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Anatomy (JC2) > Rectum, Anal Canal and Ischioanal Fossa > Flashcards

Rectum, Anal Canal and Ischioanal Fossa Flashcards

1
Q

How long is the Rectum?

A

5 inches (12cm)

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2
Q

Where is the Rectum?

A

From Vertebral level S3 to the level of the apex of the prostate in males and the lower vagina in females

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3
Q

What is the space between the Rectum and the Bladder in the male called?

A

Recto-vesical pouch

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4
Q

What is the space between the Rectum and the Uterus in the Female called?

A

Recto-Uterine Pouch of Douglas

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5
Q

What does the Rectum look like in a Coronal Section?

A
  1. Curved along the Sacrum
  2. S Shaped
  3. Has Valves of Houston going Left, Right, Left
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6
Q

What happens if the Ampulla of the Rectum is stretched?

A

The Internal Anal Sphincter Relaxes

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7
Q

Which of the Rectal Valves of Houston is the biggest?

A

The Right one–> because it has muscle

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8
Q

What is the importance of the Valves of Houston?

A

Important in Colonoscopy

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9
Q

Where is the Ampulla of the Rectum?

A

It is the lower final end of the Rectum

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10
Q

What are the features of the Rectum?

A
  1. No Taeniae Coli

2. No Appendices Epiploicae

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11
Q

Which parts of the Rectum are covered by Peritoneum?

A
  1. Upper 1/3–> Front and Sides
  2. Middle 1/3–> Front only
  3. Lower 1/3–> None
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12
Q

What structures are posterior to the Rectum?

A
  1. Sacrum
  2. Coccyx
  3. Spinal Nerves S3, S4, S5
  4. Rectal Vessels and Lymphatics
  5. Waldeyer’s Fascia
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13
Q

What structures are lateral to the Rectum?

A
  1. Distensible Fascia

2. Levator Ani

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14
Q

What structures are anterior to the Rectum in Males?

A
  1. Upper 2/3 of Peritoneum
  2. Coils of Ileum
  3. Sigmoid Colon
  4. Rectovesical Pouch
  5. Denonvillier’s Fascia
  6. Base of Bladder
  7. Prostate
  8. Seminal Vesicles
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15
Q

What structures are anterior to the Rectum in Females?

A
  1. Upper 2/3 of Peritoneum
  2. Coils of Ileum
  3. Sigmoid Colon
  4. Rectouterine Pouch of Douglas
  5. Denonvillier’s Fascia
  6. Cervix
  7. Vagina
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16
Q

What is the blood supply to the Rectum?

A
  1. Superior Rectal Artery
  2. Middle Rectal Artery
  3. Median Sacral Artery
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17
Q

Where is the Superior Rectal Artery from?

A

From the Inferior Mesenteric Artery

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18
Q

Where is the Middle Rectal Artery from?

A

Internal Iliac Artery

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19
Q

Where is the Median Sacral Artery from?

A

Aorta at level L4

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20
Q

What is the Venous Drainage of the Rectum?

A
  1. Inferior Mesenteric Vein to the Portal Vein
  2. Middle Rectal Vein to the Internal Iliac Vein to Systemic Venous Drainage
  3. Inferior Rectal Vein to Internal Iliac Vein to Systemic Venous Drainage
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21
Q

What is the Lymphatic Drainage of the Rectum?

A
  1. Presacral nodes
  2. Internal Iliac nodes
  3. Preaortic nodes
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22
Q

Where are the Internal Iliac Lymph Nodes?

A

In the lateral wall of the pelvis

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23
Q

What muscle is at the junction of the rectum and anus?

A

Puborectalis

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24
Q

What group of muscles is Puborectalis from?

A

Levator Ani

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25
Q

What is the nerve supply to Puborectalis?

A

Pudendal Nerve (Voluntary Control)

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26
Q

What are the attachments of puborectalis?

A
  1. Pubic Symphysis

2. Splits around the posterior rectum

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27
Q

What is the function of Puborectalis?

A
  1. Relaxes to allow defaecation

2. Increase the ankle between the rectum and anal canal

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28
Q

Where is the Anal Canal?

A

Between the Rectum and the Anus

29
Q

How long is the Anal Canal?

30
Q

What are the Anal Columns?

A

Mucosal organised into longitudinal folds, in between which anal glands open into the anal sinuses

31
Q

What forms the inferior aspect of the Anal Columns?

A

Anal Valves

32
Q

What do the Anal Valves form?

A

The Dentate/Pectinate Line

33
Q

What kind of epithelium is the upper 2/3rds of the Anal Canal?

A

Columnar Epithelium

34
Q

What kind of Epithelium is is the lower 1/3 of the Anal Canal?

A

Stratified Squamous Epithelium

35
Q

What is the significance of Hilton’s White Line?

A

Divides the Lower 1/3 of the Anal Canal into Non-Keratinised and Keratinised Squamous Epithelium (Non-Keratinised on top)

36
Q

What is the blood supply of the Anal Canal?

