Skala Parksa w rozpoznaniu guzków krwawicznych
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Skala Parksa w rozpoznaniu guzków krwawniczych

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Guzki krawawnicze, in. żylaki odbytu mogą dotykać nawet co drugą dorosłą osobę. Początkowym ich symptomem jest krwawienie jasnoczerwoną krwią, któremu niekiedy towarzyszy świąd w okolicy odbytu. Natomiast jeżeli pacjent odczuwa ból w tym obszarze, może to wskazywać na  zakrzepicę guzka.

Guzki krwawnicze traktowane są jako choroba hemoroidalna w przypadku ich powiększenia i przemieszczania się. Biorąc pod uwagę ich rozmiar, możemy wyróżnić 4 stopnie powiększenia guzków wewnętrznych, zgodnie ze skalą Parksa:

Stopień I – powiększenie guzków bez wypadania ich na zewnątrz,

Stopień II – wypadanie guzków na zewnątrz podczas wypróżniania się, następnie cofają się samoistnie,

Stopień III – wypadanie guzków na zewnątrz podczas wypróżniania się, konieczność odprowadzenia ich ręcznie,

Stopień IV – guzki stale utrzymują się na zewnątrz. Nie zmniejszają się i ulegają zakrzepicy.

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Do czego służą guzki wewnętrzne?

Guzki wewnętrzne to poduszkowate uwypuklenia. Tworzą je sploty żylne i tkanka łączna powyżej linii grzebieniastej. Znajdują się w organizmie od urodzenia. Służą do wspomagania pozostałych mechanizmów w zamykaniu kanału odbytu. Zazwyczaj są umiejscowione na godzinie 3., 7. oraz 11.

Guzki zewnętrzne zazwyczaj nie wykazują objawów, dopiero w przypadku wystąpienia zakrzepicy pacjent odczuwa ostry ból. Aby wykluczyć nowotwór, niezbędne będzie przeprowadzenie badania endoskopowego.

Na czym polega leczenie guzków krwawniczych?

Najważniejszym czynnikiem w leczeniu żylaków odbytu jest zapobieganie zaparciom. Dodatkowo na takie dolegliwości jak ból, pieczenie czy świąd można zastosować ciepłe nasiadówki, czopki i maści doodbytnicze, które zawierają leki znieczulające miejscowo, np. lidokainę lub benzokainę i hydrokortyzon.

W przypadku niepowodzenia w leczeniu zachowawczym guzków II i III stopnia, a także kłopotliwych guzków I stopnia stosuje się obliterację w warunkach ambulatoryjnych, za pomocą takich technik jak skleroterapia, diatermia dwubiegunowa, koagulacja w podczerwieni czy podwiązanie opaskami.

Operacyjnie w warunkach szpitalnych usuwa się guzki IV stopnia. Natomiast jeżeli leczenie zachowawcze i minimalnie inwazyjne w przypadku mniejszych guzków nie dało pozytywnych efektów oraz jeżeli u pacjenta występują zarówno guzki wewnętrzne jak i zewnętrzne, operacja również jest wskazana.

Jeżeli u pacjenta wystąpiła zakrzepica guzka wewnętrznego i zgłosił się z dolegliwością w ciągu 72 godzin od wystąpienia objawów, wówczas wycina się guzek w znieczuleniu miejscowym. Natomiast jeżeli pacjent zwlekał z wizytą dłużej, poddaje się go obserwacji, ponieważ ból towarzyszący zakrzepicy zazwyczaj mija samoistnie po 7-10 dniach.

Źródło: Bartnik W., Interna Szczeklika 2018, Medycyna Praktyczna, Kraków 2018, s. 1058-59

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