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OS 206 1ST EXAM > Colon, Rectum, Anus > Flashcards

Colon, Rectum, Anus Flashcards

1
Q

Parts of the Large Intestine

A

Cecum, appendix, colon (A, T, D, S), Rectum, Anus

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2
Q

Movement of the colon

A

Gastrocolic reflex

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3
Q

What gives you the urge to defecate?

A

Stretching or distention (stimulus) of the segments of the rectum

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4
Q

An exaggerated gastrocolic response wherein a person defecates right after eating

A

irritable bowel syndrome

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5
Q

The act of expelling wastes from the digestive tract

A

Defecation

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6
Q

the gas from stool due to what?

A

flatus due to sulfur containing compounds

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7
Q

Derivatives of the foregut

A

stomach to middle duodenum, liver, pancreas, spleen

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8
Q

derivatives of the midgut

A

middle duodenum to left colic flexure

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9
Q

derivatives of the hindgut

A

left colic flexure to rectum

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10
Q

axis during gut rotation and vascularization: foregut

A

celiac trunk

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11
Q

axis during gut rotation and vascularization: midgut

A

superior mesenteric artery

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12
Q

axis during gut rotation and vascularization: hindgut

A

inferior mesenteric artery

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13
Q

Pain localization: foregut

A

epigastric

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14
Q

pain localization: midgut

A

periumbilical region

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15
Q

pain localization: hindgut

A

hypogastric region

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16
Q

T/F Large intestine is about 1/5 the length of the SI

A

True. it is around 5 feet long

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17
Q

How many liters of chyme enter the cecum each day

A

1L

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18
Q

how much chyme is excreted in the feces?

A

100cc about 1/10 water

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19
Q

is the semi-liquid acid mass formed when food passes from the stomach to the small intestine

A

chyme

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20
Q

Absorption of water and electrolytes happen where and what are its parts

A

right colon: from ascending colon to midpoint of transverse

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21
Q

Propulsion and storage of unabsorbed fecal water for evacuation and what are its parts

A

Left colon: from midpt of transverse colon to the sigmoid colon

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22
Q

Right colon is derived from

A

midgut

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23
Q

left colon is derived from

A

hindgut

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24
Q

right colon has a _____ wall than left colon

A

thinner

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25
Q

Right colon has _____ lumen than left colon

A

Larger

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26
Q

Right colon has more or less fluid than left colon?

A

More

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27
Q

Thickened bands of smooth muscle

A

Teaniae coli

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28
Q

Longitudinal layer of the colon

A

teaniae coli

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29
Q

Teaniae coli: complete or incomplete

A

complete

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30
Q

Three bands of the teaniae coli

A

mesocolic: transverse and sigmoid
omental: appendices epiploicae
free: no attachment

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31
Q

outpouchings of the colon

A

haustra

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32
Q

in between teaniae coli

A

haustra

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33
Q

why are haustra formed?

A

teaniae coli are shorter than the intestines

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34
Q

Distinguish the colon from the small intestine in an xray or endoscope

A

plicae circulares (reaches the whole circumference of the SI) unlike haustrae

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35
Q

small fatty like omentum-like projectiuons distributed near the area of teaniae coli along the wall of colon

A

epiploic appendages

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36
Q

Functions of epiploic appendages

A

protect and cushion the colon
blood depository during colonic vessel contraction
fat storage role in absorption and immune response
seal perforations

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37
Q

cecum is located where

A

RLQ

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38
Q

widest part of the colon

A

cecum

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39
Q

blind intestinal pouch

A

cecum

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40
Q

has no mesentery but almost all covered by peritoneum

A

cecum

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41
Q

two openings of the cecum

A

ileocecal valve

opening of the appendix

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42
Q

not a real valve but prevents reflex of contents into the ileum

A

ileocecal valve

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43
Q

Gut associated lymphoid tissue (GALT) in the embryo but turns vestigial

A

appendix

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44
Q

location of appendix

A

RLQ

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45
Q

blind intestinal diverticulum that contains masses of lymphoid tissue

A

appendix

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46
Q

appendix is suspended by

A

mesoappendix

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47
Q

Most common surgical emergency

A

appendectomy

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48
Q

Good morning appendix

A

appendix that just pops out upon opening the peritoneum

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49
Q

Cute appendix

A

appendix is normal but should still be removed

50
Q

Position of the appendix

A

retrocecal 64% of the time
retroileal
pelvic

51
Q

location of appendix via a diagonal incision

A

McBurney’s point

52
Q

McBurney’s point

A

1/3 of the way along oblique line joining the right ASIS to the umbilicus

53
Q

now, how to find appendix?