A
  1. Superior Rectal Artery from the Inferior Mesenteric Artery
  2. Inferior Rectal Artery from the inferior Pudendal Artery, which is from the Interior Iliac Artery
37
Q

What is the Venous Drainage of the Anal Canal?

A
  1. Internal Venous Plexus between the internal sphincter and epithelium
  2. External Venous Plexus surrounding the External Anal Sphincter
38
Q

Where does the Internal Venous Plexus of Veins in the Anal Canal drain to?

A
  1. Superior Rectal Vein (Portal System)

2. External Venous Plexus

39
Q

Where does the External Venous Plexus of Veins in the Anal Canal drain to?

A
  1. Superior Rectal Vein (Portal System)
  2. Middle Rectal Vein
  3. Inferior Rectal Vein
40
Q

What is the nerve supply to the Anal Canal?

A

Upper–> Visceral Sensory (Autonomic)

Lower–> Somatic (Inferior Rectal nerve from Pudendal Nerve)

41
Q

Describe the course of the Pudendal Nerve

A
  1. The Pudendal Nerve arises from Roots S2,3,4 from the Sacral Plexus
  2. It goes out of the pelvis through Greater Sciatic Foramen under Piriformis
  3. It hooks around the Sacrospinous ligament and goes back through the Lesser Sciatic Foramen
  4. Goes through the Pudendal Canal
42
Q

How is the Pudendal Nerve located for Local Anaesthetic injections?

A

Located by Palpating the Ischial Spine through either the vagina or Rectum

43
Q

What type of muscle makes the Internal Anal Sphincter?

A

Smooth Muscle

44
Q

What is the nerve supply to the Internal Anal Sphincter?

A

Autonomic Nervous Control from the Rectal Plexus from the Inferior Hypogastric Plexus

45
Q

What nerves contract the internal anal sphincter?

A

Sympathetic Nerves

46
Q

What nerves relax the internal anal sphincter?

A

Parasympathetics

47
Q

What causes the internal anal sphincter to relax?

A

Dilatation of the ampulla of the rectum

48
Q

What are the 3 parts of the External Anal Sphincter?

A
  1. Subcutaneous
  2. Superficial
  3. Deep
49
Q

Which part of the External Anal Sphincter is overlapping with the Internal Anal Sphincter?

A

The Deep part

50
Q

What type of muscle is the External Anal Sphincter?

A

Striated Skeletal Muscle

51
Q

What does the Deep part of the External Anal Sphincter attach to?

A

Puborectalis

52
Q

What does the Superficial part of the External Anal Sphincter attach to?

A

Perineal body and Coccyx

53
Q

What does the Subcutaneous part of the External Anal Sphincter Attach to?

54
Q

What is the nerve supply to the External Anal Sphincter?

A

Somatic Nerve Supply from the Pudendal Nerve (S2,3,4)

55
Q

What makes up the Perineal Body?

A
  1. External Anal Sphincter
  2. Bulbospongiosus Muscle
  3. Superficial Transverse Perineal Muscle
  4. Levator Ani
  5. External Urinary Sphincter
  6. Deep Transverse Perineal Muscle
56
Q

What are the borders of the Ischioanal Fossa?

A

Floor: Skin beside anus
Roof: Levator Ani
Lateral Wall: Obturator Internus, Alcock’s (Pudendal) Canal, Pudendal Nerve and Vessels

57
Q

What are the contents of the Ischioanal Fossa?

58
Q

What is the function of the Ischioanal Fossa?

A

Allow expansion of the anus during defaecation

59
Q

What can be palpated in a Rectal Examination in males?

A
  1. Ischial Spine/Tuberosity
  2. Appendix
  3. Prostate (Seminal Vesicles)
  4. Base of Bladder
  5. Bulb of Penis
60
Q

What can be palpated in a Rectal Examination in Females?

A
  1. Ischial Spine/tuberosity
  2. Appendix
  3. Cervix
  4. Ovaries
  5. Internal Iliac Nodes
61
Q

What are Haemorrhoids?

A

Swollen vascular structures in the anal canal which can bleed and be painful

62
Q

What is the difference between internal and external haemorrhoids?

A

Internal–> Above Pectinate line

External–> Below Pectinate line

63
Q

Where does the blood come from in internal Haemorrhoids?

A

Superior Rectal Vein - Inferior Mesenteric Vein - Portal System

64
Q

Where does the blood come from in External Haemorrhoids?

A

Inferior Rectal Vein - Internal Pudendal Veins–> Inferior Vena Cava

65
Q

What are Anal Fissures?

A

Tear f the Anus or Anal canal caused by hard stool/constipation

66
Q

What is the treatment for Anal Fissures?

A
  1. Stool softeners
  2. Nitrate-based ointment/ Calcium channel blockers
  3. Botox
  4. Surgery
67
Q

What are Rectal Carcinomas?

A

Tumour on the bowel wall

68
Q

How will a patient present if he/she has Rectal Carcinoma?

A
  1. Bleeding
  2. Altered Bowel Habit
  3. Back Pain
  4. Weight Loss

Anatomy (JC2) (20 decks)

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