Rectum And Anal Canal Flashcards by Iseoluwa Ojo

Rectum

The teniae coli of the sigmoid colon spreads to form a __________ layer of smooth muscle.

continous outer longitudinal

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The rectum is the (anterior or Posterior?) part of the lesser pelvis

In front of ______ pieces of ____ and the ____ vertebrae

Posterior

lower three

sacrum

coccyx

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Extents of the rectum

Begins at the _____ junction– at level of ________ vertebra

Ends at the ____ junction – _____ cm (in front of or behind?) and a little (below or above ?) the coccyx.

rectosigmoid

third sacral

anorectal

2-3

In front of

Below

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The _____ of the rectum receives and hold the accumulating fecal mass

ampulla

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Rectum

Length = __ cm

Diameter
–__ cm (in the upper part)
–(dilated or constricted?) (in the lower part)

Dilated

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Rectum

Flexures
•Lateral flexures (__ in number) –correspond to the _______ folds

List them

transverse rectal

Superior
Intermediate
Inferior

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Rectum

Superior
– (concave or Convex?) to the (right or left?)
•Intermediate
– (concave or Convex?) to the (right or left?)
• Inferior
– (concave or Convex?) to the (right or left?)

Convex ; right

Convex; left

Convex ; right

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Most prominent lateral flexure of the rectum Is????

The intermediate flexure

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Peritoneal Reflection of the rectum

•Superior 1/3rd of the rectum
– Covered by peritoneum on the _______ surfaces
•Middle 1/3rd of the rectum
– Covered by peritoneum on the _____ surface
•Inferior 1/3rd of the rectum
–covered by Peritoneum on the ____ surface

anterior and lateral

Devoid of peritoneum

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Visceral  Relations of rectum in males
– Upper 2/3rd
●\_\_\_\_\_\_\_  pouch
●Coils of \_\_\_\_\_
●\_\_\_\_\_ colon

– Lower 1/3rd
●\_\_\_\_\_\_\_\_ of the \_\_\_\_\_\_
● \_\_\_\_  parts of the \_\_\_\_\_
●\_\_\_\_\_\_
●\_\_\_\_\_\_\_
●\_\_\_\_\_\_

Rectovesical
ileum
Sigmoid

Fundus (base) ; urinary bladder

Terminal; ureters

Seminal vesicles

Ductus deferentes

Prostate

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Visceral Relations of rectum in females
– Upper 2/3rd
•\_\_\_\_\_\_\_ pouch
•Coils of \_\_\_\_\_
•\_\_\_\_\_\_\_ colon

– Lower 1/3rd

•_____ part of _____

Rectouterine

ileum

Sigmoid

Lower; vagina

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Posterior Relation of rectum

•• Bones
– _______ pieces of ____
– ____

•• Ligaments
–________ ligament

•Muscles
–______
–________
– ________

Lower three ; sacrum

Coccyx

Anococcygeal

Piriformis; Coccygeus;levator ani

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Posterior Relation of rectum

•Vessels
–_________
–________
–________

• Nerves
–\_\_\_\_\_\_\_ chain with ganglion impar
– Ventral primary rami of \_\_\_\_\_\_\_\_\_\_\_\_\_
–\_\_\_\_\_\_\_\_\_\_\_\_ nerves
•Lymph nodes and lymphatics
••••\_\_\_\_\_

Median sacral

Superior rectal

Lower lateral sacral

Sympathetic; S3, S4, S5, Co1

Pelvic splanchnic

fat

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Arterial Supply of the rectum

___________ artery
____________ artery
______________ artery

Superior Rectal

Middle Rectal

Inferior rectal

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Venous Drainage of the rectum

_______ vein
________ vein
_________ vein

Superior Rectal

Middle Rectal

Inferior rectal

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Lymphatic Drainage of

Superior half of the rectum
•–______ lymph nodes
•–_______ lymph nodes

Inferior half of the rectum
– _____ group of lymph nodes or ______ lymph nodes

Pararectal

Inferior mesenteric

Sacral ; Internal iliac

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Lymphatic Drainage of Superior half of the rectum
•–pararectal lymph nodes, located directly on the _____ layer of the rectum
•– Inferior mesenteric lymph nodes, via either the ____ lymph nodes or the nodes along the _______ vessels

Inferior half of the rectum
– Sacral group of lymph nodes or Internal iliac lymph nodes

muscle

sacral; superior rectal

Nerve Supply

Sympathetic
●__,__ fibres
●Vaso____
●Carries sensation of ___

Parasympathetic
__,___,___ fibres
•(Inhibitory or excitatory ?) to internal sphincter
•Carry sensations of ______ and ________

L1, L2

constrictor; pain

S2, S3, S4

Inhibitory

pain and distension

Anal canal
•The anal canal is the terminal part of the ____________.
•It extends from the (superior or inferior?) aspect of the _______ to the _____.

•Its length is about ___-____cm

large intestine

Superior

pelvic diaphragm

anus

2.5 – 3.5

The anal canal begins at the terminal end of the _______ where it (widens or narrows?) at the pelvic floor

•It terminate at the ____ after passing through the _____.

rectal ampulla

Narrows

anus

perineum

The anal canal is surrounded by an internal (___untary- ) and external (___untary) sphincters which normally keep it (open or close?)

invol

vol

The upper part of the canal is lined by mucosa similar to that of _____, it is distinguished by a number of (longitudinal or transverse ?) orientation fold called the _______________.

