Hemorrhoid

Hemorrhoid

Q. 1

Pain of External hemorrhoids is carried by?

 A Pudendal nerve
 B

Perineal nerve

 C Superior rectal nerve
 D

Dorsal nerve of penis or clitoris

Q. 1

Pain of External hemorrhoids is carried by?

 A Pudendal nerve
 B

Perineal nerve

 C Superior rectal nerve
 D

Dorsal nerve of penis or clitoris

Ans. A

Explanation:

Pudendal nerve REF: Gray’s anatomy 39′ ed p- 1371

External hemorrhoids are innervated by cutaneous nerves that supply the perianal area, such as the pudendal nerve and branches of the sacral plexus


Q. 2

The following is ideal for the treatment with injection of sclerosing agents:

 A

External hemorrhoids

 B

Internal hemorrhoids

 C

Prolapsed hemorrhoids

 D

Strangulated hemorrhoids

Q. 2

The following is ideal for the treatment with injection of sclerosing agents:

 A

External hemorrhoids

 B

Internal hemorrhoids

 C

Prolapsed hemorrhoids

 D

Strangulated hemorrhoids

Ans. B

Explanation:

Injection sclerotherapy is ideal for first degree internal haemorrhoids which bleed.

Early second degree internal haemorrhoids may also be treated but a proportion relapses.

 
Ref: Bailey and Love’s Short Practice of Surgery, 24th Edition, Page 1258

 


Q. 3

Which is the most common cause of fresh lower gastointestinal bleed in India?

 A

Ca rectum

 B

Rectal polyp

 C

Hemorrhoids

 D

Diverticulitis

Q. 3

Which is the most common cause of fresh lower gastointestinal bleed in India?

 A

Ca rectum

 B

Rectal polyp

 C

Hemorrhoids

 D

Diverticulitis

Ans. C

Explanation:

Hemorrhoids is the cmmonost cause of fresh GI bleed, in India.


Q. 4

External hemorrhoids are innervated by:

 A

Pudendal Nerve

 B

Lumbar Nerve

 C

Obturator Nerve

 D

Gluteal Nerve

Q. 4

External hemorrhoids are innervated by:

 A

Pudendal Nerve

 B

Lumbar Nerve

 C

Obturator Nerve

 D

Gluteal Nerve

Ans. A

Explanation:

External hemorrhoids are varicosities of the tributaries of the inferior rectal vein.

They are covered by the mucous membrane of the lower half of the anal canal.

They are innervated by the inferior rectal nerve which is a branch of pudendal nerve.

They are sensitive to pain temperature and pressure.

Ref: Snell’s, Clinical Anatomy, 7th Edition, Page 424.


Q. 5

A jaundiced, 43 year old alcoholic male presents to the emergency room complaining of bright red blood in his last two stools. He denies pain on defecation or changes in his bowel habits. Which of the following would be the most likely finding on sigmoidoscopic examination?

 A

Colorectal carcinoma

 B

Diverticulitis

 C

Hemorrhoids

 D

Hyperplastic polyps

Q. 5

A jaundiced, 43 year old alcoholic male presents to the emergency room complaining of bright red blood in his last two stools. He denies pain on defecation or changes in his bowel habits. Which of the following would be the most likely finding on sigmoidoscopic examination?

 A

Colorectal carcinoma

 B

Diverticulitis

 C

Hemorrhoids

 D

Hyperplastic polyps

Ans. C

Explanation:

The patient’s jaundice indicates that he has significant alcoholic liver disease.

Hepatic fibrosis or cirrhosis both produce vascular injury and portal hypertension, which leads to the development of portosystemic shunts-most typically causing esophageal varices, caput medusae, and hemorrhoids. Bright red blood in stools is a classic presentation of hemorrhoids.

 

Colorectal carcinoma generally develops in an older population, and produces occult blood loss rather than frankly bloody stools.
 
Although diverticulosis may be an asymptomatic condition, diverticulitis is associated with significant abdominal distress, which may be accompanied by blood loss and diarrhea and/or constipation.
 
Hyperplastic polyps are asymptomatic, non-neoplastic, polypoid growths, generally less than 5mm in diameter.

They do not produce bleeding or any increased risk of carcinoma.
 
