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GI > Clinical anatomy of faecal continence > Flashcards

Clinical anatomy of faecal continence Flashcards

1
Q

what are the functions of the rectum, anal canal and anus?

A

= to excrete stool

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2
Q

what is the holding area of stored faeces called before it is fefecated?

A

the rectum

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3
Q

what senses ‘fullness’ of the rectum?

what responds to the fullness?

A

= normal visceral afferents nerve fibres

Response
= functioning muscle sphincters around the distal end of the GI tract

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4
Q

what do the sphincters do to allow defeceation?

A

= to allow contraction, preventing defeceation and to relax allowing defeceation

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5
Q

what controls the appropriate time to defecate?

A

= normal cerebral function

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6
Q

what can all of the normal visceral afferent nerve fibres, normal cerebral function e.t.c be affected by?

A

neurological pathology

e.g. stroke, dementia, stroke, MS, trauma

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7
Q

how else can faecal continence be affected? (3)

A

1) by medications
2) by natural age related degeneration of nerve innervation of muscle
3) by consistency of stool

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8
Q

where dos the pelvic cavity lie?

A

= bony pelvis

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9
Q

what is the pelvic cavity continuous with?

A

abdominal cavity above

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10
Q

what does the pelvic cavity lie between?

A

= pelvic inlet and pelvic floor

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11
Q

what does the pelvic cavity contain?

A

= pelvic organs and supporting tissue

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12
Q

where is the rectum located?

A

= within pelvic cavity

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13
Q

what does openings in the pelvic floor permit?

A

= permits the distal parts of alimentary, renal and reproductive tracts to pass from pelvic cavity into the perineum

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14
Q

what must pass trough the pelvic floor?

A

= rectum/anal canal

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15
Q

when does the sigmoidal colon become rectum?

A

= anterior to S3

“recto-sigmoidal junctions:

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16
Q

when does the rectum become the anal canal?

A

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

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17
Q

describe the anus.

A

= distal end of the anal canal and is the orifice through with faeces pass

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18
Q

where is the rectum, anal canal and anus located?

A

Rectum
= pelvis

Anal canal and anus
= perineum

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19
Q

where does the rectal ampulla lie?

A

= immediately superior to elevator ani muscle

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20
Q

why do the rectal walls relax?

A

= two accommodate faecal material

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21
Q

why are functioning muscles and muscle sphincters required?

A

= to hold faeces in the ampulla until appropriate to defecate

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22
Q

what does the peritoneum cover?

A

= the superior rectum

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23
Q

where does the Rectouterine/rectovesical pouch lie?

A

= anterior to superior rectum

24
Q

describe the location of the rectum in male and female anatomy?

A

Male
= prostate gland lies anterior to inferior rectum

female
= the vagina and cervix lies anterior to inferior/middle rectum

25
Q

what do the levator ani muscles form?

A

= most of pelvic diaphragm together with fascial coverings

Forms

  • most of floor of pelvis
  • forms most of roof of perineum
26
Q

what is the levator ani muscles made up of?

A

= a number of smaller muscles

  • puborectalis
  • pubococygeus
  • iliococcygeus
27
Q

what sort of muscle is levator ani muscles?

A

= skeletal muscle

28
Q

what do levator ani muscles provide?

A

= continual support for the pelvis organs - tonically contracted most of the time

  • reflexively contracts further during increase in intra-abdominal pressure e.g. coughing or sneezing
  • the muscles relax to allow defecation (& urinnation) to occur
29
Q

what is the levator ani muscles supplied by?

A

= nerve to levator ani (a branch of the sacral plexus) & pudendal (S2, 3, 4)

30
Q

what does contraction of puborectalis result in?

A

= decreases anorectal angles, acting like a sphincter

31
Q

what is puborectalis controlled by?

A

= skeletal muscles; contraction is under voluntary control

32
Q

describe what happens when the rectal ampulla is relaxed and filled with faecees and then voluntary contraction occurs?

A

= voluntary contraction of this muscle will helps maintain continence

33
Q

describe the location of anal canal and anorectal junction.

A

anal canal is below the anorectal junction

34
Q

what are the 2 anal sphincters?

A

1 internal sphincter (smooth muscle)

  • superior 2/3rds of anal canal
  • contraction stimulated by sympathetic nerves
  • contraction is inhibited by parasympathetic nerves
  • contracted all the time, relaxes reflexively in response to distension of renal ampulla

1 external sphincter (skeletal muscle)

  • inferior 2/3rds of anal canal
  • contraction stimulated by pudenal nerves
  • voluntary contracted in response to renal ampulla distension and internal sphincter relaxation
35
Q

why is the nerve supply fundamental?