They are united (inferiorly or superiorly?) by the ________ and Superiorly to each of these is a depression termed ______

rectum; longitudinal

anal columns

inferiorly

anal valves

The anal valves together forms a curve round the canal at a location known as ______, which marks the approximate position of the ________ in the fetus.

•Inferior to the line, is a _____ zone . This is where the anal canal becomes _______. It is lined by ____________________ epithelium.

pectinate line

anal membrane

transition

true skin

non keratinized stratified squamous

Blood supply of the anal canal

The ____ rectal artery
The ______ rectal arteries
The _____ rectal arteries

superior

two inferior

middle

Blood supply of the anal canal * The superior rectal artery – supply the anal canal (superior or Inferior?) to the ___________ * The two inferior rectal arteries – supplies the (superior or inferior?) part of the anal canal and the surrounding muscles and _____ skin. * The middle rectal arteries - support in the anal supply by forming anastomoses with the _____ and _____

superior; pectinate line. Inferior; perianal superior and inferior.

Venous and lymphatic drainage •The internal rectal plexuses drain _______ and _______ to the pectinate line. •It drains superior to the pectinate line into _________ vein and _____ system while inferior to the pectinate line into the _______ vein around the margin of anal sphincter. •Middle rectal vein drains mainly the ________ of the ampulla and anastomoses with the ______ and ———— vein.

both the superior and inferior superior rectal; portal inferior rectal muscularis externa superior and inferior rectal

Nerve supply of the anal canal •The superior to the pectinate line is (visceral or somatic?) innervated from the _________ plexus. •Involving sympathetic fiber ((maintain or inhibit ?) the tonus) and parasympathetic fiber ((maintain or inhibit?) tonus) and inferior afferent fibers. •The inferior to the pectinate line is (somatic or visceral?) innervation derived from ______ rectal nerves, branches of the ______ nerve

Visceral ; inferior hypogastric Maintain ; inhibit Somatic inferior anal ; pudendal

ANAL FISSURE Anal fissure may result from ____ of the _____ and _____ by ______ in chronically constipated persons. * (Superficial or deep?) , small but ______ ——— * Fissure ends below the _______ * Commonly occurs in the ____, posteriorly or anteriorly, inferior to the anal valves.

tearing Anal valves; mucosa hard feces Superficial ; distressing lesion dentate line midline

ANORECTAL ABSCESS •infected cavity filled with ____ found near the ____ or ___ result in formation of the anorectal abscess. •Usually produces a painful, throbbing swelling in the anal region •Subdivided according to anatomical site into _______,________ ,________ and _______.

pus anus or rectum perianal ischiorectal submucous and pelvirectal

ANAL FISTULA Anal fistula is a chronic abnormal communication which runs outwards from the ______ lumen (the internal opening) to an external opening on the _____ of the ____ or buttock or vagina. •An anal fistula may result from the spread of an anal infection and ______

anorectal skin of the perineum cryptitis

cryptitis inflammation of the ________

anal sinus

ANORECTAL INCONTINENCE Anal incontinence is the lack of control over ________ leading to (voluntary or involuntary?) loss of bowel content. can occur: •With ________,_______ , damage to structures involved in continence especially during a _______________ or complications from ________ surgery.

defecation involuntary constipation; diahrrea traumatic child birth anorectal

RECTAL PROLAPSE Rectal prolapse is _____ of the rectum and _____ of the prolapse through the ___. May involve: •______ and ______ layers. • mucosal lining of the rectum. •May also be an internal prolapse which is the ________ of the rectal wall but (with or without?) the prolapse protruding through the anal canal.

evagination; protrusion anus mucosa and the muscular intussusceptions Without

PRURITUS ANI Intractable ____ in and around the anus presentation •Skin is ______(color), hyp__keratotic, ______ & moist •Poor hygiene, Anal discharge (due to fissure/fistula/piles/ warts/Skin diseases.

itching reddened er cracked

ANAL WARTS •It is caused by __________________ increased incidence •sexual promiscuity (especially _____ intercourse or ___) • ___-infected individuals presentation •Pruritus, discharge, bleeding and pain

Human Papilloma Virus(HPV) anal; MSM HIV

Most common sexually transmitted anal disease is ______?

Anal warts

Anal warts is always benign T/F

May be present with Benign warts or malignant warts

``` HAEMORRHOIDS Internal hemorrhoids (_____) are ____ of rectal mucosa (more specifically, of the rectal _____) containing the _________ veins of the _______ venous plexus ```

piles prolapses; cushions normally dilated internal rectal

HAEMORRHOIDS External hemorrhoids are ____________ in the veins of the ______ venous plexus and are covered by skin. Predisposing factors include ________,_________, and ________

thromboses (blood clots) external rectal pregnancy, chronic constipation and prolonged toilet sitting and straining.

ANAL CANCER They arise from the ________ epithelium of the anal margin or from the ______________ epithelium of the anal transitional zone immediately above the dentate line

keratinized squamous non-keratinized squamous

Anal cancers are ______ cell carcinomas.

squamous

_______ is the primary cause of anal cancer

HPV