Rectum and anal canal

Hemorrhoids: Definition

Dilated vascular channels

Most common cause of bleeding per rectum

Hemorrhoids

Hemorrhoids: Primary positions (Clock)

3, 7, and 11 o'clock

Hemorrhoids: Type of bleeding typically seen

Arterial bleeding (painless usually)

External hemorrhoids: Pain source

Below dentate line

Hemorrhoids: Investigation of choice (IOC)

Proctoscopy

Thrombosed Piles: Natural history

Melency's 5 day self-healing lesion

Thrombosed Piles: DRE finding

Palpable mass (regular hemorrhoids are not palpable)

Grade 1 Hemorrhoids: Definition

Bleed only, no prolapse

Grade 2 Hemorrhoids: Definition

Prolapse with spontaneous reduction

Grade 3 Hemorrhoids: Definition

Prolapse requiring manual reduction

Grade 4 Hemorrhoids: Definition

Permanently prolapsed

Hemorrhoids Grade 2: Management options

Banding or Sclerotherapy

Sclerotherapy: Most common agent used

Sodium tetradecyl sulfate

Hemorrhoid Surgery: Surgery of choice

Stapled hemorrhoidopexy

Milligan-Morgan procedure: Type

Open hemorrhoidectomy

Ferguson procedure: Type

Closed hemorrhoidectomy

Post-hemorrhoidectomy: Most common complication

Urinary retention (reflex)

Anal Fissure: Most common site (midline)

6 o'clock (Posterior midline)

Anal Fissure: Site associated with obstructed labor

12 o'clock

Sentinel Pile: Association

Chronic anal fissure

Anal Fissure: Investigation finding

DRE is contraindicated (due to pain)

Lateral Anal Sphincterotomy: Muscle cut

Internal sphincter

Anal Fissure: Medical management (Topical)

Diltiazem cream or Nitrate gel

Pilonidal Sinus: Most common site

Natal cleft

Pilonidal Sinus: Occupation association

Barbers (Interdigital area)

Pilonidal Sinus: Surgical flap options

Rhomboid/Limberg flap or Karydakis technique

Bascom's technique: Indication

Pilonidal sinus

Anorectal Abscess: Pathophysiology

Infection of anal glands

Anorectal Abscess: Late clinical sign

Fluctuation

Most common type of fistula-in-ano

Intersphincteric fistula

Goodsall's Rule: Posterior fistula path

Curved tracts, opens in midline (Horseshoe)

Goodsall's Rule: Anterior fistula path

Straight, radial tracts

Fistula-in-ano: Investigation of choice (IOC)

MR Fistulogram

High Fistula: Landmark definition

Above the Anorectal ring

Low Fistula: Management

Fistulectomy or Fistulotomy

High Fistula: Management technique to avoid incontinence

Seton treatment

Seton treatment: Advantage

Gradual cutting of tract allows healing/prevents incontinence

Rectal Prolapse: Partial vs Complete layers

Partial = Mucosa only; Complete = All layers

Partial Rectal Prolapse: Common population

Children

Rectal Prolapse: D/D for complete prolapse in children

Intussusception

Thiersch wiring: Indication

Rectal prolapse (frail/elderly)

Delorme repair: Technique

Mucosa and prolapse plicated

Rectopexy: Definition

Mesh placed in sacrum to prevent prolapse

Solitary Rectal Ulcer Syndrome (SRUS): Location

Anterior wall of rectum

SRUS: Histopathology hallmark

Fibromuscular obliteration of lamina propria

VACTERL: 'A' stands for

Anorectal malformations

Anorectal Malformation: Best investigation for anatomy

MRI

Invertogram: Timing

Done after 24 hours (allow gas to reach rectum)

Low Anorectal Malformation: Measurement on Invertogram

< 2 cm distance between coin and gas

Anorectal Malformation: Definitive surgery name

PSARP (Posterior Sagittal Anorectoplasty)