Mar 23rd, 2015 - Jackfraust 69
re: hemorroid columm
Hemorrhoids are highly vascular submucosal cushions that generally lie along the anal canal in three columns—the left lateral, right anterior, and right posterior positions. These vascular cushions are made up of elastic connective tissue and smooth muscle, but because some do not contain muscular walls, these cushions may be considered sinusoids instead of arteries or veins. Clinically evident bleeding arises from the perisinusoidal arterioles and are therefore arterial in nature. Hemorrhoids play a significant physiologic role in protecting the anal sphincter muscles and augment closure of the anal canal during moments of increased abdominal pressure (e.g., coughing, sneezing) to prevent incontinence and contribute 15 to 20% of the resting anal canal pressure. Increases in abdominal pressure increase the pressure in the inferior vena cava that cause these vascular cushions to engorge and prevent leakage. This tissue is also thought to help differentiate stool, liquid, and gas in the anal canal.
The dentate line differentiates external and internal hemorrhoids. External hemorrhoids are located below the dentate line and drain via the inferior rectal veins into the pudendal vessels and then into the internal iliac vein. These vessels are covered by anoderm that is comprised of modified squamous epithelium. As a result, these tissues contain pain fibers and affect how patients present and are treated. Internal hemorrhoids lie above the dentate line and are covered by columnar cells that have visceral innervations. These drain via the middle rectal veins into the internal iliac vessels. Internal hemorrhoids are classified further into the degree of prolapse. First-degree hemorrhoids protrude into the anal canal, but do not prolapse out of the canal. Second-degree hemorrhoids prolapse outside of the canal, but reduce spontaneously. Third-degree hemorrhoids prolapse out of the canal and require manual reduction; fourth-degree hemorrhoids are irreducible.
Additional information (copied from AAPC forum)
Here is the lay description from Encoder Pro -The physician performs ligation of internal hemorrhoids. The physician explores the anal canal and identifies the hemorrhoid columns. A single suture ligation of the hemorrhoid columns is performed in 46945. Multiple suture ligations of the hemorrhoid columns are performed in 46946.
A "column" is just what it sounds like ... an anatomic part (area) or structure in the form of a pillar. A "hemorrhoid" is a varicose condition of a rectal vein. So when the rectal vein is swollen in its "varicose condition" it appears to be like a pillar or column.
There is a paper written by Elizabeth J. McConnell MD FACS FASCRS Google "hemorroid columm" with her name for the paper- excellent info