Anatomy of the Distal GI Tract Flashcards

1
Q

What are the components of the distal GI tract

A
  • Colon - Caecum, appendix, ascending, transvers and descending colon
  • Rectum
  • Anal canal
  • Anus
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2
Q

Whats the anatomy of Faecal continene

A

Control of the excretion of faeces- complex

  • Needs holding area (rectum) to store faeces until appropriate do defecate
  • Normal visceral affarents nerve fibres to sense the fullness of the rectum
  • Functioning muscle sphincters - around the distal end of the GI tract to respond to the fullness
  • To contract preventing defecation and relax allowing defecation
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3
Q

What can affect faecal continence

A
  • Neurological pathology - dementia, stroke, MS, trauma
  • Medications
  • Natural age-related degeneration of nerves innervation of muscle
  • Consistency of stool
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4
Q

Describe the anatomy of the pelvic cavity

A
  • Lies within the bony pelvis
  • Continues with the abdominal cavity
  • Lies between the pelvic inlet (superior aspect) and pelvic floor
  • Contains pelvic organs and supporting tissues
  • Rectum - located within the pelvic cavity
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5
Q

Which muscle formes the pelvic floor

A

Levator ani

Separates the pelvic cavity from the perineum

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6
Q

Whats the significant of openings in the pelvic floor

A

Permits the distal parts of alimentary, anal and reproductive tracts to pass from the pelvic cavity into the perineum

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7
Q

At what level does the sigmoid colon become the rectum

A

S3 - Recto-sigmoid junction

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8
Q

When does the rectum become the anal canal

A

Anterior to tip of coccyx -just after passing through levator ani muscle

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9
Q

What are locations of the rectum anal canal

A
  • Anus is the distal end of the anal canal both- perineum
  • Rectum - pelvis
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10
Q

What is the rectal ampulla and whats its anatomy

A
  • Lies immediately superior to the levator ani muscle
  • Walls relax to accommodate faecal material
  • contains functioning muscle and sphincters to hold faeces in the ampulla until appropriate to defecate
  • Function: Stores faeces
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11
Q

Describe the anatomical relations of the rectum

A
  • Rectouterine/rectovesical pouch lies anterior to the superior rectum
  • Males - the prostate gland lies anterior to the inferior rectum
  • females - the vagina and cervix lies anterior to the inferior/middle rectum
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12
Q

What is the superior rectum covered by

A

Peritoneum

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13
Q

Describe the anatomy to the Levator ani muscle

A
  • Forms most of the pelvic diaphragm along with Fascial covering
  • Made up of a number of smaller muscles -> Puboccygeus, puborectalis and illeococcygeus
  • Forms most of the pelvis floor and most of the peritoneum roof
  • Skeletal muscle
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14
Q

What are the functions of the levator ani muscle

A
  • support for pelvic organs - most of the time tonically contracted
  • Reflexively contracts further during increased intra-abdominal pressure - e.g coughing, Sneezing
  • Relaxes during - urination and defecation
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15
Q

What is the nerve innervation of the Levator ani

A

‘nerve to levator ani’

  • Branch of the sacral plexus and pudendal S2,3,4
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16
Q

Describe the anatomy of the Puborectalis muscle

A
  • Part of levator ani
  • function: maintaining faecal continence
  • Contraction decreases the Anorectal angle - acting like a sphincter
  • Skeletal muscle - controle
  • When the rectal ampulla is relax and filled with faeces this muscle will help to maintain continence
17
Q

What is the anorectal angle

A
18
Q

Describe the anatomy of the anal canal and anal sphincter

A
  • Anal canal is below the anorectal junction

Two anal sphincters

  • 1 internal sphincter - Smooth muscle
  • 1 external sphincter - Skeletal muscle
19
Q

Describe the anatomy of the internal anal sphincter

A
  • Smooth muscle
  • Forms superior 2/3rd of anal canal
  • Contraction -> sympathetic nerves
  • Contraction inhibited -> parasympathetic nerves
  • Contracted all the time will only relax reflexively in responce to destension of the rectal ampulla
20
Q

