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GI > 3- Faecal continence: the distal part of the GI tract > Flashcards

3- Faecal continence: the distal part of the GI tract Flashcards

1
Q

what makes up the distal GI tract?

A
  • rectum
  • anal canal
  • anus
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2
Q

what are paracolic gutters - why are they clinically important? where are they?

A
  • para (beside) colic (colon) = beside the colon. sit between lateral edge of ascending and descending colon, and abdominal wall
  • they’re part of greater sac of peritoneal cavity
  • they’re significant as potential sites of excess blood/pus/fluid so when lying down one of the areas that you check for excess fluid (similar to hepatorenal recess and subphrenic recess)
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3
Q

what are the sacs of large intestine?

A

the bumps = haustra

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4
Q

which flexure of large intestine is more superior - hepatic or splenic flexure?

A

splenic flexure usually more superior than hepatic (because hepatic is lower due to presence of liver)

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5
Q

what are the smooth muscle bands in large intestine?

A

there are 3 distinct longitudinal bands of thickened smooth muscle running from caecum to distal end of sigmoid colon

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6
Q

what are normal things to see on abdominal x-ray?

A
  • bubbles of air throughout colon
  • mottled appearance of faeces mixing with air in rectum
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7
Q

what is holding area for faeces?

A

rectum

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8
Q

what nerves are for detecting when rectum is full?

A

picked up by sensory nerves and since rectum is viscera = visceral afferents

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9
Q

what can affect faecal continents?

A
  • medication
  • natural age related degeneration of nerve innervation of muscle
  • consistency of stool
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10
Q

what are 2 parts of pelvic cavity?

A

lighter green = greater/false pelvis

darker green = true/lesser pelvis

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11
Q

is abdominal cavity and pelvic cavity seperate?

A

no - they’re contiunuous

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12
Q

what is pelvic inlet?

A

ring of bone by sacrum, ileum and pubic bone

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13
Q

what is purpose of pelvic cavity?

A

supports organs of pelvis, has lots of supporting (fatty, connective) tissue and is where rectum is located

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14
Q

what is pelvic floor the floor and roof of?

A
  • floor of pelvis
  • roof of perineum
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15
Q

what are openings in the pelvic floor?

A

alimentary, renal and reproductive tracts to pass from the pelvic cavity into the perineum

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16
Q

when does sigmoid colon become rectum?

A

rectosigmoid junction = anterior to S3

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17
Q

when does rectum become anal canal?

A

anterior to the tip of the coccyx just prior to passing through the levator ani muscle

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18
Q

what organs are in pelvis or perineum out of rectum, anal canal, anus?

A
  • rectum in pelvis
  • anal canal & anus in perineum
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19
Q

what is main part of rectum?

A

rectum ampulla (sac like enlargement)
→can enlarge in response to faces collecting in it →smooth muscle relaxes and allows filling, the muscles must also contract to defecate

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20
Q

what lies over the superior aspect of rectum?

A

peritoneum

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21
Q

what pouch lies anterior to superior rectum?

A

rectouterine in females (pouch of douglas)
rectovesical in males

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22
Q

where does prostate gland lie in relation to rectum?

A

prostate gland lies anterior to inferior rectum

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23
Q

where does vagina & cervix lie in relation to rectum?

A

vagina & cervix lies anterior to inferior/middle rectum

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24
Q

what is the levator ani muscles?

A

= means elevating/lifting anus (rectum)

  • forms most of pelvic diaphragm

makes up 3 different muscles. skeletal muscles so under voluntary control

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25
Q

what are the 3 different muscles of levator ani muscle?

A

pubococcygeus = pubic & coccyx

ileococcygeus = ileum & coccyx

puborectalis = pubic & rectum →important one

26
Q

what happens when levator ani muscle relaxes/contracts?

A

levator ani muscles are always a bit contracted (tonic) to provide support to organs of pelvic

27
Q

what nerve supplies the levator ani muscles?

A

pudendal s2,3,4

s2,3,4 keeps the anus on the floor

28
Q

what is the anorectal angle?

A

between anal canal and rectum

29
Q

what is puborectalis function when contracting?

A

puborectalis is one of the levator ani muscles
= when contracting pulls anal rectal angle towards pubic bone (decreases angle) which means less room internally for any faeces to go through →so kinda acts like a sphincter (NOT A SPHINCTER) - stops defecating if you want to (under control)

30
Q

what are the 2 anal sphincters?

A
  • 1 internal smooth muscle = involuntary control
  • 1 external skeletal muscle = voluntary control
31
Q

what supplies the internal anal sphincter? and what is it composed of?

A
  • it’ composed of smooth muscle (involuntary)
  • contraction is stimulated by sympathetic nerves (sphincter closed)
  • contraction is inhibited by parasympathetic nerves

= it’s contracted all the time, relaxes reflexively in response to distension (filling) of rectal ampulla

32
Q

what supplies the external anal sphincter? and what is it composed of?

