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Q1: Classification (2 min)
"Grade a patient with prolapse that needs manual reduction."
- Grade III (Goligher): I = bleed only, II = self-reducing, III = manual reduction, IV = irreducible
- Grade III-IV: surgical (haemorrhoidectomy)
- Grade I-II: rubber band ligation + dietary modification
Q2: Anatomy (2 min)
"Why are internal haemorrhoids painless?"
- Dentate line: above = visceral innervation (painless), below = somatic (painful)
- Anal cushions at 3, 7, 11 o'clock
- Banding is painless ONLY above the dentate line
Q3: Rectal bleeding approach (3 min)
"A 55-year-old with rectal bleeding. How do you work them up?"
- DRE + proctoscopy first
- Colonoscopy mandatory if over 40 (exclude CRC — never assume bleeding is from piles)
- If haemorrhoids confirmed: treat by grade
Q4: Pitfalls (2 min)
"Name two situations where haemorrhoidectomy is dangerous."
- Active Crohn's disease (non-healing wounds, fistulas)
- Portal hypertension with rectal varices (varices are NOT haemorrhoids — different management)