderness, distention
l. Stool characteristics: bright red blood (fresh blood)
Akonstipasi can occur
nutrition:
Symptoms: Weight loss
m. anorexia
Symptoms: pale conjunctiva, pale face, looks weak
n. sleep patterns
Symptoms: Changes in sleep patterns
Pain in the anus during sleep
Signs: face looks tired, eye bags appear darko. mobilization
Symptoms: limiting the activity
Signs: face looks anxious, a lot of sitting and lying positions changed
2. Nursing Diagnosis
a. pre Operative
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1) Risk of nutritional deficiencies (deficiency) associated with the
outbreak of the venous plexus hemmoroidalis characterized by
bleeding that continues - chapter time basis.
2) Disruption of comfort associated with the anal or rectal mass, rectal
area marked lumps, pain and itching in the anal region.
3) Personal hygene of the rectum is less related to the mass that comes
out on the external area.
b. Postoperative
1) Disruption of comfort (pain) in the surgical wound associated with
the stitches on the wound and their installed wind chimney.
2) Resikol occurrence of wound infection related to inadequate primary
defenses
3) Lack of knowledge related to the lack of information about home
care.
Preoperatif
No. Nursing
Diagnosis
Goal and
ExpectedOutcomes
Interventions Rationale
1. Risk of
nutritional
deficiencies
associated
with the
outbreak of thevenous plexus
hemmoroidalis
characterized
by bleeding
that continues
- CHAPTER
time basis.
After
nursing
actions for
3 x 24
hours, the
risk ofnutritional
deficiencies
are met.
KH:
1. There is
no anemis,
1. Observed
signs anemis
2. Low-fiber
diet during
the rest or
theoccurrence
of bleeding
3.Berikan
explanation
of the
importance
of diet cure
1. Sign - a sign
anemis suspected of
iron deficiency (Hb
falls)
2. May reduce the
stimulation of theanal region so there is
no bleeding.
3. Education about
diet, helping to
increase the
participation of
patients in a state of
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2. bleeding
stops
3.BB not
go down.
the disease.
4. Apply ice
to the area of
hemorrhage
5. give
medication
or treatment
in
accordance
with
physician
orders
illness.
4. Patients with
rupture of the venous
plexus hemoriodalis
need a drug that can
help the prevention of
bleeding
mememrlukan
periodic assessment
of the response.
5. Patients with
venous rupture flexus
hemmoroidalis need a
drug that can help the
prevention of
bleeding requiring
penilayan to periodic
drug response.
2. Disruption of
comfort
associated
with the anal
or rectal mass,rectal area
marked lumps,
pain and
itching in the
anal region
After
nursing
actions for
2 x 24
hours,impaired
sense of
comfort
terratasi.
KH:
1.Nyeri
1. Give
randam
sitting
2. Give the
lubricant at
the time of
going
Chapter
1. Lowering of local
discomfort, reduce
edema and promote
healing.
2. Assist in theconduct of defikasi so
it does not need
straining.
3. Reducing anal
stimulation and
undermines feces.
4. The force of
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reduced
2.Rasa less
itchy
3.Massa
smaller.
3. Give the
rest of the
diet randah
4. Instruct
patients not
to stand or
sit bannyak
(must be in
balance).
5.
Observation
of patient
complaints
6. Provide an
explanation
of the onset
of pain and
describe
briefly
7. Give the
patient
suppositories
gravity will affect the
onset of hemorrhoids
and sitting can
increase intra-
abdominal pressure.
5. Help evaluate the
degree of discomfort
and lack of
effectiveness of
actions or states of
complications.
6. Education about
the patient's
participation helps to
prevent / reduce pain.
7. Can soften the
stool and can reduce
the patient to avoid
straining during
defikasi.
3. . Deficits in
personal
hygene anal
mass
associated
with the exit
After
nursing
actions for
2 x 24
hours, anal
hygiene.
1. Give your
bath with the
solution sit
permagan
1/1000% in
the morning
1. Improve hygiene
and facilitate the
healing of prolapse.
2. Inflammation of
the rectum indicate
an infection of the
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stitches on the
wound and
their installed
wind chimney.
met.
KH:
1.Tidak there
is pain in the
surgical
wound, 2.
patients can
perform light
activity.
3. 0-1 pain
scale.
4. clients
seemed to
relax.
bandage every
morning
according to
aseptic
techniques
3. Exercise road
as early as
possible
4. Observations
of the rectal
area if there is
bleeding
5. Chimney
anus is released
according to
doctor's advice
(orders)
6. Provide an
explanation of
the purpose of
installation of
flue-anus (anus
patients from
cross
contamination
during the
dressing change.
Acted as a wet
dressing of
external
contamination
and cause
discomfort.
3. reduce
problems that
occur due to
immobilization.