A
  • skeletal muscle (voluntary)
  • contraction is stimulated by the pudendal nerve (because in perineum) →contract voluntarily in response to ampulla filling up and internal one relaxes -external one cause wait not appropriate time right now
33
Q

when does external anal sphincter contract?

A

voluntarily contracted (along with puborectalis muscle) in response to rectal ampulla distension and internal sphincter relaxation

34
Q

where is
a) external anal sphincter?
b) internal anal sphincter?

A

a) superior two thirds of anal canal
b) inferior two thirds of anal canal (superior part of the sphincter is continuous with the puborectalis muscle)

= they overlap

35
Q

what control are organs in pelvis under?

A

autonomic control

36
Q

what control are organs in perineum under?

A

part of body wall →somatic, under voluntary control (somatic motor, somatic sensory)

37
Q

what type of pain is in pelvis?

A

part of viscera so dull & achy

38
Q

what type of pain is in perineum?

A

part of body wall so sharp, stabbing, well localised

39
Q

what is nerve supply is above levator ani?

A

above levator ani = in pelvic cavity

sympathetic supply = thoracolumbar - sympathetic motor is T12-L2 to supply rectum

parasympathetic supply = craniosacral - s2,3,4 (same level as pudendal nerve but not part of pudendal nerve)

40
Q

what nerves run from s2,3,4 level?

A
  • visceral afferents
  • parasympathetic
  • pudendal
41
Q

what nerves run from T12-L2 level?

A

sympathetic motor

42
Q

what is pudendal nerve?

A

branch of sacral plexus that comes from S2, S3, S4 anterior rami and supplies external anal sphincter

43
Q

what is route of pudendal nerve?

A

from S2, S3, S4 anterior rami and exits pelvis via greater sciatic foramen then quickly enters perineum via lesser sciatic foramen and branches to supply structures of perineum

44
Q

what are ways pudendum can be damaged in labour?

A
  • the branches of the pudendal nerve could be stretched →resultant stretch of the nerve fibres
  • fibres within the puborectalis or external anal sphincter muscle could be torn →results in weakened muscle
  • faecal incontinence could result
45
Q

what is pectinate line?

A

junction formed between the part of the embryo which formed the GI tract (endoderm) and the part that formed the skin (ectoderm)

= everything above is visceral and everything below is parietal (means different blood supplies etc on either side of line)

46
Q

for above pectinate line, what is
a) nerve supply
b) anterior supply
c) venous drainage
d) lymphatic drainage

A

above = visceral

a) autonomic
b) inferior mesenteric artery
c) to portal venous system
d) inferior mesenteric nodes (internal iliac nodes)

47
Q

for below pectinate line, what is
a) nerve supply
b) anterior supply
c) venous drainage
d) lymphatic drainage

A

below = perineum
a) somatic and pudendal
b) internal iliac artery
c) to systemic venous system via internal iliac
d) superficial inguinal nodes

48
Q

where are lymph vessels of pelvic?

A

lymph vessels tend to lie alongside arteries

49
Q

what are the main groups of lymph nodes draining the pelvic organs?

A
  • internal iliac (draining inferior pelvic structures)
  • external iliac (draining lower limb, and more superior pelvic structures)
  • common iliac (drain the lymph from the external and internal iliac nodes)
  • lymph draining through the common iliac nodes then drains to the lumbar nodes
50
Q

what artery supplies the hindgut organs?

A

inferior mesenteric artery

51
Q

what level of anal canal has what artery?

A

proximal half (up to pectinate line) is part of hindgut so inferior mesenteric artery
- the rest of GI tract is supplied by internal iliac artery

52
Q

when do rectal varices form?

A

relation to portal hypertension

  • dilation of collateral veins between portal and systemic venous systems
53
Q

when do hemorrhoids form?

A

= are prolapses of the rectal venous plexuses

  • their development is not related to portal hypertension
  • raised pressure e.g. chronic constipation, straining, pregnancy
54
Q

what is ischioanal fossa?

A

space on either side of anal canal (between ischium & anal canal)

= it’s filled with fat & loose connective tissue allowing rectum & anal canal to expand into fatty area without effecting anything else important

55
Q

what is an infection of ischioanal fossa called?

A

ischioanal abscesses

56
Q

what can happen to ischioanal fossa if malnourished?

A

they can lose fatty pads in ischial, more prone to prolapse

57
Q

what is assessed in digital rectal examination?

A
  • “assess anal tone”: the effectiveness/strength of the external anal sphincter
  • in the male, palpate the prostate anteriorly
  • in the female, palpate the cervix
58
Q

what is proctoscopy?

A

viewing the interior of the rectum

59
Q

what is sigmoidoscopy?

A

viewing the interior of the sigmoid colon

60
Q

what is colonoscopy?

A

viewing the interior of the colon

GI (56 decks)

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