ROSH Gastrointestinal Practice Exam

Which structure differentiates between internal and external hemorrhoids?

1. Anal verge

2. Dentate line

3. Linea alba

4. Perineum

The correct answer is: Dentate line

The correct answer is the dentate line, which serves as a critical anatomical landmark in the anal canal. This line is where the rectal mucosa transitions to the anoderm, and it defines the boundary between internal and external hemorrhoids. Internal hemorrhoids are located above the dentate line and are covered by rectal mucosa, which is innervated by visceral nerves. As a result, internal hemorrhoids are typically not painful unless they protrude and become thrombosed. On the other hand, external hemorrhoids are situated below the dentate line, covered by anoderm that is richly supplied with somatic nerves. This nerve supply makes external hemorrhoids sensitive and often painful, especially if thrombosed. Understanding the exact location of the dentate line is crucial for clinicians when evaluating and managing hemorrhoidal disease, as the treatment approach can differ significantly based on whether the hemorrhoids are internal or external.