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Anal Fissures and Anatomy
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1
Question
What marks the transition between columnar rectal mucosa and squamous anoderm?
Answer
Dentate (pectinate) line
2
Question
Where does the surgical anal canal begin and end?
Answer
Anorectal junction to anal verge
3
Question
What is the length of the surgical anal canal?
Answer
About 4 cm
4
Question
What are the longitudinal mucosal folds surrounding the dentate line?
Answer
Columns of Morgagni
5
Question
Into what do the anal crypts empty?
Answer
Columns of Morgagni
6
Question
What is a common source of cryptoglandular abscesses?
Answer
Anal crypts
7
Question
What forms the bulk of the anal sphincter complex?
Answer
External sphincter
8
Question
What innervates the external anal sphincter?
Answer
Pudendal nerve
9
Question
What is the internal anal sphincter?
Answer
Thickened distal circular muscle of rectum
10
Question
How is the internal anal sphincter innervated?
Answer
Autonomic nervous system
11
Question
What is the intersphincteric plane?
Answer
Potential space between external and internal sphincters
12
Question
What does the intersphincteric plane contain?
Answer
Intersphincteric anal glands
13
Question
What is a route for pus spread in the anal canal?
Answer
Intersphincteric plane
14
Question
What is an anal fissure?
Answer
Longitudinal tear in distal anoderm
15
Question
Where does an anal fissure extend?
Answer
From anal verge to dentate line
16
Question
In what position do most anal fissures (>85%) occur?
Answer
Posterior midline
17
Question
What is the location of 10-15% of anal fissures?
Answer
Anterior midline
18
Question
What may non-midline anal fissures indicate?
Answer
Specific underlying diseases
19
Question
What causes an initial tear in the anoderm?
Answer
Passage of hard stool or recurrent diarrhea
20
Question
What results from a tear in the anoderm during defecation?
Answer
Pain and bleeding
21
Question
What reflex occurs in response to anal fissure pain?
Answer
Spasm in internal anal sphincter
22
Question
What precedes chronic anal fissure development?
Answer
Acute anal fissure
23
Question
What is the primary symptom of anal fissure at defecation?
Answer
Tearing pain
24
Question
What type of bleeding is associated with anal fissures?
Answer
Fresh blood related to straining
25
Question
What additional symptoms may occur with anal fissures?
Answer
Pruritus and discharge
26
Question
How does constipation relate to anal fissures?
Answer
Both cause and result
27
Question
Why might digital rectal examination be omitted in anal fissures?
Answer
Extremely painful
28
Question
Under what condition is DRE performed for acute anal fissures?
Answer
General anesthesia
29
Question
What skin change is seen in acute anal fissures?
Answer
Puckered anal skin
30
Question
How is an acute anal fissure visualized?
Answer
By separating the buttocks