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
AltemeiercProcedure
(perinealc rectosigmoidectomy)c -c CORRECTc ANSWERc --c lithotomyc position
- prolapsec rectum
- circularc incisionc throughc mucosac 2c cmc proximalc toc dentatec line
- dissectc peritoneumc awayc fromc rectum
- ligatec mesorectum/mesosigmoid
- suturec peritoneumc toc anteriorc bowelc asc proximalc asc possible
+/-c re-approximatec puborectalis
- incisec anteriorc redundantc bowelc 1c cmc distalc toc analcverge
- anchorc sutures
- resectc redundantc bowel
- colo-analc anastomosis
Condylomac Acuminatac -c CORRECTc ANSWERc --c p/wc cauliflowerc mass
- duec toc HPV
- txc -c lasercsurgery
Analc Fissurec -c CORRECTc ANSWERc -=splitc inc anodermc fromc straining/constipation
- 90%c inc posteriorc midline
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
AltemeiercProcedure
(perinealc rectosigmoidectomy)c -c CORRECTc ANSWERc --c lithotomyc position
- prolapsec rectum
- circularc incisionc throughc mucosac 2c cmc proximalc toc dentatec line
- dissectc peritoneumc awayc fromc rectum
- ligatec mesorectum/mesosigmoid
- suturec peritoneumc toc anteriorc bowelc asc proximalc asc possible
+/-c re-approximatec puborectalis
- incisec anteriorc redundantc bowelc 1c cmc distalc toc analcverge
- anchorc sutures
- resectc redundantc bowel
- colo-analc anastomosis
Condylomac Acuminatac -c CORRECTc ANSWERc --c p/wc cauliflowerc mass
- duec toc HPV
- txc -c lasercsurgery
Analc Fissurec -c CORRECTc ANSWERc -=splitc inc anodermc fromc straining/constipation
- 90%c inc posteriorc midline
