Anal canal Flashcards

1
Q

Where does the anal canal run from and to

A

From the rectal ampulla to the anus

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2
Q

What does the anal canal run between (Anteroposteriorly)

A

Anococcygeal ligament (posterior) and the perineal body (anterior)

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3
Q

What is the anal canal located within

A

The anal triangle of the perineum

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4
Q

Length of the anal canal

A

4cm

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5
Q

What direction does the anal canal follow

A

Posteroinferior

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6
Q

What surrounds the anal canal and what is there function

A

Internal and external anal sphincters

They maintain faecal continence

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7
Q

Which anal sphincters are voluntary and involuntary muscle

A

External is voluntary

Internal is involuntary

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8
Q

Where is the internal anal sphincter

A

Surrounds the upper 2/3 of the anal canal

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9
Q

Where is the external anal sphincter

A

Surrounds the lower 2/3 of the anal canal

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10
Q

What does the external anal sphincter blend with

A

Puborectalis muscle

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11
Q

What must occur to allow defecation

A

Relaxation of both anal sphincters

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12
Q

What is at the anorectal junction

A

Anorectal ring (muscular ring formed by fusion of the internal anal sphincter, external anal sphincter and puborectalis muscle)

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13
Q

What are anal canals

A

Series of longitudinal ridges in the superior aspect of the mucous membrane

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14
Q

What do anal columns contain

A

Terminal branches of the superior rectal vessels

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15
Q

What joins the anal columns inferiorly

A

Anal valves

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16
Q

What’s superior to the anal valves and what do they contain

A

Anal sinuses which contain glands that secrete mucus

17
Q

When do anal sinuses secrete mucus

A

When compressed by faeces to aid defecation

18
Q

What do the anal valves form

A

The pectinate line

19
Q

Embryological origin above and below the pectinate line

A

Above - hindgut

Below - ectoderm of the proctodeum

20
Q

Epithelial lining above and below the pectinate line

A

Above - columnar

Below - non keratinised stratified squamous which transitions to keratinised (I.e skin) at the inter-sphincteric groove

21
Q

How does the anal canal superior to the pectinate line differ from the anal canal inferior to the pectinate line

A

Blood supply
Innervation
Lymphatic drainage
Embryological origin

22
Q

Arterial supply above the pectinate line

A

Aorta -> IMA -> Superior rectal artery

23
Q

Arterial supply below the pectinate line

A

Aorta -> common iliac -> internal iliac -> internal pudendal -> inferior rectal artery

24
Q

What other artery contributes to supply of the anal canal

A

Middle rectal arteries anastomose with the superior and inferior rectal arteries

25
Q

Venous drainage above and below the pectinate line

A

Above - superior rectal vein which drains into the IMV

Below - inferior rectal vein which drains into the internal pudendal vein

26
Q

Innervation above and below the pectinate line

A

Above (visceral) - inferior hypogastric plexus

Below (somatic) - inferior anal nerves which are branches of the pudendal nerve

27
Q

Where is pain above the pectinate line referred to

A

S2-4 dermatomes

28
Q

What is the anal canal sensitive to above and below the pectinate line

A

Above - stretch

Below - pain, touch, temperature and pressure

29
Q

What does lymph drain into from above and below the pectinate line

A

Above - internal iliac lymph nodes

Below - superficial inguinal lymph nodes

30
Q

What are haemorrhoids

A

Vascular cushions found within the anal canal which help with the maintenance of faecal continence

31
Q

What are pathological haemorrhoids

A

Swollen or distended haemorrhoids

32
Q

Who are pathological haemorrhoids seen in

A

People who suffer from:
Constipation
Prolonged straining when defecating
Raised intra-abdominal pressure (pregnancy, ascites)

33
Q

Consequences of pathological haemorrhoids

A

Bleeding and pain on defecation