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NBME 24 Answers

nbme24/Block 4/Question#50

A 47-year-old man comes to the physician because of ...

Superior rectal vein

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submitted by m-ice(184),

This patient shows signs of cirrhosis, which is likely associated with portal hypertension. Portal hypertension will cause increased pressure in all veins draining into the portal vein, and can cause bulging of these veins at areas where they meet those that drain to the vena cava. One area is the rectum and anus, where the superior rectal vein (from the portal system) meets up with the middle and inferior rectal veins (which drain to the caval system). Increased pressure in the superior rectal vein will cause hemorrhoids at this location.

Pg 360 First Aid 2019

Internal Hemorrhoids

-Visceral innervation (no pain felt), Superior rectal a., Superior rectal vein (drains to IMV), Internal iliac lymph nodes


External Hemorrhoids

-Somatic innervation (they hurt), Inferior rectal a., Inferior rectal vein (drains to internal pudendal vein), Superficial inguinal lymph nodes

kateinwonderland  Above pectinate -V:sup. rectal v -> inf. mesenteric v. -> splenic v. -> portal v -internal iliac LN Below pectinate -V:inf. rectal v -> internal pudendal v->internal iliac v->common iliac v->IVC -superficial inguinal LN (FA 2018 p360) +1  
sherry  Venous drainage above pectinate, most to the portal vein, some to internal iliac v via middle rectal vein. I think the real solid key here is that the clinical vignette suggests hepatic cirrhosis. +  
moxomonkey  internal hemorroids are not related to portal hypertension https://www.ncbi.nlm.nih.gov › pmc › articles › PMC4691702 also FA 383 anorectal varices are. now if you check FA it say Pg 359 First Aid 2019 Anorectal varices Superior rectal ↔ middle and inferior rectal all of them include in the answers options so? +1