Proctology

Question 1

Small frequent portions (3)

Answer 1

Enterocel
Simoidocel
Intussusception

Question 2

“faux besoin” (4)

Answer 2

Intussusception
Internal rectal prolaps
Adenoma
Hypertrophic papilla

Question 3

False friend (shart)

Answer 3

Deep seating rectum carcinoma

Question 4

Sphincter defect, most common localisation

Answer 4

anterior

Question 5

Inside knot

Answer 5

Thrombosis from the plexus hemorrhoidalis internus

Question 6

Perianal venous thrombosis

Answer 6

< 72h : incise

> 72h : Flavinoid and analgesia

Question 7

Hemorrhoid grades

Answer 7

I : only visible by proctoscopy
II : prolaps by valsalva, reduce spontaneously
III : digitally reducible
IV : irreducible

Question 8

Grade I Treatment

Answer 8

Flavinoid and stool regulation

Question 9

Grade II Treatment

Answer 9

Band ligation

Contra-indication :

• Crohn
• HIV
• Anticoagulation

Alternative : HAL (hem. arterial ligature)

Question 10

Grade III Treatment

Answer 10

Band ligation
Closed Hamorrhoidectomy (Ferguson, Milligan-Morgan)

If circular :
Stapler Longo (CAVE HSH)

Question 11

Grade IV Treatment

Answer 11

1 cushion : Ferguson

Circular : Longo

Question 12

Anal fissura, most frequent localisation

Answer 12

posterior

Question 13

Anal fissura acute, treatment

Answer 13

Nifedipin or nitroglycerin Cream 6 Weeks (3-4 times daily)

CAVE Nitroglycerin makes headache

Question 14

Anal fissura chronic

Answer 14

more than 6 weeks and/or

• skin tag
• hypertrophic anal papilla
• ingrown borders or visible sphincter

Question 15

Anal fissura chronic, treatment

Answer 15

Conservative works only in 50% of cases
Goldstandard : lateral sphincterotomy but creates gas incontinency
CAVE if not midline : Morbus Crohn vs Lues !!