lec 7

Question 1

relation of descending colon to the anterior abdominal wall

Answer 1

left hypochondriac + left lumber

Question 2

position of descending colon in the body

Answer 2

descends vertically btw psoas major + quadratus lumborum

and then crosses the iliac crest, and turns medially and downwards in contact with the iliacus and psoas major

Question 3

posterior relations of descending colon

Answer 3

Lateral border of left kidney
psoas major , iliacus, quadratus lumborum

femoral N. , left iliohypogastric , left ileoinguinal , lateral femoral cutaneous, subcostal N

Question 4

blood supply for descending colon

Answer 4

Left colic and sigmoid branches of the inferior mesenteric artery.

Question 5

position of sigmoid colon in body

Answer 5

coiled in front of rectum, on peritoneal (superior) surface of bladder in male, and uterus in female

Question 6

relation of sigmoid colon to anterior abdominal wall

Answer 6

Lies in lesser pelvis

Question 7

the sigmoid extends to

Answer 7

pelvic surface of 3rd piece of sacrum.

Question 8

relation of sigmoid to peritoneum

Answer 8

completely surrounded

Question 9

lateral relations of sigmoid colon

Answer 9

vas deferens –> male , ovary –> female
obturator N. , external ileac vessels
lateral pelvic wall

Question 10

posterior relations of sigmoid

Answer 10

internal iliac vessels

ureter, piriformis, sacral plexus, and rectum

Question 11

inferior relation of sigmoid colon

Answer 11

Rest on bladder in male, and on uterus and bladder in female

Question 12

blood supply of sigmoid + veins

Answer 12

Sigmoid branch of inferior mesenteric artery. Veins correspond to arteries and drain into inferior mesenteric vein, which joins portal venous system

Question 13

nerve supply of sigmoid colon

Answer 13

symp+parasymp (pelvic splanchnic) from inferior hypogastric plexus

Question 14

position of teania coli

Answer 14

In the caecum, ascending colon, descending colon, and sigmoid colon the taeniae coli are placed: Anterioly, posteromedially, and posterolaterally.

transverse colon
antertior –> inferior
posterolateral –> anterosuperior
posteromedial –> posterior

Question 15

In the rectum the longitudinal muscle fibers are

Answer 15

thicker on the anterior and posterior surfaces forming two bands

Question 16

The anorectal junction lies

Answer 16

2 – 3 cm beyond tip of coccyx, which in the male is opposite apex of prostate.

Question 17

peritoneum relation with rectum

Answer 17

is related only to upper two-thirds of rectum, covering at first its front and sides, but lower down its front only.

Question 18

anterior relations of sigmoid (upper 2 thirds + lower third)

Answer 18

Upper two-thirds
In the male to rectovesical pouch.
In the female to rectouterine pouch.
In	both	sex	the	pouch	contains	terminal  coils of ileum and sigmoid colon
In the female to vagina

Lower third:
In the male to posterior surface of bladder ,vas deferens, seminal vesicles, terminal part of ureter , prostate

Question 19

posterior relations of rectum

Answer 19

In the median plane, it is related to lower three sacral vertebrae, coccyx, median sacral vessels, ganglion impar, and
branches of superior rectal vessels On each side of the median plane, it is related to piriformis, anterior rami of lower three sacral and coccygeal nerves, sympathetic trunk, right and left coccygeus and right and left levator ani.

Question 20

lateral relations of rectum

Answer 20

Sigmoid colon or distal part of ileum, pelvic sympathetic plexuses, coccygei, and levatores ani

Question 21

posterior relations of anal canal

Answer 21

Related to anococcygeal raphe

Question 22

lateral relations of anal canal

Answer 22

It is separated from the fat of ischiorectal
fossae by levator ani and external anal
sphincter muscles.

Question 23

anterior relations of anal canal

Answer 23

In the male, it is separated from membranous urethra by the perineal body.
In the female, it is related to perineal body and lower part of vagina.

Question 24

anal canal lateral walls during defecation are maintained in position by

Answer 24

levator ani , anal sphincters

Question 25

The upper half of the anal canal is lined by

Answer 25

columnar epithelium

Question 26

The lower half of the anal canal is lined by

Answer 26

stratified squamous epithelium

Question 27

if the external sphincter is paralyzed

Answer 27

sphicter control is lost –> incotenince

Question 28

anorectal ring is formed by

Answer 28

puborectal muscle , deep part of external sphincter , internal sphincter at the anorectal junction

Question 29

arterial supply of rectum

Answer 29

superior rectal artery with

median sacral + middle +inferior rectal arteries

Question 30

at which level divides the superior rectal artery

Answer 30

S3 right and left

Question 31

superior rectal artery is a branch of

Answer 31

inferior mesenteric

Question 32

superior rectal artery anastomose with

Answer 32

inferior rectal artery

Question 33

middle rectal artery is a branch of

Answer 33

internal iliac artery

Question 34

middle rectal artery supplies

Answer 34

muscles of middle and lower portion of rectum

Question 35

inferior rectal artery is a branch of

Answer 35

internal pudendal (branch of internal iliac)

Question 36

inferior rectal artery supplies

Answer 36

It supplies the internal and external anal sphincters, portion of anal canal below anal valves (lower half of the canal), and perineal skin.

Question 37

median sacral artery is a branch of

Answer 37

descending abdominal aorta

Question 38

median sacral artery supplies

Answer 38

Supplies the posterior wall of anorectal junction, and of the anal canal.

Question 39

origin of superior rectal vein

Answer 39

internal venous plexus

Question 40

origin of inferior rectal vein

Answer 40

external venous plexus

Question 41

rectum drainage

Answer 41

The upper half of anal canal drains into pararectal lymph nodes and then mesenteric lymph nodes.
The lower half of anal canal drains into medial group of superficial inguinal lymph nodes.

Question 42

nerve supply of rectum

Answer 42

symp –> inferior messentric plexus
parasymp–> S2-3-4 by pelvic splanchnic nerves via hypogastric plexus , motor , distention
pain fibers with both of them

Question 43

anal canal mucos membrane in the upper half is supplied by

Answer 43

sensitive to distention

sensory fibers from hypogastric plexus

Question 44

lower half of anal canal is supplied by

Answer 44

sensitive to touch pressure pain temp.

inferior rectal N.

Question 45

internal sphincter innervation

Answer 45

sympathetic from hypogastric plexus

Question 46

the voluntary external sphincter is supplied by

Answer 46

inferior rectal N. –> pudendal –> perineal–> S4

Question 47

Internal hemorrhoids are varicosities of the tributaries of

Answer 47

superior rectal

Question 48

superior rectal tributaries of the vein, which lie in the anal column at ———————- particularly liable to become varicosed

Answer 48

the 3-, 7-, and 11- o’clock

Question 49

External hemorrhoids are varicosities of the tributaries of

Answer 49

inferior rectal

Question 50

The anal fissure occurs most commonly in the

Answer 50

midline posteriorly, or less commonly, anteriorly.

Question 51

is internal hemorrhoids painful ?

Answer 51

no, are sensitive only to stretch.

Question 52

is external hemorrhoids painful

Answer 52

yes
They are sensitive to pain, temperatures, touch, and pressure, which explains why external hemorrhoids are painful
(inferior rectal n.)

Question 53

is anal fissures painful?

Answer 53

extremely painful.