A

pt of maximal tenderness

54
Q

Vasculature of cecum

A

ileocolic artery (terminal branch of SMA)

55
Q

vasculature of appendix

A

appendicular artery

56
Q

causes of appendicitis

A

obstruction of the lumen of the appendix -> intraluminal pressure -> venous congestion -> inflammation

57
Q

Referred pain of appendicitis

A

initially starts inRUQ or in epigastric region then localizes to RLQ

58
Q

Natural reflex of pain

A

guarding behavior and abdominal rigidity

59
Q

Diagnostics of appendicitis

A 
Psoas sign (hip extension)
Obturator sign (hip flexion and internal rotation, coughing)
Rovsing's sign (pain in RLQ when pressure is applied in LLQ)
Rebound ternderness (more pain felt when pressure in released in RLQ)
60
Q

2nd part of the intestine

A

ascending colon

61
Q

ascending colon is intraperitoneal T/F

A

False. It is retroperitoneal

62
Q

T/F ascending colon has no mesentery

A

True but peritoneum covers anterior and lateral with areolar tissue posteriorly

63
Q

Longest and most mobile part of the colon

A

transverse

64
Q

T/F transverse is completely covered by the peritoneum

65
Q

transverse colon: intra or retroperi

A

Intraperitoneal

66
Q

Mesentery of the transverse colon

A

transverse mesocolon

67
Q

Serves as the natural barrier for reciprocal infection

A

Transverse Mesocolon

68
Q

Arterial anastomosis: transverse colon

A

marginal artery of Drummond

69
Q

T/F IMA and SMA can be cut and bowels will still survive

A

True but SMA supplies the intestine and SI will not survive

70
Q

descending colon: intra or retroperi

71
Q

Mainly immobile part of the colon

A

descending, no mesentery

72
Q

Sigmoid colon: intra or retroperi

A

Intraperitoneal

73
Q

Most prone part of colon to twisting

A

sigmoid colon

74
Q

site at which the sigmoid colon becomes the rectum

A

rectosigmoid junction

75
Q

Rectosigmoid jxn: with peritoneum?

A

No peritoneym, true mesentery

76
Q

Where does the 3 taeniae coli converge?

A

Sigmoid colon

77
Q

Twisting of the colon on itself or on the mesenteric tissue causing obstruction

78
Q

one section of the bowel tunnels into an adjoining section

A

small bowel and colonic intussusception

79
Q

cecum goes inside the ascending colon

A

colocolic intussusceptions

80
Q 
The anastomosis of
ileocolic 
right colic
middle colic
left colic
sigmoidal arteries 
around the internal margin of the cecum and colon
A

Marginal artery of Drummond

81
Q

connects IMA to middle colic

A

Meandering Mesenteric Artery (Arc of Rolan)

82
Q

Arterial arcade in colon

A

between ascending and descending colon

83
Q

imptance of the arcade in the colon

A

colon will survive even if a section of the colon is removed

84
Q

Venous supply of colon

A

follow arteries except IMV (more superior)

goes to portal circulation! not systemic

85
Q

Suspensory ligament that connects the duodenum to the diaphragm

A

Ligament of Treitz

86
Q

T/F colon will have both sytematic and portal circulation

87
Q

Lymphatic Drainage of Intestines

A

entire colon and proximal 2/3 of the rectum: paraaortic LN to cisterna chylii
remaining rectum and anus: same or drain to the internal iliac and superficial inguinal nodes

88
Q

Innervation of the large intestine

A

Sympathetic:
SM plexus, IM plexus and the hypogastric plexus inhibit colonic motility

Parasympathetic:
Vagus nerve, sacral nerve, preganlionic fibers (motility)

Colonic wall intrinsic plexus:
aka myenteric/auerbach’s/submucous/meissner’s (major control of motility)

89
Q

Anatomically starts at the S3 vertebral body

90
Q

Surgically starts at the sacral promontory

91
Q

Perforation in which region of the rectum will be safer?