A

= fundamental to dividing which nerve fibre types are carrying out with function

36
Q

what are the structures in pelvis and perineum?

A

Pelvis;

  • body cavity
  • sympathetic, para-sympathetic and visceral afferents

Perineum

  • body wall
  • somatic motor and somatic sensory
37
Q

where does the sympathetic fibres run from?

A

T12-L2
- travels from inferior mesenteric ganglia - synapse- then travel via peri-arterial plexuses around branches of IMA

= contraction of internal anal sphincter
= inhibits peristalsis

38
Q

where do the parasympathetic fibres run from?

A

S2-S4
- via pelvic splanchnic nerves, synapse in walls of rectum

= inhibits internal anal sphincter
= stimulates peristalsis

39
Q

describe the visceral afferents and somatic motor?

A

Viceral afferents;
- back to S2-S4
= run with parasympathetics
= sense stretch, ischaemia

Somatic motor;
- from pudendal nerve (S2-S4) and nerve to elevator ani (S3-S4)
= contraction of external anal sphincter and puborectalis

40
Q

describe the pudendal nerve?

A

= branch of sacral plexus
- S2, S3, S4 anterior rami

= supplies external anal sphincter
= exits pelvis via greater sciatic foramen
= quickly enters perineum via lesser sciatic foramen
- branches to supply structure of perineum

41
Q

what does the tear of perineum result in?

A

= tear extends posteriorly to involve the external anal sphincter

42
Q

describe what happens during labour?

A

= branches of pudendal nerve could be stretched

  • fibres within the pubo-rectalis or external anal sphincter muscle could be torn
  • results in weakened muscle and lead to faecal in-continence
43
Q

what line is the anal Canal on?

A

= pectinate line
- marks the junction between part of embryo which formed the GI tract (endoderm) and part that formed the skin (endoderm)

44
Q

True or False.

Arterial supply, venous drainage, lymphatic drainage and nerve supply differ above and below pectinate line.

A

True

Superior to line = visceral
Inferior to line = pariettal

45
Q

what is above the pectinate line?

A

Nerve supply = autonomic

Arterial supply = from inferior mesenteric artery

Venous drainage = to hepatic portal system

Lymphatic drainage = inferior mesenteric nodes

46
Q

what is below the pectinate line?

A

Nerve supply = somatic and pudendal

Arterial supply = from internal iliac artery

Venous drainage = to systemic venous system

Lymphatic drainage = superficial inguinal nodes

47
Q

what are the 4 main groups of lymph nodes gaining the pelvic organs?

A

1) Internal iliac (draining inferior pelvic structures)
2) External iliac (draining lower limb, and more superior pelvic structures)
3) Common iliac (drain the lymph from the external and internal iliac nodes)
4) Lymph draining through the common iliac nodes then drains to the lumbar nodes

48
Q

what does the inferior mesenteric artery supply and what is the remainder of GI tract supplied by?

A

= the hindgut organs
- hindgut extends to proximal half of the anal canal (the pectinate line)

Remainder;
= supplied by internal iliac artery
- there is a degree of anastomoses between these vessels

49
Q

what drains the hindgut organs?

A

= inferior mesenteric veins

  • above pectinate line
  • portal venous system
50
Q

what vein drains below the pectinate line? (systemic venous system)

A

= internal iliac vein

51
Q

when do rectal varices from?

A

= in relation to porttal hypertension

  • distension of collateral veins between portal and systemic venous system
52
Q

what are haemorrhoids?

A

= prolapses of rectal venous plexuses
- their development is NOT related to portal hypertension

  • i.e. raised pressure e.g. chronic constipation, straining, pregnancy
53
Q

where does the ischioanal fossa lie?

A

= on each side of anal canal

54
Q

what is the ischioanal fossa filled with?

A

= fat and loose connective tissue

55
Q

how do the two ischioanal fossa communicate with each other?

A

= posteriorly

56
Q

what is an infection within the ischioanal fossa called?

A

= ischioanal abscess

57
Q

what is proctoscopy, sigmoidoscopy and colonoscopy?

A

Proctoscopy
= viewing interior of rectum

Sigmoidoscopy
= viewing interior of sigmoid colon

Colonoscopy
= viewing the interior of colon

GI (43 decks)

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