Describe the External anal sphincter

A
  • Skeletal muscle
  • Inferior 2/3 of the anal canal - superior part of sphincter is continous with puborectalis muscle
  • Contraction- sitmulated by pudendal nerve
  • Voluntarliy contracted (along with puborectalis) in responce to rectal ampulla distension and internal sphincter relaxation
21
Q

What are the two important spinal cord levels

A

T12-L2 and S2-S4

22
Q

What types of fibres are carried within the S2-S4 nerves

A
  1. Visceral afferents back to S2-S4 - Run with parasympathetics
    * Function: sense Stretch, ischaemia ​​
  2. Parasympathetic fibres from S2-S4 - Via pelvic spkanchic nerves, Synapse in walls of rectum
    * Function: inhibit internal anal sphincter and sitmulate peristalsis
  3. Somatic motor form pundendal nerve and nerve to levator ani
    * Function: Contraction of external anal sphincter and puborectalis
23
Q

What type of nerve fibres are carried within the T12-L2

A
  1. Sympathetic fibres- Travel to inferior mesenteric ganglia - synapse then travel via periarterial plexus around branches of IMA
    * Function: contraction of internal anal sphincter and inhibit peristalsis
24
Q

Whats the nerve supply to the external sphincter

A

pundendal nerve

25
Q

Describe the pundendal nerve

A
  • Branch of the sacral plexus
  • S2, S3, S4, Rami
  • Supplies external anal sphincter
  • Exits pelvis via -> Greater sciatic foramen
  • Enters perineum via -> Lesser sciatic foramen
  • branches to supply structures of perineum
26
Q

What happens when there is pundenal nerve or sphincter damage

A

During labour

  • Branches of pundendal nerve could be stretched
  • Fibres within puborectalis or external anal sphincter muscle could be torn
  • Result -> weakness of muacle and faecal incontinence
27
Q

What is the pectinate line in the anal canal

A
  • Marks the junction between the part of the embryo which formed the GI tract (endoderm) and the part which formed the skin (ectoderm)
  • Aterial supply, venous drainage, neve suppy and lympathetics all differ above and below the pectinate line
  • Superior to line -> visceral
  • Interior to line -> Parietal
28
Q

What are the differences above the pectinate line and below it

A
29
Q

Describe the lymphatics of the pelvis

A
  • internal illiac nodes - inferior pelvic structures
  • External iliac nodes - lower limbs and more superior structures
  • Common iliac nodes - drains from internal and external iliac nodes
  • Common illiac then drains into lumbar nodes
30
Q

What is the blood supply to the rectum and anal canal

A
  • The inferior mesenteric artery - supplies hindgut (all the way to petinate line)
  • The remainder of the GI Tract = Internal iliac artery
  • There is some degree of anastomoses between these vessels
31
Q

What is the venous drainage from the anal canal and the rectum

A
  • Inferior mesenteric vein - Hingut - above pectinate line into the portal venous system
  • The internal illac vein - drains below the pectinate line - into the systemic venous system
32
Q

Whats the difference between rectal varices and haemorrhoids

A
  1. Varices -
  • form due to Dillation of collateral veins between portal and systemic venous system
  • Portal hypertension
  1. Haemorrhoids
  • Prolapses of rectal venous plexus- not due to Porta hypertension
  • Raised pressure - chronic constipation, straning and pregnancy
33
Q

What is the Ischioanal Fossae

A
  • Right and left fossae that lie each side of the anal canal
  • Filled with fat and loose connective tissue
  • The two fossae communicate with each other posteriorly
  • Infection in fossa - Ischioanal abcess
34
Q

What is the PR exam use for

A

To asses anal tone, the effectiveness/ Strenght of the external sphincter

  • Female: palpate cervix anteriorly
  • Males: palplate the prostate anteriorly
35
Q

What are the different types of endoscopies for the distal GI tract

A
  • Proctoscopy - rectum
  • Sigmoidoscopy - sigmoid colon
  • Colonoscopy - colon