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GI- Week 4 & 5 > Anatomy of Faecal continence > Flashcards

Anatomy of Faecal continence Flashcards

1
Q

What are the anatomical requirements and innervation needed for faecal continence?

A
  1. A holding area- rectum
  2. Normal visceral afferent nerve fibres
  3. Functioning muscle sphincters
  4. Normal cerebral function
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2
Q

The pelvic cavity lies between the _ and _

A

Pelvic inlet and Pelvic floor

Rectum is found withiin the pelvic cavity

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3
Q

Openings in the pelvic floor allow structures to move from the pelvic cavity into the _

A

Perineum

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4
Q

The sigmoid colon becomes the rectum anterior to _, also known as the _ junction.

A

S3

Recto-sigmoid

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5
Q

Rectum becomes the anal canal anterior to the tip of the coccyx. T/F

A

True

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6
Q

The walls of the rectal _ can relax to accomodate faecal matter.

A

Ampulla

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7
Q

What are the pouches found in the rectum in males and females?

A

Males- Rectovesical pouch

Females- Rectouterine and vesicouterine pouch

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8
Q

What anterior structures are found to the inferior rectum

A

Males- Prostate gland

Females- Vagina and cervix

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9
Q

Which muscle forms most of the pelvic diaphragm?

Label the muscle parts.

A

Levator Ani muscle- forms most of the floor of the pelvis and the roof of the perinuem.

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10
Q

The levator ani muscle is tonically contracted. T/F?

The ani muscle reflexively contracts further with increase in intra-abdominal pressure. T/F?

The levator ani muscle must _ to allow defecation.

A

True

True

Relax

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11
Q

Puborectalis is a part of the Levator ani muscle. What is its signifance?

A

Skeletal muscle- Under voluntary control

Anorectal angle reduced when it contracts, acts as a sphincter

When the rectal ampulla is relaxed and filled with faeces, contraction of the Puborectalis maintains continence

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12
Q

What are the two types of anal sphincters?

A

Internal & external

Internal- smooth

External- skeletal

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13
Q

Main differences between the muscle of the two anal sphincters?

A

Internal

  • Smooth muscle
  • Superior 2/3rds of anal canal

​External

  • Skeletal muscle
  • Inferior 2/3rds of anal canal
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14
Q

Contraction in the Internal sphincter is stimulated and inhibited by the _ and _

Contraction in the external sphincter is stimulated by the _ nerve.

A

Internal = Contration stimulated by Sympathetics and inhibited by Parasympathetics

External = Contraction stimulated by the Pudendal nerve

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15
Q

The internal sphincter is contracted all the time and relaxes as a _ action, in response to distension of the rectal ampulla.

The external sphincter is _ contracted in response to rectal ampulla distension and internal sphincter relaxation.

A

Reflex

Voluntarily

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16
Q

What is the difference in nerve supply between the pelvis and the perinuem?

A
  1. Pelvis- Smpya, parasympa & Visceral afferent. Supplies body cavity.
  2. Perineum- Somatic & Motor sensory. Supplies body wall
17
Q

What are the two important levels from which the nerves innervate the rectum/anal canal?

A
  1. T12-L2
  2. S2-S4

S2,3,4 KEEPS YOUR GUT OFF THE FLOOR

18
Q

The Sympathetic nerve fibres which supply the _ anal sphincter, arise from which level of the Spinal cord?

A

T12-L2

19
Q

The parasympathetic nerve fibres supplying the internal anal sphincter arises from which spinal cord level? What is its effect?

A

S2-S4

Inhibits anal sphincter- Stimulates peristalsis

20
Q

The visceral afferent nerves run back to which level of the spinal cord?

A

S2-S4, Runs along parasympathetics

21
Q

Somatic motor sense from the pudendal nerve and the “nerve to levator ani” leave at which levels? What are their effects?

A
  1. S2-S4 and S3-S4 respectively

Effects- Contraction of external anal sphincter and puborectalis

22
Q

The pudendal nerve supplies which sphincter in the rectum?

A

External anal sphincter

23
Q

When can the pudendal nerve or the anal sphincter get damaged?

A

During labour- damage to pudendal nerve

Fibres of levator ani or external anal sphincter damage- Weakened muscle

24
Q

What is the significance of the Pectinate line?

A

The arterial, venous, lymphatic and nervous supply is very different above and below the Pectinate line-

The line is a junction between the part of the Embryo which formed the GI tract- Endoderm, and the part that formed the skin- Ectoderm

25
Q

Detail the supplies to the structures Above the pectinate line with regards to:

  1. Nerve supply
  2. Arterial supply
  3. Venous drainage
  4. Lymphatic drainage
A
  1. Autonomic- Sympa, para
  2. Inferior mesenteric artery
  3. To portal venous system via IMV
  4. Inferior mesenteric nodes
26
Q

Detail the supplies to the structures Below the pectinate line with regards to:

  1. Nerve supply
  2. Arterial supply
  3. Venous drainage
  4. Lymphatic drainage
A
  1. Pudendal
  2. Internal ilac
  3. Systemic venous system- via internal ilac vein
  4. Superficial Inguinal nodes
27
Q

Lymph vessels in the pelvis tend to run alongside the _

A

Arteries

28
Q

Which structures do the external and internal ilac lymph nodes drain?

A
  1. Internal- drains inferior pelvic structures
  2. External- drains lower limb+ superior pelvic structures
29
Q

Lymph from the internal and external ilac node drains into which node?

A

Common ilac

30
Q

The common ilac node then drains into which node?

A

Lumbar nodes

31
Q

The _ artery supplies the hindgut.

This hindgut extends to what part of the GI tract?

A

Inferior mesenteric

Proximal half of the anal canal

32
Q

Structures below the proximal half of the anal canal are supplied by which artery?

A

Internal ilac artery

A degree of anastamoses exists between the IMA and the IIA

Venous drainge- exact same as arterial supply, IMV above pectnate, IIV below

33
Q

Rectal varices occur as a result of _ hypertension

A

Portal

Dilation of collateral veins between portal and systemic venous systems

34
Q

What are haemorrhoids? What is the difference between rectal haemorrhoids and varices?

A

Haemorrhoids- prolapses of rectal venous plexuses, will cause swelling

Haemorroids are caused by raised pressure eg chronic constaption, pregnancy etc while Rectal varices are an effect of portal hypertension

35
Q

Identify the Iscioanal fossae.

They are filled with fat and loose _ tissue

What is their main function?

An infection in this region is called a _

A

Connective

Distension of the anal canal

Ischioanal Abscess

36
Q

What structure is found immeadiately superior to the Levator Ani muscle?

A

Rectal ampulla

37
Q

During PR examination the “anal tone” is assessed. What does this mean?

A

Anal tone- strenght of the External anal sphincter

38
Q

What structures are palpated for in males and females in PR exam?

A

Male- Prostate

Female- Cervix

GI- Week 4 & 5 (15 decks)

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