Mar1 M2-Anorectal disorders Flashcards
anal canal anatomy
endodermal lining, mucosa, tunica muscularis, no serosa bc extraperitoneal
dentate (or pectinate) line function
separates endodermal mucosa of rectum and ectodermal derived tissue of perianal skin
type of epithelium in anoderm compared to rectum
stratified squamous epithelium with a lot of nerves. very sensate. rectum is insensate
anatomical and surgical anal canal
anatomical = pectinate line + anoderm
surgical anal canal = anal transition zone (right after rectum) (has hemorrhoid and internal sphincter + dentate line + anoderm (has external sphincter)
internal anal sphincter
the circular muscle of the rectum that thickens (INVOLUNTARY control)
external anal sphincter
SKELETAL muscle under VOLUNTARY control
hemorrhoid def
sinusoid cushion with arterial and venous blood that is in the upper part of the anal canal (surgical). provide 15% of continence
how to check end of anal canal physically
surgical anal canal is tight part. rectum is not tight
when hemorrhoids function
increase in abd P = they engorge to fill the gap and prevent fecal loss and endoderm injury from hard stools
crypts of Morgan fct + clinical
secrete mucous to help passage of stool. problem if are stuck
internal hemorrhoids charact
above dentate line: insensate, visceral. come from branches of superior and middle rectal arteries. endoderm derived
external hemorrhoids charact
near anal verge, on perianal skin. somatic, sensate. from inferior rectal artery (which branches from PUDENDAL) vessels. ectoderm derived.
possible problems of external hemorrhoids
can get swollen if cough, deliver babt. can get thrombosed
ddx of hemorrhoid (if see something protruding)
- anal fissure (the sentinel pile)
- rectal prolapse
- anal cancer skin
- condylomas
- IBD (Crohn’s)
- infection
possible problem of internal hemorrhoid + position of hemorrhoids there
prolapse.
one left lateral
one right antero-lateral
one right postero-lateral
symptoms of internal hemorrhoids
- BRBPR
- pain (irritation)
- tenesmus (feeling of incomplete evacuation)
- perianal mass
- urgency
- pruritus ani
4 grades of internal hemorrhoids
1 = prominent vessels no prolapse 2 = prolapse, spontaneous reduction 3 = prolapse need manual reduction 4 = chronically prolapsed manual reduction ineffective
internal hemorrhoid treatment
stool bulking, good water intake, no creams suppository, no prolonged pressure. surgical excision (if grade 3,4)
external hemorrhoid treatment
-stool softeners if thrombosed for more than 48 hrs
-surgery if thromb for less 48 hrs
always stool bulking, good water intake
anal fissure def and cause
linear tear in anoderm distal to dentate line
cause: passage of hard bowel mvmt
* may get chronic fissure (tear, spasms, healing cycle)
charact of chronic anal fissure
inflamed, edematous, chronic inflam, hypertrophied.
ischemia prevents healing, cycle of constipation and spasm and pain, tears, scarring
fissures where usually
posterior midline (75%), after that it’s anterior midline (25%)
other causes of anal fissures
CD, UC, STDs, anorectal trauma, neoplasm (leukemia, lymphoma)
anal fissure treatment
break cycle of constipation. stool bulkng (fiber, psyllium, water, topical anesthetics)
