High-Yield Concepts in Anorectal Disorders (Gastrointestinal Diseases)

Question 1

Procidentia (Rectal Prolapse)

Answer 1

Circumferential, full-thickness protrusion of the rectal wall through the anal orifice

Question 2

Fecal Incontinence

Answer 2

Involuntary passage of fecal material >10 mL for at least 1 month

Question 3

Anismus

Answer 3

The result of attempting to defecate against a closed pelvic floor (a.k.a. non relaxing puborectalis)

Question 4

Mucosal vs. Full-thickness Rectal Prolapse

Answer 4

Radial vs. circumferential grooves around anus

Question 5

Mainstay of Therapy for Rectal Prolapse

Answer 5

Surgical correction

Question 6

3 Hemorrhoidal Complexes in the Anal Canal

Answer 6

Left lateral, right anterior, and right posterior

Question 7

Most common presentation of Hemorrhoids

Answer 7

Bleeding and/or protrusion

Question 8

Hallmarks of an Anorectal Abscess

Answer 8

Perianal pain and fever

Question 9

Most common location of Anal Fissures

Answer 9

Posterior position, followed by anterior (lateral fissure is worrisome, and systemic disorders should be ruled out)

Question 10

Most common location of Internal Opening of Fistula in Ano (FIA)

Answer 10

Dentate line

Question 11

Most common type of FIA

Answer 11

Intersphincteric, followed by transsphinteric

Question 12

Goodsall’s Rule for FIA

Answer 12

Anterior fistula:straight tract to nearest crypt
Posterior fistula: curved tract to enter anal canal at posterior midline
Exception: fistulas exiting >3 cm from the anal verge may not obey Goodsall’s rule

Question 13

Best Management for Newly Diagnosed FIA

Answer 13

Seton (vessel loop or silk tie placed through the tract)