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Gross III Final > Rectum > Flashcards

Rectum Flashcards

1
Q

What is the rectum?

A

pelvic end of alimentary tract where feces accumulate prior to defecation

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2
Q

Where is the rectum located?

A

located between sigmoid colon and anal canal

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3
Q

Rectosigmoid junction located anterior to what?

A

S3

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4
Q

Is the rectum retro/intra/extra peritoneal?

A

retroperitoneal

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5
Q

Which structure expands into a continuous layer onto the rectum?

A

Teniae coli of sigmoid colon

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6
Q

Does the rectum have epiploic appendages, haustra, or sacculations?

A

no, they are absent

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7
Q

What is the sacral flexure?

A

rectum follows contour of sacrum and coccyx

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8
Q

What is the anorectal flexure?

A

shape turn at coccyx where rectum pierces pelvic diaphragm

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9
Q

What is approximate 80degree posterior turn of the anorectal flexure important for?

A

maintaining fecal continence (control of bowels)

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10
Q

What muscle maintains tonus of the anorectal flexure?

A

Puborectalis m.

- must actively contract to resist peristaltic contractions in rectum and prevent defecation

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11
Q

What needs to happen for conscious defecation to occur?

A

relaxation of puborectalis m.

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12
Q

what are the 3 sharp lateral flexures present in rectum and what do they correspond to?

A

Superior, intermediate and inferior

- correspond to Transverse rectal folds of the mucosa and submucosa

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13
Q

What is the ampulla of the rectum?

A

dilatable terminal region lying above and supported by levator ani m.
-Relaxes to hold accumulating fecal material prior to defecation

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14
Q

Yo, the superior 3rd of rectum is retroperitoneal and inferior 3rd is subperitoneal

A

random part in the notes…. guess there is no middle area

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15
Q

What structures provide space for rectum to distend as it fills with feces? (male vs. female)

A 
Rectovesical pouch (male)
Rectouterine pouch (females)
Pararectal fossae
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16
Q

What forms the peritoneal reflection in males?

A

rectovesical pouch

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17
Q

What forms the peritoneal reflection in females?

A

rectouterine pouch

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18
Q

What forms as the lateral peritoneal reflection in both sexes?

A

Pararectal fossae

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19
Q

What structures are associated with rectum posteriorly? (both sexes)

A
  • sacral vertebrae and coccyx
  • sacral plexuses and inferior ends of sympathetic trunks
  • median sacral a. and v.
20
Q

What structures are associated with the rectum anteriorly for males?

A

-Fundus of urinary bladder and terminal parts of ureters
-Ductus deferens, seminal vesicles and prostate
(separated from these structures by rectovesical pouch)

21
Q

What structures are associated with the rectum anteriorly for females?

A

Vagina, posterior fornix, and cervix of uterus

separated from these structures by rectouterine pouch

22
Q

What is the arterial supply to rectum?

A

Superior rectal a.
Middle rectal a.
inferior rectal a.

23
Q

Superior rectal a.

A

Branch from Inferior mesenteric a.

-supplies proximal part of sacrum

24
Q

Middle rectal a.

A

Branches from internal iliac (anterior division)

25
Q

Inferior rectal a.

A

Branches from internal pudendal a.

-supplies anorectal junction and anal canal

26
Q

What is the venous drainage of the rectum?

A

Superior rectal v.
Middle rectal v.
Inferior rectal v.

27
Q

Superior rectal v.

A

drains hepatic portal venous system

28
Q

Middle and inferior rectal v.v.

A

drains to systemic system via internal iliac v.

-anastomoses b/t these veins create an important portacaval anastomosis

29
Q

What are enlarged veins around the inferior rectum and anal canal?

A

Hemorrhoids

30
Q

What are hemorrhoids?

A

Dilated and prolapsed veins of rectal venous plexus

31
Q

What are predisposing factors of hemorrhoids?

A

those that cause increased intra-abdominal pressure

  • E.g. pregnancy or chronic constipation
  • Can occur in cases of portal hypertension (rectal v.v. are an anastomosis b/t portal and systemic system)
32
Q

What are the types of hemorrhoids?

A

Internal or External

33
Q

Internal hemorrhoids

A

probably due to breakdown of muscularis mucosa

-prolapse into lumen of anal canal and ulcerate (blood in stool)

34
Q

External hemorrhoids

A

Involves external rectal venous plexus and are covered by skin

35
Q

What is the superior lymphatic drainage of the rectum?

A

drains through pararectal to inferior mesenteric and lumbar nodes

36
Q

What is the inferior lymphatic drainage of the rectum?

A

drains though internal iliac nodes

37
Q

What is the sympathetic innervation of the rectum?

A

via lumbar splanchnic n. through superior hypogastric plexus

  • Follow superior recta a. (branch of Inferior mesenteric a.)
  • Possibly vasomotor but not functionally significant
38
Q

What is the parasympathetic innervation of the rectum?

A

via pelvic splanchnic n. through inferior hypogastric plexus

-motor fibers to rectal muscularis externa

39
Q

Visceral afferents pass retrogradely through what?

A

pelvic splanchnic n. S2-S4

-both pain and/or distention (indicating gas or feces)

40
Q

What n. mediated innervation controls defecation?

A

pelvic splanchnic n.

41
Q

What happens when ampulla is empty?

A

Internal anal sphincter m. contracted

External anal sphincter m. relaxed

42
Q

What happens when feces accumulates in ampulla and sufficiently distends it?

A

Internal anal sphincter m. reflexively relaxes
External anal sphincter m. reflexively contracts
-Initiated by visceral afferents in pelvic splanchnic n.

43
Q

What is required for defecation?

A

Requires voluntary override of reflexive external anal sphincter m. contraction
-Puborectalis m. also must voluntarily relax

44
Q

What causes movement of feces?

A

Parasympathetic stimulation increases peristaltic activity in rectum
-movement assisted by increased abdominal pressure

45
Q

Rectal examination, and what are you feeling for in males and females?

A

Provides opportunity to palpate many clinically significant structures

  • Males: prostate and seminal vesicles
  • Females: cervix
  • Both: sacrum, coccyx, ischial spines and tuberositie
46
Q

What pathologies are you looking for during a rectal exam?

A

enlarged nodes, thickened ureters or abscesses

47
Q

What is used to visualize rectal lumen and remove lesions?

A

Proctoscope

Gross III Final (15 decks)

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