4. Bleeding on
the network, or
local imflamasi
infection can
increase the pain.
5. Improve the
physiological
function of the
anal and giving
comfort to the
patient's anal
region because
there is no
blockage.
6. Knowledge of
the benefits of
the chimney can
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to funnel to
drain the
remnants of the
bleeding that
occurs in order
to get out).
make the patient
understand the
anus to funnel
anus to cure the
wound.
2. The risk of
wound
infection
related to
inadequate
primary
defenses
After nursing
actions for 2
x 24 hours,
the risk of
infection is
resolved.
KH:
1. there are
no signs of
infection
(dolor, calor,
rubor, tumor,
fungsiolesa).
2.
inflammation
of the wound
dry.
3. the LAB:
- leukocytes
- platelets
1. Observation
of vital signs
every 4 hours
2. Obserpasi
bandage every
2-4 hours,
check for
bleeding and
odor.
3. Replace
packing with
aseptic
technique
4. Clean the
perianal area
after each
depfikasi
5. Provide low-
fiber diet / rest
and drink
enough
1. TD includes
autonomic response,
respiration, pulse
denagan related
complaint / pain
relievers. Abnormalities
in vital signs need
further observation.
2. Early detection of the
infection process and /
supervision oprasi
wound healing that
existed before.
3. Prevent the spread
and limit the wide
spread of infection or
cross contamination.
4. reduce / prevent
contamination of the
wound area.
5. reduce the stimulation
to the anus and prevent
straining at defikasi.
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3. Lack of
knowledge
related to the
lack of
information
about home
care.
After nursing
actions for 3
x 24 hours,
lack of
knowledge of
the top.
KH:
1. client did
not ask many
questions
about the
disease.
2. patients
can express
or understand
about home
care.
3. understand
the client's
family about
the disease
process.4. clients
show a calm
face
1. Discuss the
importance of
the
management of
low-residual
diet.
2.
Demontrasikan
treatment of
anal area and
ask the patient
menguilanginya
3. Give soak
sitting to order
4. Bersihakan
anal area welland dry
completely after
defecation.
5. Give the
dressing
6. Discuss the
symptoms of
1. Rationalization:
Knowledge of the diet is
useful to involve the
patient in home diet plan
that suits are
recommended by
nutritionists.
2. Understanding will
enhance cooperation in
the patient's therapy
program, promotes
healing and repair
process of the disease.
3. Improve the
cleanliness and comfort
in the anal area (wound
or polaps).
4. Protect against
contamination of the
anal area germs that
come from the rest of
the bowel to avoid
infection.
5. Protect the wound
from outside
contamination.
6. Early recognition of
symptoms of infection
and immediate
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wound infection
to be reported
medicine.
7. Discuss
difekasi
maintain
software using
stool softeners
and laxatives
foods natural.
8. Explain the
importance of
avoiding lifting
heavy objects
and straining.
intervention can prevent
progression of a serious
situation.
7. Prevent straining
during difekasi and
soften the stool.
8. Intra-abdominal
pressure lowering
unnecessary and muscle
tension.
3. Diagnostic tests
a. Physical examination of the inspection and rektaltouche (digital rectal).
On digital rectal examination, early-stage internal hemorrhoids can not
be felt because the venous pressure in it is not too high and usually
painless. Hemorrhoids can be felt if very large. If hemorrhoids are
prolapsed, mucous membrane will thicken. Thrombosis and fibrosis in
the palpability feels solid with a wide base. Digital rectal examination
to rule out the possibility of rectal carcinoma.
b. Inspection with binoculars is anoscopy or rectoscopy. In this way it can
be seen that the internal hemorrhoids do not bulge out. Anoskop
included to observe the four quadrants. The patient in lithotomy
position. Anoskop and penyumbatnya inserted in the anus as deep as
possible, the stopper is removed and the patient was told to breathe
long. Internal hemorrhoids seen as a vascular structure protruding into
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the lumen. When people are asked to push a little hemorrhoid will
enlarge the size and protrusion or prolapse will be more obvious. The
number of bumps, degree, location, size and other conditions such as
polyps in the rectum, fissure ani and malignant tumors must be
considered.
c. examination proktosigmoidoskopi, Proktosigmoidoskopi needs to be
done to ensure that complaints are not caused by inflammation or
malignancy in high-level process, since hemorrhoids is a physiological
condition or signs that accompany it. Stool should be checked for occult
blood.
d. X-rays (colon inloop) and / or colonoscopy.
