Digestive Tract Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Digestive Tract Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations

A 22-year-old woman presents for follow-up of intermittent bright red blood found on toilet paper lasting several weeks, despite recent lifestyle and topical interventions. She reports no pain, normal soft stools, and no systemic symptoms. Physical exam and anoscopy reveal specific findings above the dentate line. How should persistent, painless rectal bleeding in this scenario be approached? What key clinical features should inform the management plan for continued symptoms despite initial therapies? VIDEO INFO Category: Digestive Tract Anatomy, Human Anatomy, USMLE Step 1 Difficulty: Easy - Basic level - Suitable for medical students Question Type: Treatment Failure Case Type: Routine Visit - Standard clinical encounter in outpatient setting Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 22-year-old woman comes to clinic for a routine visit and follow-up of intermittent bright red blood on toilet paper for 6 weeks. She reports soft daily stools after starting a fiber supplement and water bottle reminder, but bleeding persists when she strains during longer bathroom sessions. She denies fever, weight loss, abdominal pain, or dizziness. She has social anxiety disorder.... OPTIONS A. Perform office rubber band ligation of the internal hemorrhoids above the dentate line using an anoscope in the outpatient clinic (no general anesthesia), after counseling on risks and avoidance with active anticoagulation. B. Offer outpatient injection sclerotherapy of the internal hemorrhoids using a standard sclerosant in the clinic as first choice over banding after brief topical therapy failure. C. Schedule excisional hemorrhoidectomy under general anesthesia for definitive removal of presumed hemorrhoidal tissue despite grade II findings and stable blood counts. D. Extend external hydrocortisone-pramoxine cream for 4 more weeks and add daily topical lidocaine around the anal verge as the main therapy before any procedure. CORRECT ANSWER A. Perform office rubber band ligation of the internal hemorrhoids above the dentate line using an anoscope in the outpatient clinic (no general anesthesia), after counseling on risks and avoidance with active anticoagulation. EXPLANATION This patient has persistent, painless bleeding from grade II internal hemorrhoids confirmed on anoscopy after an adequate trial of fiber and hydration. Office rubber band ligation above the dentate line is the best next step because it treats the prolapsing internal cushions by strangulating redundant mucosa where visceral innervation minimizes pain and the procedure requires no general anesthesia. Current colorectal guidance continues to list rubber band ligation as the preferred office procedure for grades I-II (and some III) when conservative measures fail, with strong symptom control and low complication rates. A 2025 narrative review of hemorrhoid management highlights newer variants and adjuncts but does not supplant rubber band ligation as the default office intervention; counseling should include brief post-banding pain/pressure, minor delayed bleeding, and short-term avoidance of NSAIDs and anticoagulation when possible, as well as continuing fiber, fluids, and stool softener to avoid straining. Per the 2024 ASCRS guideline, excisional surgery is reserved for higher grades or refractory cases, not initial therapy for typical grade II disease. Other choices are less appropriate.... --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this book to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this book as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------