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First Year > 9G. Anatomy of faecal continence > Flashcards

9G. Anatomy of faecal continence Flashcards

1
Q

what makes up the large intestine

A

caecum, appendix, colon (ascending, transverse, descending and sigmoid)

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2
Q

which is more superior to the other in terms of flexures

A

splenic flexure lies more superiorly than the hepatic flexure

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3
Q

what is the name of the longitudinal bands of thickened smooth muscle running from caecum to distal end of sigmoid colon

A

teniae coli

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4
Q

what is formed by tonic contraction of the teniae coli

A

haustra

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5
Q

what if you can see air in the ascending colon in the X ray

A

that is normal

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6
Q

what is used as contrast in imaging the GI system

A

Barium

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7
Q

how many paracolic gutters are there and name them

A

2 and they are Left and right

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8
Q

where are the paracolic gutters

A

between the lateral edge of ascending and descending colon, and abdominal wall

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9
Q

is the paracolic gutters part of the greater sac or the lesser sac

A

greater

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10
Q

what are the paracolic gutters susceptible to

A

collecting blood/pus

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11
Q

what 4 things do you need to control excretion of faeces and why

A
  1. holding area - rectum
  2. visceral afferent nerve fibres-to sense fullness of rectum
  3. functioning muscle sphincters-to contract and relax
    4.cerebrum- to control the appropriate time to defecate
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12
Q

faecal continence is affected by what

A

medications, natural age related degeneration of nerve innervation of muscle

neural pathology - stroke, MS, Dementia, trauma (childbirth, spinal cord injury)

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13
Q

where is the pelvic cavity

A

within bony pelvis
between pelvic inlet and pelvic floor

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14
Q

what part of the GI system is located withing the pelvic cavity

A

rectum

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15
Q

what is the scienctific name for the pelvic floor

A

levator ani muscle

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16
Q

what gets let through the pelvic floor

A

openings in pelvic floor allow
uterus, neck of bladder and alimentary to pass from the pelvic cavity into the perineum

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17
Q

what is levator ani muscle

A

pelvic floor

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18
Q

when does the sigmoid colon become the rectum (and what’s its name)

A

anterior to S3
the rectosigmoid junction

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19
Q

when does the rectum become anal canal

A

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

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20
Q

what is the distal end of anal canal called

A

anus

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21
Q

so where is the rectum/anal canal/anus in terms of perineum/pelvis

A

rectum is in pelvis and anal canal and anus are perineum

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22
Q

what lies immediately superior to the levator ani muscle

A

rectal ampulla

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23
Q

what is the rectal ampulla

A

The rectal ampulla is the dilated (wider) section of the rectum, located just above the anal canal. (its walls can relax)