e. Examination of blood, urine, feces as investigations
4. Medical Treatment
a. Medical management
Hemorrhoidal symptoms and discomfort can be eliminated by good
personal hygiene and avoid excessive straining during defecation. High-
fiber diet containing fruit and chaff may be the only action needed, if
these measures fail, laxatives that function mengapsorpsi water as it
passes through the intestines may help. Bed rest is an act that allows the
magnification is reduced. There are various types of actions nonoperatif
for hemorrhoids. Infrared photocoagulation, bipolar diathermy, and
laser therapy is the latest technique used to embed the mucosa into the
underlying muscle. Sclerosant injection is also an effective solution for
small and bleeding hemorrhoids. This procedure helps prevent prolapse.b. management Surgikal
1)Surgical therapy: Surgical therapy for selected patients who have
chronic complaints and in patients with degree III and IV
hemorrhoids. Surgical therapy can also be done with recurrent
bleeding and anemia that can not be cured by other therapies are
more modest. IV degree hemorrhoids sufferers who experienced
thrombosis and severe pain can be helped immediately by
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hemoroidektomi. Principles to be considered in hemoroidektomi is
excision is only performed on the network that is really overkill.
Excision may be performed on anoderm economical and normal skin
does not interfere with the anal sphincter. Excision of this tissue
must be combined with reconstruction of the tunica mucosa because
of a deformity of the anal canal due to mucosal prolapse. There are
three surgical approaches are currently available conventional
surgery (using a knife and scissors), laser surgery (laser beam for
cutting tools) and the surgical stapler (using the principle of stapler).
2) Conventional Surgery
Currently there are three techniques commonly used operations are:
1. Techniques Milligan Morgan
This technique is used for hemorrhoids bulge in three main
points. Hemorrhoidal mass base just above the linea
mucocutaneous dicekap with hemostats and diretraksi of the
rectum. Catgut sutures and placed proximal to the plexus
transfiksi hemoroidalis. Important to prevent the installation of
suture through the internal sphincter muscle. The second hemostat
is placed distal to the external hemorrhoids. An elliptical incision
is made with a scalpel through the skin and the tunica mucosa
around internus and externus plexus hemoroidalis, who was
released from the underlying network. Haemorrhoids excised as a
whole. When the dissection reached transfiksi cat gut suture the
excised skin under ekstena hemorrhoids. After securinghemostasis, the rectal mucosa and skin was closed longitudinally
with a simple tack. Usually no more than three groups of
hemorrhoids are removed at one time. Rectal stricture may be a
complication of excision of the tunica mucosa of the rectum is too
much. So it is better to take too little rather than take too much
tissue.
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2. Whitehead techniques
Surgical technique that is used for hemorrhoids that this circular
is to peel the entire hemorrhoids with mucosal release of
submucosal resection and held against the mucosa of the circular
area. Then try again the continuity of the mucosa.
3. Langenbeck technique
In the Langenbeck technique, the internal hemorrhoids radier
clamped by the clamp. Perform tack under the clamp with the
paint chromic gut No. 2/0. Then excision of tissue above the
clamp. After the clamp is released and baste under the clamp jaws
tied up. This technique is more often used because it is easy and
does not contain the risk of secondary scarring is usually caused
stenosis. In conducting the necessary operations of the narcotics
because this sphincter to be completely paralyzed.
3) Laser Surgery
In principle, this same surgery with conventional surgery, only using
a laser cutter tool. When the laser cut, etched tissue vessels that are
not a lot of bleeding, not a lot of injuries and with minimal pain. At
the laser surgery, pain is reduced because of nerve pain seared
participate. In the anus, there are a lot of nerve. In the conventional
surgery, when post-operative pain will be felt at all because at the
time of cutting the tissue, nerve fibers nerve fibers did not open due
to shrink while the sheath to shrink. Whereas in laser surgery, nervefibers and nerve sheath attached together, such as seared so that
nerve fibers do not open. To hemoroidektomi, required laser power
12-14 watts. Once the tissue is removed, the incision antiseptic
soaked. Within 4-6 weeks, the wound will dry up. This procedure
can be done only by an outpatient basis.
4) surgicalStapler
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The tools used in accordance with the principles of
stapler. This tool forms such as flashlights, consisting of a circle in
front of and driving force behind it.
Basically hemorrhoids is a natural tissue found in the anal
canal. Its function is to cushion during bowel movements.
Cooperation and m.sfingter hemorrhoidal tissue to dilate and
constrict to ensure control and sewage discharge from the rectum.
PPH technique reduces tissue prolapsed hemorrhoids by pushing it
to the top of the line mucocutaneous hemorrhoidal tissue and
restore it to its original anatomic position because of hemorrhoidal
tissue is still required as a cushion during defecation, so it does not
need to be removed all.