A

Posterior region because material can be drained extraperitoneally. Anterior region will cause fecal matter to enter peritoneum

92
Q

Rectum is intra or retroperitoneal?

A

EXTRAperitoneal with fascia propria

93
Q

Sphincters of the rectum

A

Internal - superior 2/3 of rectum

External - inferior 1/3

94
Q

Internal sphincter is controlled by

A

autonomic nervous system

95
Q

The 3 U shaped loops of the external sphincter

A

puborectalis - top loop/ deep
superficial anal sphincter - intermediate loop
subcutaneous portion - base loop

96
Q

External sphincter controlled by

A

pudendal nerve (somatic innervation)

97
Q

Arterial supply of the rectum

A

superior rectal
middle and inferior rectal
middle sacral

98
Q

Venous drainage of the rectum

A

superior rectal vein

inferior rectal vein

99
Q

3 lateral curves of the rectum

A

Valves of Houston

100
Q

point of anterior peritoneal reflection

A

middle rectal valve (valves of houston)

101
Q

dilated terminal portion of the rectum?

significance?

A

ampulla of the rectum

neonates are ale to hold their fecal matter up to two weeks

102
Q

Fasciae of the rectum

A

Presacral (waldeyer’s) fascia
Rectovesical: denonvillier’s fascia (males)
lateral ligament: middle rectal vessels
Rectal fascia proper: rectum n mesorectum

103
Q

surrounds posterior 1/2 or more of the rectum, enveloped by thin fibrous covering(which is?)

A

Mesorectum

Fascia Propria

104
Q

important oncologic barrier to primary and lymphatic spread to extrarectal pelvic tissues

A

mesorectum

105
Q

Anatomically from dentate line to anal verge

106
Q

Surgically: terminal protion of large bowel that passes through levator ani and opens to the anal verge 4cm in length

107
Q

Formed via teh anteriorly directed pull of the purorectalis muscle; usually acute

A

Anorectal angle

108
Q

anorectal angle

A

mean angle: 102 degrees
sitting: 119
sphincter squeeze: 81

109
Q

flap valve effect

A

puborectalis pulls rectum anteriorly during squeeze, increasing intraabdominal pressure

110
Q

most important element to maintain fecal continence

A

puborectalis muscle

111
Q

Venous drainage of anus

A

via portal and systemic circulation

112
Q

Nerve supply to anorectal region

A

Somatic innervation: (PuInPer)
pudendal nerve
inferior rectal n: sensory and motor
perineal n: sensory and motor to perineal region

Autonomic innervation:
sympathetics from thoracolumbar via hypogastric plexus and nerve
Parasympathetic from S2-S4

113
Q

Rectal cancer operation may lead to what ?

A

dennervation in pelvic area, bladder dysfunction, sexual dysfunction

114
Q

When these are occluded, secondary infection may occur

A

Columns of Morgagni

115
Q

between the columns of morgagni are

A

anal glands

116
Q

differentiates external from internal hemorrhoids

A

pectinate line

above: internal
below: external

117
Q

3 consistently placed submucosal vascular plexuses formed by anastomosis of rectal veins within anal canals

A

anal cushions

118
Q

Differentiate internal and external hemorrhoids

A

internal painless and drain to portal circ.

external painful and drain to IVC

119
Q

I-IV Grading o fPiles

A

Grade

1: hardly seen
2: bulgen then disappears
3: visible bulges can be pushed inside
4: cannot be pushed inside

120
Q

types of hemorrhoids

A

Internal, external, mixed

121
Q

usual position of internal hemorrhoids

A

left lateral, right anterior, right posterior

OS 206 1ST EXAM (6 decks)

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