AOBPr Proctology cheat sheet

Hemorrhoids are classified by location relative to the dentate line: internal (above, insensate, covered by columnar mucosa) versus external (below, somatic pain fibers, covered by anoderm).

Internal hemorrhoid grading: I = bleed only, no prolapse; II = prolapse reduces spontaneously; III = prolapse requires manual reduction; IV = irreducible prolapse.

Acute thrombosed external hemorrhoid presents as a painful, firm, blue perianal nodule; excision is favored if seen within 48-72 hours, otherwise conservative care with sitz baths and analgesia.

Anal fissure: most are posterior midline; lateral or multiple fissures raise suspicion for Crohn disease, malignancy, HIV, or tuberculosis and warrant further workup.

Chronic anal fissure treatment ladder: fiber/sitz baths, then topical nitrates or calcium channel blockers, then botulinum toxin injection, then lateral internal sphincterotomy (risk of incontinence).

Anorectal abscess is treated by prompt incision and drainage; antibiotics alone are inadequate. Fistula-in-ano is described by the Park classification (intersphincteric, transsphincteric, suprasphincteric, extrasphincteric).

Anal fistula: Goodsall rule predicts tract course - anterior external openings track radially; posterior openings track to the posterior midline with a curved tract.

Pilonidal disease occurs in the natal cleft; acute abscess needs drainage, while chronic disease may need excision or off-midline flap closure to reduce recurrence.

Colorectal and anal cancer red flags: rectal bleeding with altered bowel habit, unintentional weight loss, iron-deficiency anemia, or a palpable mass require endoscopic evaluation regardless of presumed benign cause.

OCC is the AOA continuous certification framework for osteopathic physicians; it is a maintenance-of-certification process rather than a one-time terminal exam.

Core OCC components include: professional standing/licensure, lifelong learning (CME), cognitive expertise (examination), practice performance assessment, and commitment to osteopathic philosophy/principles.

Active, unrestricted licensure in all states of practice is a foundational requirement; licensure actions must be reported and may affect certification status.

Lifelong learning requires documented AOA Category 1 CME credits over each certification cycle, with specialty-specific and osteopathic CME minimums.

Cognitive expertise is demonstrated by a periodic proctored or secure examination relevant to the specialty; passing maintains the certification cycle.

Practice performance assessment requires documented quality-improvement activity and reflective practice/patient-safety participation within the cycle.

Osteopathic principles and practice (OPP) integration is a distinguishing OCC element; evidence of incorporating OMT/whole-person care into practice is expected.

Certification cycles are time-limited (commonly multi-year); failure to complete components within the cycle can result in loss of board certification status.

Diplomates should verify current cycle deadlines and component requirements directly with the AOA/ specialty board, as specific credit hours and intervals are updated periodically.