Anal

Question 1

RF for Haemorrhoids?

Answer 1

Lower venous return
Raised intra-abdo Pa
High rectal vein pressure
Age

Question 2

Significance of dentate line?

Answer 2

ANS above dentate line - no pin-prick sensation
Somatic nerve below - inferior rectal nerve.

Question 3

Grading tool for internal haemorrhoids?

Answer 3

Banov grading. Grade 1-4.
Operation for Grade 3/4

Question 4

What is anal fissure?

Answer 4

Split in anoderm distal to dentate line

Question 5

Surgery or nah for anal fissures/

Answer 5

Acute fissure usu responds to medical Tx
Chronic fissures likely need surgery

Question 6

Why do most acute fissures heal with medical mx?

Answer 6

Cuz of good blood supply (within 1-2 days)
Others include lifestyle modifications, bulking agents, stool softeners, warm sitz baths, lidocaine jelly

Question 7

Can haemorrhoids present with itching?

Answer 7

Yes! Pruritus ani is a rare symptom

Question 8

Mx of Haemorrhoids?

Answer 8

Grade 1 - Meds, lifestyle mods
2 - Rubber Band Ligation
3 - Excisional haemorrhoidectomy
4 - Use hyperosmolar solution to reduce haemorrhoids first, then surgery

Question 9

What portion of rectum is intra or extra-peritoneal?

Answer 9

Proximal 1/3 = Ant and Lat intraperitoneal.
Middle 2/3 = Ant intraperitoneal