Ref: Bullard Dunn K.M., Rothenberger D.A. (2010). Chapter 29. Colon, Rectum, and Anus. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwartz’s Principles of Surgery, 9e.

Q. 6

A patient with external hemorrhoids develops pain while passing stools. Which of the following nerve mediating this pain?

 A

Pudendal nerve

 B

Hypogastric nerve

 C

Sympathetic plexus

 D

Splanchnic visceral nerve

Q. 6

A patient with external hemorrhoids develops pain while passing stools. Which of the following nerve mediating this pain?

 A

Pudendal nerve

 B

Hypogastric nerve

 C

Sympathetic plexus

 D

Splanchnic visceral nerve

Ans. A

Explanation:

External hemorrhoids are covered by the mucous membrane of the lower half of the anal canal or the skin, and they are innervated by the inferior rectal nerves. Inferior rectal nerve is a branch of pudendal nerve. Lower half of anal canal is sensitive to pain, temperature, touch, and pressure.

  • The pectinate line indicates the level where the upper half of the anal canal joins the lower half.
  • The mucous membrane of the upper half is sensitive to stretch and is innervated by sensory fibers that ascend through the hypogastric plexuses.
  • The involuntary internal sphincter is supplied by sympathetic fibers from the inferior hypogastric plexuses.
  • The voluntary external sphincter is supplied by the inferior rectal nerve, a branch of the pudendal nerve and the perineal branch of the fourth sacral nerve.

Q. 7

A patient with external hemorrhoids develops pain while passing stools. The nerve mediating this pain is:

 A

Hypogastric nerve

 B

Pudendal nerve

 C

Splachnic visceral nerve

 D

Sympathetic plexus

Q. 7

A patient with external hemorrhoids develops pain while passing stools. The nerve mediating this pain is:

 A

Hypogastric nerve

 B

Pudendal nerve

 C

Splachnic visceral nerve

 D

Sympathetic plexus

Ans. B

Explanation:

B i.e. Pudendal nerve

Transitional epithelium lies below the dentate line in middle third of anal canal.

–  Upper half of anal canal is insensitive to pain, lined by columnar epithelium, supplied by superior rectal vessels and drained by internal iliac lymph nodes.

Lower half of anal canal is sensitive to pain (through inferior rectal br of pudendal nerve), lined by stratified
squamous epithelium, supplied by inferior rectal vessels and drained by superficial inguinal lymph nodes.


Q. 8

External hemorrhoids below the dentate line are –

 A

Painful

 B

Ligation is done as management

 C

Skin tag is not seen in these cases

 D

May turn malignant

Q. 8

External hemorrhoids below the dentate line are –

 A

Painful

 B

Ligation is done as management

 C

Skin tag is not seen in these cases

 D

May turn malignant

Ans. A

Explanation:

Ans. is ‘a’ i.e. Painful 

  • Hemorrhoidal tissues are part of the normal anatomy of the distal rectum and anal canal. These are cushions of submucosal tissue containing venules, arterioles, and smooth-muscle fibres. These anal cushions are found in the left lateral, right anterior and right posterior position (3, 7 & 11 ‘0 clock positions)
  • These anal cushions function as protective pillows that become engorged with blood during the act of defecation, protecting the anal canal from direct trauma during passage of stool. They are also thought to be part of the continence mechanism.
  • Hemorrhoids are likely the result of a sliding downwards of these anal cushions.
  • Some books write that the term ‘hemorrhoids’ shoud be restricted to clinical situations in which these cushions are abnormal and cause symptoms.

Q. 9

Five-day self subsiding pain is diagnostic of ‑

 A

Anal fissure

 B

Fi stul -in -ano

 C

Thrombosed external hemorrhoids

 D

Thrombosed internal hemorrhoids

Q. 9

Five-day self subsiding pain is diagnostic of ‑

 A

Anal fissure

 B

Fi stul -in -ano

 C

Thrombosed external hemorrhoids

 D

Thrombosed internal hemorrhoids

Ans. C

Explanation:

Ans. is ‘c’ i.e., Thrombosed external hemorrhoids 


Q. 10

Which of the following is the commonest cause of lower GI bleed:

 A

Angiodysplasia

 B

Enteric fever

 C

Diverticulosis

 D

Hemorrhoids

Q. 10

Which of the following is the commonest cause of lower GI bleed:

