A 50-year-old male presents with acute lower gastrointestinal bleeding. On physical examination, there are painful, swollen, thrombosed masses protruding below the dentate (pectinate) line covered by squamous epithelium. What is the diagnosis?
Answer and explanation
Correct answer: D. Thrombosed external hemorrhoids
- Step 1: External hemorrhoids arise below the dentate (pectinate) line and are covered by richly innervated anoderm / squamous epithelium.
- Step 2: Because they receive somatic sensory innervation from the inferior rectal nerves, thrombosis causes acute, exquisite, severe pain.
- Step 3: Internal hemorrhoids are located above the dentate line and are insensitive to sharp pain.
Answer
Thrombosed external hemorrhoids.
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