Faecal continence

Question 1

where is the pelvic cavity?

Answer 1

lies in bony pelvis between the pelvic inlet and pelvic floor

Question 2

what is contained within the pelvic cavity?

Answer 2

pelvi organs and supporting tissues

Question 3

is the pelvic cavity continuous with the abdominal cavity?

Answer 3

yes

Question 4

what separates the pelvic cavity and peroneum?

Answer 4

pelvic floor

Question 5

what do the openings in the pelvic floor permit?

Answer 5

passing of distal parts of alimentary, renal and urinary tract to pass
through
(only 2 in male as urinary and alimentary combine)

Question 6

at what vertebral level does the sigmoid colon become the rectum?

Answer 6

S3

“recto-sigmoid junction”

Question 7

what is the rectal ampulla?

Answer 7

its walls relax to accommodate faecal material

lies immediately superior to the levator ani muscle

Question 8

what holds faeces in the ampulla until appropriate to defecate?

Answer 8

functioning muscles and muscle sphincters of rectum

Question 9

what creates the pouches over the pelvic organs?

Answer 9

covering of peritoneum

Question 10

what is the levator Ani muscle?

Answer 10

skeletal muscle forming most of pelvic diaphragm together with fascical coverings
forms floor of pelvis and roof of perineum

Question 11

what are the smaller muscles of the levator ani muscle?

Answer 11

iliococcygeus (most lateral)
pubococcygeus (middle)
puborectalis (most medial)

Question 12

what does the levator ani muscle do?

Answer 12

contracts to hold pelvic organs in

prevents them from moving inferiorly when eg.coughing/sneezing (increasing intra-abdominal pressure)

Question 13

what is the normal state of the levator ani muscle?

Answer 13

tonically contracted most of the time

Question 14

what nerve supplies the levator ani muscle?

Answer 14

nerve to lavatory ani (branch of sacral plexus) and pudenal (S2,3,4)
S2,3,4 keeps pelvic organs off the floor

Question 15

what does the puborectalis muscle do?

Answer 15

voluntary contraction decreases the anorectal angle, acting like a sphincter (maintains continence when rectal ampulla filled with faeces)

Question 16

which is bigger anal sphincter?

Answer 16

external

made of skeletal muscle (voluntary)

Question 17

where is the ampulla in the rectum?

Answer 17

widened part

Question 18

what nerves stimulate contraction of internal anal sphincter?

Answer 18

sympathetic

contraction inhibited by parasympathetic

Question 19

what part of the anal cancal is covered by the internal anal sphincter?

Answer 19

upper 2/3rds

Question 20

is the internal sphincter contracted all the time?

Answer 20

yes

Question 21

what part of the anal canal is covered by the external sphincter?

Answer 21

inferior 2/3rds

overlaps with internal

Question 22

what nerve stimulates external anal sphincter contraction?

Answer 22

pudenal nerve

Question 23

what nerves are involved in the pelvic cavity?

Answer 23

sympathetic, parasympathetic and visceral afferent

Question 24

what nerves are involved in the perineum?

Answer 24

somatic motor and somatic sensory

Question 25

what artery do the sympathetics “piggy back” on

Answer 25

inferior mesenteric

Question 26

s 2,3,4 is what give what 2 sets?

Answer 26

somatics to levator ani and parasympthetics to hindgut

Question 27

what 2 muscles aintain continence?

Answer 27

levator ani

external anal sphincter

Question 28

what is the craniosaccral outflow?

Answer 28

parasypathetics

Question 29

what is the pudenal nerve a branch of?

Answer 29

sacral plexus

Question 30

what is the course of the pudenal nerve?

Answer 30

leaves the pelvic cavity via greater sciatic foramen, loops round a ligament and comes back in via lesser sciatic foramen to supply genitalia/external anal sphincter

Question 31

what can childbirth damage?

Answer 31

branches of pudenal nerve

fibres in puborectalis or external anal sphincter could be torn leading to muscle weakness and faecal incontinence

Question 32

what is the pectinate line?

Answer 32

boundary
above = derived from endoderm (inner lining of embryo)
below = derived from endoderm (inner lining of embryo)

Question 33

what does the pectinate line look like?

Answer 33

zig zag line at anus

Question 34

why might you not feel any pathology above the pectinate line?

Answer 34

above = visceral supply

Question 35

what is the course of the lymphatic drainage?

Answer 35

follows arterial supply

Question 36

what is the difference between rectal varices and haemorrhoids?

Answer 36

haemorrhoids = plexus of dilated veins prolapse down due to prolonged periods of increased pressure (chronic constipation, increased straining, pregnancy)
Varices = form in relation to portal hypertension (due to liver cirrhosis etc)

Question 37

where can haemorrhoids originate from?

Answer 37

internal and external anal sphincter venous plexuses

external hurts more

Question 38

what are the pros and cons of the fat and connective tissue in the ischioanal fossa?

Answer 38

allows expansion etc
infection/fistula/abscess wouldn’t result in pain so can grow until it travels all the way around and reaches the body wall or forwards into the organs

Question 39

what is an infection within the ischioanal fossae called?

Answer 39

ischioanal abscess

Question 40

what are you looking for in a PR exam?

Answer 40

assess anal tone (strength of sphincter)
palpate prostate
palpate cervix

Question 41

what is a proctoscopy?

Answer 41

viewing interior of the rectum