 A

Angiodysplasia

 B

Enteric fever

 C

Diverticulosis

 D

Hemorrhoids

Ans. D

Explanation:

Answer is D (Hemorrhoids)

‘Hemorrhoids are probably the most common cause of Lower GIBleed (LGIB)’


Q. 11

MC complication following hemorrhoidectomy is:

March 2013 (h)

 A

Hemorrhage

 B

Infection

 C

Fecal impaction

 D

Urinary retention

Q. 11

MC complication following hemorrhoidectomy is:

March 2013 (h)

 A

Hemorrhage

 B

Infection

 C

Fecal impaction

 D

Urinary retention

Ans. D

Explanation:

Ans. D i.e. Urinary retention


Q. 12

Treatment of choice for 3rd degree hemorrhoids is:

September 2007

 A

Sclerotherapy

 B

Band ligation

 C

Hemorrhoidectomy

 D

All of the above

Q. 12

Treatment of choice for 3rd degree hemorrhoids is:

September 2007

 A

Sclerotherapy

 B

Band ligation

 C

Hemorrhoidectomy

 D

All of the above

Ans. C

Explanation:

Ans. C: Hemorrhoidectomy

External hemorrhoids develop around the rim of the anus. External hemorrhoids cause most of the symptoms associated with hemorrhoids (pain, burning, and itching) because the skin around them is very sensitive. If an external hemorrhoid becomes strangulated, a clot can form in it and become an excruciatingly painful thrombosed hemorrhoid. Internal hemorrhoids develop inside the passageway of the anus. Internal hemorrhoids are often present without causing any discomfort or even awareness of their presence. Internal hemorrhoids are usually painless, although they sometimes cause discomfort and bleeding if a hard stool rubs against them during a bowel movement. Internal hemorrhoids also may prolapse outside the anus, where they appear as small, grape-like masses. These can be painful.

Internal hemorrhoids are classified by the degree of tissue prolapse into the anal canal:

  • First-degree – hemorrhoids that bleed but do not prolapse
  • Second-degree – hemorrhoids that prolapse with straining or defecating and retract on their own
  • Third-degree – hemorrhoids that prolapse and require manual reduction
  • Fourth-degree – hemorrhoids that chronically prolapse and, if reducible, fall out again

Management:

  • Rubber band ligation – A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
  • Sclerotherapy is one of the oldest forms of treatment. A chemical solution is injected directly into the hemorrhoid or the area around it. This solution causes a local reaction that interferes with blood flow inside the hemorrhoid, making the hemorrhoid shrink.
  • Laser or electro-coagulation techniques – Both techniques use special devices to burn hemorrhoidal tissue.

– Cryotherapy uses cold temperatures to obliterate the veins and cause inflammation and scarring. It is more time consuming, associated with more posttreatment pain, and is less effective than other treatments. Therefore, this procedure is not commonly used.

– Hemorrhoidectomy – Occasionally, extensive or severe internal or external hemorrhoid may require removal by surgery known as hemorrhoidectomy. This is the best method for permanent removal of hemorrhoid

Hemorrhoidectomy is the treatment for:

  • Severe third-degree and fourth-degree hemorrhoids.
  • Second degree hemorrhoids that have not been cured with conservative measures.
  • Fibrosed hemorrhoids
  • Interno-externo hemorrhoids when the external hemorrhoid is well defined.

Q. 13

Not a cause of acute anal pain

 A

Thrombosed hemorrhoids

 B

Acute anal fissure

 C

Fistula in ano

 D

Perianal abscess

Q. 13

Not a cause of acute anal pain

 A

Thrombosed hemorrhoids

 B

Acute anal fissure

 C

Fistula in ano

 D

Perianal abscess

Ans. C

Explanation:

Ans. c. Fistula in ano


Q. 14

External hemorrhoids below the dentate line are:

 A

Painful

 B

Ligation is done as management

 C

Skin tag is not seen in these cases

 D

May turn malignant

Q. 14

External hemorrhoids below the dentate line are:

 A

Painful

 B

Ligation is done as management

 C

Skin tag is not seen in these cases

 D

May turn malignant

Ans. A

Explanation:

Ans. a. Painful



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