At first the prolapse of hemorrhoidal tissue is pushed
upwards by a tool called a dilator, and then sewn into the tunica
mucosa of the anal wall. Then the stapler device is inserted into the
dilator. Removed from the stapler inserted a titanium bracelets of
the suture and implanted in the upper anal canal to strengthen the
position of the hemorrhoidal tissue. Part of excess hemorrhoidal
tissue into the stapler. By turning the screw located at the tip of the
tool, the tool will cut off the excess network automatically. The
truncated hemorrhoidal tissue with the blood supply to tissues is
interrupted so that the hemorrhoidal tissue to deflate by itself. The
advantage of this technique is to return to the anatomical position,
does not interfere with the function of the anus, no anal discharge,
pain minimal because of the actions carried out the sensitive, rapidaction takes place around 20-45 minutes, patients recover more
quickly so that inpatient care in hospitals are increasingly short .
5. Complications
1. thrombosis occurred
Because hemorrhoids out so that the old - old blood will clot and
thrombosis occurs.
2. Inflammation
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If blisters occur because of hemorrhoidal venous pressure of infection and
inflammation can occur because there are a lot of dirt germs - bacteria.
3. the occurrence of bleeding
On the degree of blood dripping and gushing out. Acute bleeding in
general are rare, only occurs when the rupture is the major blood vessels.
Hemorrhoids can form a shortcut portal portal systemic hypertension, and
if this kind of bleeding hemorrhoids it can be so much blood. More often is
chronic and if recurrent bleeding can cause anemia because of the number
of red cells produced could not offset the amount that comes out. Chronic
anemia occurs, so it often does not cause complaints in patients with even
very low Hb due to the mechanism of adaptation. If the hemorrhoids out,
and can not go anymore (inkarserata / pinched) will easily happen that the
infection can cause sepsis and can lead to death.
The Theraphy
Ambulatory hemorrhoid therapy with radiofrequency coagulation
Background:
Despite availability of numerous surgical and non-surgical options for the
treatment of hemorrhoids like sclerotherapy, rubber band ligation,
cryosurgery, infrared photocoagulation, bipolar diathermy, and electro
coagulation, none of these therapies has been acclaimed as the ultimate.
Coagulation of hemorrhoids using a radio-frequency device is a new therapy
to be added to the list.
Patients and Methods:
In the present retrospective study, the early and long -term effects of
radiofrequency coagulation on patients presenting with hemorrhoids is
described. An Ellman radiofrequency generator was used for this procedure.
In a separate, randomized, and blinded study, a comparative evaluation was
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carried out between radiofrequency coagulation and rubber band ligation in
terms of their effectiveness and patient comfort.
Results:
Two hundred and forty patients with Grade I and II hemorrhoids were treated
by radiofrequency coagulation technique and were followed up for a period of
16 months. While 33 patients reported persistence or recurrence of bleeding,
only few complained of pain or discomfort. The comparative study showed
that though rubber band ligation is an effective procedure, its pain quotient is
greater than the radiofrequency coagulation.
Conclusion:
This study shows that radiofrequency coagulation is an easy and effective
alternative to conventional techniques employed in the treatment of bleeding
hemorrhoids. It is easy to perform, is less painful, and has a low rate of
complications. However, further results based on a longer follow-up of larger
number of patients and its comparison with other conventional treatment
techniques are called for.
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CHAPTER V
CONCLUSION AND SUGGESTIONS
A. Conclusion
Hemorrhoids are distended veins in the anorectal area. Common but less attention
except when it causes pain and bleeding. The term hemorrhoids more commonly
known as piles or haemorrhoids by the community. Result is the emergence of a
hemorrhoidal discomfort. Hemorrhoids are not only annoying aspect of health, but
also aspects of cosmetic and even social aspects. Haemorrhoids result in
complications, such as thrombosis occurs, inflammation, and going
perdarahan.Hemoroid can also cause anxiety in the sufferer due to ignorance
about the disease and its treatment.
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B. advice
Need intensive counseling about the disease, the disease process and treatment in
patients with hemorrhoids. Informed about the prevention-prevention ofhemorrhoids by:
1. Eating foods high in fiber, vitamin K, and vitamin B12.
2. Suggest to sit or not much activity menenkan buttocks area.
3. Suggest to not too strong when straining as it can add a large
hemorrhoids.
4. Suggest that eating less spicy foods which can irritate hemorrhoids.
5. Suggest to hemoroidektomi hemorrhoids have reached the stage
when the third-degree internal hemorrhoids to prevent infection.
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BIBLIOGRAPHY
Syvia Anderson Price, 1991. Patofisiologi Konsep Klinik Proses-ProsesPenerbit buku Kedokteran EGC, Jakarta.
Doenges Moorhouse Geissle, 1999. Rencana Asuhan Keperawatan Ed. 3
Penerbit Buku Kedokteran EGC, Jakarta.
Susan Martin Tucker, 1998. Standar Perawatan Pasien, Edisi V Vol 2.
Penerbit Buku Kedokteran EGC, Jakarta.
http://nersferdinanskeperawatan.wordpress.com/2010/05/19/asuhan-
keperawatan-pada-klien-dengan-hemorrhoid/