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24
Q

what keeps the faeces in the ampulla

A

functioning muscles and muscle sphincters

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25
what covers the superior rectum
peritoneum
26
what is the pouch called that lies anterior to the superior rectum in men
rectovesicle pouch
27
what is the pouch called that lies anterior to the superior rectum in women
rectouterine pouch
28
what is the pouch called that lies between the bladder and uterus
vesicouterine pouch
29
what lies anterior to the inferior rectum
in men its prostate gland in women its vagina and cervix
30
what do the levator ani muscles do (forms)
forms most of pelvic floor and roof of perineum forms most of pelvic diaphragm - together with fascial coverings
31
what kind of muscle is levator ani muscles
skeletal
32
what are the names of the smaller muscles making up the levator ani muscle
iliococcygeus pubocoocygeus puborectalis
33
are the levator ani muscles relaxed or contracted most of the time
contracted
34
when do the levator ani muscles contract further
due to an increase in intra-abdominal pressure like coughing or sneezing
35
when do the levator ani muscles relax
defecation and urination
36
the 'nerve to levator ani' is a branch of what
sacral plexus
37
what nerves supplies levator ani muscles
the 'nerve to levator ani' and Pudendal (S2,3,4)
38
is skeletal muscle voluntary or involuntary
voluntary
39
which muscle decreases the anorectal angle when it contracts
puborectalis
40
when the puborectalis contracts what happens
decreases the anorectal angle and acts as a sphincter
41
how many sphincters in anal canal
2
42
describe the 2 sphincters of anal canal
1 is internal - smooth muscle 1 is external - skeletal muscle
43
where is the anal canal (what is it below)
ano-rectal junction
44
contraction of the internal anal sphincter is stimulated by what nerves
sympathetic
45
contraction of internal anal sphincter is inhibited by what nerves
parasympathetic
46
contraction of external anal sphincter is stimulated by what nerve
pudendal nerve
47
what nerves if the structure is in the pelvis and is body cavity
sympathetic, parasympathetic and visceral afferent
48
what nerves if the structure is in perineum and body wall
somatic motor and somatic sensory
49
what is the route of sympathetic fibres to inhibit peristalsis and contract anal sphincter internal
T12-L2 release sympathetic fibres - travels to inferior mesenteric artery annd synapse - travel along the periarterial pexuses around the IMA
50
what is the course for parasympathetic nerve fibres to stimulate peristalsis and relax anal internal sphincter
from S2 to S4 via pelvic spanchnic nerves to the walls in rectum
51
what nerve supplies the external anal sphincter
pudendal nerve
52
what rami is the pudendal nerve on
S2 S3 S4 ANTERIOR
53
where does the pudendal nerve exit in the pelvis
the greater sciatic foramen
54
where does the pudendal nerve enter in the perineum
the lesser sciatic foramen
55
when do you get pudendal or sphincter damage
during labour
56
why is there pudendal nerve damage or sphincter damage during labour
branches of pudendal nerve could be stretched fibres within the puborectalis or external anal sphincter muscle could be torn leading to weakened muscle this could result in faecal incontinence
57
what is the pectinate line
marks the junction between the part of the embryo which formed the GI tract (endoderm) and the part that formed the skin (ectoderm) Arterial supply, venous drainage, lymphatic drainage and nerve supply differ above and below pectinate line Superior to line = visceral Inferior to line = parietal
58
what is the line called which marks the junction between the part of the embryo which formed the GI tract (endoderm) and the part that formed the skin (ectoderm) and tells you that the arterial supply, venous drainage and lymphatic drainage differs above or below it
pecinate
59
Arterial supply, venous drainage, lymphatic drainage and nerve supply differ above and below pectinate line. which is Superior which is inferior to the line
superior to the line is visceral and inferior to the line is parietal
60
describe the vessels above the pectinate line
nerve - autonomic arterial- inferior mesenteric venous drainage - portal veinous system lymphatic - inferior mesenteric nodes
61
describe the vessels below the pectinate line
nerve - somatic, pudendal arterial - internal iliac venous - systemic venous system lymph - superficial inguinal nodes
62
name the 2 blood vessels suppling the rectum and anal canal
1. Inferior mesenteric artery a. Supplies HINDGUT organs i. Only extends as far as proximal half of anal canal so only above pectinate line 2. Internal iliac artery a. Everything else
63
what arteries branch from the internal iliac artery
middle and inferior rectal artery
64
describe the venous drainage from rectum and anal canal
the inferior mesenteric artery drains the hindgut organs that are above the pectinate line and part of the portal venous system the internal iliac vein drains below pectinate line and is part of the systemic venous system
65
where does the superior rectal vein drain into
inferior mesenteric vein
66
where do the middle and inferior rectal vein drain into
internal iliac vein
67
are rectal varices and haemorrhoids the same thing
no!
68
why do rectal varices form
portal hypertension
69
what are rectal varices
dilation of collateral veins between portal and systemic venous systems
70
what are haemorrhoids
prolapses of the rectal venous plexus - not related to portal hypertension due to raised pressure e.g. cronic constipation, straining, pregnancy
71
where can you find the ischioanal fossae
either side of the anal canal
72
how do the two ischioanal communicate
posteriorly
73
what is the ischioanal fossae filled with
fat and loose connective tissue
74
what happens if you get an infection in the ischioanal fossae
ischioanal abscess
75
whats the fossae that can get abscesses that lies either side of anal canal
ischioanal fossae
76
whats the exam for viewing the interior of the colon
colonoscopy
77
whats the exam for viewing the interior of the sigmoid colon
Sigmoidoscopy
78
whats the exam for viewing the interior of the rectum
proctoscopy
79

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