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Metabolism CC > Defecation + Anal Anatomy > Flashcards

Defecation + Anal Anatomy Flashcards

1
Q

Primitive Gut tube

A

Derived from dorsal part of yolk sac

4th week

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2
Q

Endoderm

A 
Forms the inner lining of organs
Lung cells (alveolar cells), thyroid cells, digestive cells
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3
Q

Mesoderm

A

Develops into organs- cardiac muscle cells, skeletal muscle cells, tubule cells of kidney, RBCs, smooth muscle cells in gut

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4
Q

Ectoderm

A

Forms exoskeleton- skin cells of epidermis, neurones on brain, pigment cells

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5
Q

Foregut

A 
Oesophagus
Stomach
Liver
Gallbladder
Bile duct
Pancreas
Proximal duodenum
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6
Q

Midgut

A 
Distal duodenum
Jejunum
Ileum
Cecum
Appendix
Ascending colon
Proximal 2/3 of transverse colon
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7
Q

Hindgut

A

Distal 1/3 of transverse colon
Descending colon
Sigmoid colon
Upper anal canal

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8
Q

Foregut blood supply

A

Coeliac artery

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9
Q

Midgut blood supply

A

Superior mesenteric artery

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10
Q

Hindgut blood supply

A

Inferior mesenteric artery

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11
Q

Tracheoesophageal septum

A

Divides foregut into oesophagus and trachea

Failure to develop results in tracheoesophageal fistula (TEF) and or oesophageal atresia

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12
Q

Duodenal atresia

A

Due to failed canalization

Midgut

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13
Q

Meckel’s diverticulum

A

Midgut

occurs when remnant of yolk sac (Vitelline duct) persists

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14
Q

Malrotation

A

If midgut doesn’t complete rotation prior to returning to abdomen

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15
Q

Cranial end of hindgut

A

Distal 1/3 transverse colon, descending colon + sigmoid colon

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16
Q

Terminal end of hindgut

A

Upper anal canal

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17
Q

7th week hindgut

A

Urorectal septum fuses with Cloacal membrane

–> give rise to anal + urogenital membrane

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18
Q

When does anal membrane rupture

A

8th week

–> communication between anal canal + amniotic fluid

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19
Q

Most anorectal malformations

A

Linked to failure of urorectal septum to close the cloaca

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20
Q

Imperforate anus

A

Caused by failure of rupture of anal membrane

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21
Q

Enteric nervous system

A

Intrinsic NS of gut

Derived from 2 populations of neural crest cells - vagal and sacral NCC

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22
Q

Extrinsic NS

A

Derived from Neural crest cells
Vagal + sacral NCC –> parasympathetic innervation
Truncal NCC –> symp. innervation

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23
Q

Hirschsprungs diseases

A

Birth defect
Absence of ENS in terminal part of intestine
Colon smooth muscle permanently conrracted (no nNOS to relax)

24
Q

Hirschsprungs disease symptoms

A

Failure to pass meconium within 48hrs
Swollen belly
Vomiting green fluid (bile)

25
Q

Hirschsprungs disease treatment

A

Surgical resection of aganglionic part of colon

26
Q

Normal faecal continence maintained by

A

Anal canal
Pelvic floor musculature
Rectum

27
Q

Pelvic floor muscles

A

Levator ani- puborectalis, pubococcygeus and iliococcygeus

Coccygeus

28
Q

Puborectalis

A

Passes directly backward from back of pubic symphysis- U shaped loop that slings rectum to pubis
Striated muscle layer with central ligamentous structure

29
Q

Puborectalis function

A

Supports External anal sphincter

Assists in creating anorectal angle

30
Q

Faecal continence maintained by

A

Anal sphincters- external + internal

Puborectalis

31
Q

Internal anal sphincter

A

Involuntary

Thickened muscle

32
Q

External Anal sphincter

A

Voluntary
Encircles IAS
Voluntary control of EAS key in voluntary deferring of pooping until right time

33
Q

Nerves responsible for continence

A

S2-S4
–> pudendal
–> derived from ventral rami of sacral plexus
Parasympathetic supply

34
Q

EAS nerve supply

A

Inferior branch of pudendal nerve

35
Q

IAS nerve supply

A

Enteric nervous system - which is innervated by ANS
Parasymp= S2-S4 pelvic nerves inhibitory
Symp= L1, L2 via hypogastric nerves excitatory

36
Q

Pudendal nerve branches

A

Gives off inferior rectal nerves
Divides into 2 terminal branches
–> perineal nerve + dorsal nerve penis
–> dorsal nerve of clitoris

37
Q

Defecation

A

Relaxation of EAS + puborectalis muscle

–> create broader anorectal angle

38
Q

Initiation of defecation

A

IAS

Reflex dilation in response to rectal distension

39
Q

IAS state

A

Continuously tonic

40
Q

Squeeze pressure

A

EAS
High resting pressure in anal canal
Prevents leakage of mucus and gas

41
Q

Rectoanal inhibitory reflex

A

Transient involuntary relaxation of the internal anal sphincter in response to distention of the rectum
RAIR provides the upper anal canal with the ability to discriminate between flatus and faecal material

42
Q

Paediatrics

A

Incontinence is result of constipation in >80%

43
Q

Constipation

A 
Purely symptomatic
Infrequent stools (<3/week)
Passage hard stools (>25%)
Sensation of incomplete evacuation (>25%)
F>M
Elderly
44
Q

Continence

A

Extrinsic afferent neurones mediate the conscious sensation of urgency which is activated by mechanoreceptors

45
Q

Rectal sensation- hypersenstivie

A

Reduced sensory threshold to volumetric rectal distension

IBS

46
Q

Rectal sensation- hyposensitive

A

Increased sensory threshold to volumetric rectal distension

Constipation

47
Q

Normal transit constipation

A

Normal transit yet patient feels constipated

48
Q

Slow transit constipation

A

Infrequency + slow movement of stool

Young women + children

49
Q

Rectal evacuatory disorder constipation

A

Hard/painful stools
Bleeding
Common in children

50
Q

Rectal prolapse

A

Rectal walls slides out through anus

Weakened muscles + ligaments and increased abdomen pressure

51
Q

Rectal intussusception

A

Telescoping of rectum into itself during straining

52
Q

Defecation dyssynergia

A

Pelvic floor dysfunction

53
Q

Passive Faecal incontinence

A

Structural/Functional lesion

Internal sphincter

54
Q

Faecal Urge incontinence

A

Structural/Functional lesion

External sphincter

55
Q

Senna, bisacodyl

A

Stimulant

Laxative

56
Q

Docusate

A

Stool softener

Laxative

Metabolism CC (29 decks)

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