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Arterial supply to anus
Inferior rectal artery
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Venous drainage to anus
External hemorrhoid plexus
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Number of hemorrhoidal plexuses
3 (left lateral, right anterior, right posterior)
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painful hemorrhoids
external
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bleeding or prolapsing hemorrhoids
internal
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treatment of thrombosed external hemorrhoid
lance and drain
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bandable hemorrhoids
primary, secondary and tertiary internal hemorrhoids
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pudendal neuropathy and laxity of anal sphincters causes:
rectal prolapse
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treatment of rectal prolapse
rectosigmoid resection (altmeier) or LAR/rectopexy
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cauliflower mass caused by HPV
condylomata acuminata
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split in anoderm causing pain and bleeding
anal fissure
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sign seen with anal fissure
sentinel pile
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surgical treatment of anal fissure
lateral subcutaneous internal sphincterotomy
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method of drainage of perianal, intersphincteric and ischiorectal abscess
through skin
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method of drainage of supralevator abscesses
transrectally
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sinus or abscess formation over sacrococcygeal junction
pilonidal cyst
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goodsall�s rule
fistulae in ano that are anterior connect with the rectum in a straight line, and those that are posterior connect with the rectum in a curved line toward a midline internal opening
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treatment of rectovaginal fistula
simple: transanally unroof and place rectal advancement flap. Complex: resection and reanastamosis, colostomy
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most common anal cancer in patients with AIDS
Kaposi�s sarcoma
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Anorectal ulcers in an AIDS patient (3)
CMV, HSV, Bcell lymphoma
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Treatment of SCCA of anus
Chemotherapy and XRT (Nigro protocol)
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Treatment of adenocarcinoma of anus
APR
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Treatment of anal melanoma
APR
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Margin needed for anal melanoma
Same as that dictated for standard skin melanoma
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Common metastatic site for SCCA of anus
Inguinal nodes
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Intraepidermal squamous cell Ca
Bowen�s disease
-
Intraepidermal apocrine gland Ca
Paget�s disease
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Nodal drainage of superior and middle rectum
IMA nodes
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Nodal drainage of lower rectum
IMA and internal iliac nodes
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Nodal drainage of upper 2/3 of anal canal
Internal iliac, pelvic nodes
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Nodal drainage of lower 1/3 of anal canal
Inguinal nodes
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