ABSITE – ANORECTAL QUESTIONS WITH CORRECT ANSWERS

ABSITE – ANORECTAL QUESTIONS WITH
CORRECT ANSWERS
Anus Blood Supply - CORRECT ANSWER -artery - inferior rectal artery

vein, proximal to dentate - internal hemorrhoid plexus

vein, below dentate - external hemorrhoid plexus



Hemorrhoids - CORRECT ANSWER -hemorrhoid plexuses - leſt lateral, right anterior, right posterior

- radial appearance

*straining



- tx - fiber, stool soſteners, fluids

- Sitz baths



External Hemorrhoids - CORRECT ANSWER -- thrombosis --> pain

- swelling, itching



- tx <72 hrs --> lance

- tx >72 hrs --> elliptical excision



Internal Hemorrhoids - CORRECT ANSWER -- bleeding

- prolapse



Stage 1 - protrudes below dentate with strain

Stage 2 - prolapses and reduces spontaneously

Stage 3 - prolapse, reduces manually

Stage 4 - unable to reduce



- tx for Stage 1/2 - banding

, - tx for Stage 3/4 - resection, down to internal anal sphincter



Rectal Prolapse - CORRECT ANSWER -- starts 6-7 cm proximal from anal verge

- pudendal neuropathy, laxity of anal sphincters

- female gender, straining, chronic diarrhea, previous pregnancy, redundant sigmoid

- tx - high-fiber diet

- surgery - rectopexy

- rectopexy + LAR if constipation

- Altemeier if older/frail



AltemeierxProcedure

(perinealx rectosigmoidectomy)x -x CORRECTx ANSWERx --xlithotomyx position

- prolapsex rectum

- circularx incisionx throughx mucosax 2x cmx proximalx tox dentatex line

- dissectx peritoneumx awayx fromx rectum

- ligatex mesorectum/mesosigmoid

- suturex peritoneumx tox anteriorx bowelx asx proximalx asxpossible

+/-xre-approximatex puborectalis

- incisex anteriorx redundantx bowelx 1x cmxdistalx tox analxverge

- anchorx sutures

- resectx redundantx bowel

- colo-analx anastomosis



Condylomax Acuminatax -x CORRECTx ANSWERx --x p/wx cauliflowerx mass

- duex tox HPV

- txx -x laserxsurgery



Analx Fissurex -x CORRECTx ANSWERx -=splitx inx anodermx fromx straining/constipation

- 90%x inx posteriorx midline