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GI > Anatomy- Faecal Continence > Flashcards

Anatomy- Faecal Continence Flashcards

1
Q

what is the role of the rectum

A

a holding area to store faeces until appropriate to defecate

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2
Q

what senses the fullness (stretching) of the rectum

A

normal visceral afferent nerve fibres

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3
Q

what can affect faecal continence

A

neurological pathology, medications, old age degeneration of nerve innervation of muscle, consistency of stool

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4
Q

what does the pelvic cavity lie within

A

the bony pelvis- between the pelvic inlet and pelvic floor

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5
Q

what is the pelvic cavity continuous with

A

abdominal cavity

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6
Q

what separates the abdominal cavity and the pelvic cavity

A

peritonium

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7
Q

what does the pelvic cavity contain

A

pelvic organs and supporting tissues- inc rectum

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8
Q

what muscle is known as the pelvic floor

A

levator ani

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9
Q

what do openings in the levator ani allow

A

distal parts of the alimentary, renal and reproductive tracts to pass from the pelvic cavity to the perineum

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10
Q

at what vertebrae does the sigmoid colon become the rectum

A

anterior to S3 (recto-sigmoid junction)

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11
Q

where does the rectum become the anal canal

A

anterior to the coccyx just prior to passing through the levator ani muscle

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12
Q

are the rectim, anal canal and anus in the pelvis or perineum

A

rectum in pelvis

anal canal and anus in the perineum

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13
Q

what is the difference between sigmoid and rectum

A

looses tinae coli and has longitundinal muscle fibres

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14
Q

where is the rectal ampulla

A

lies immediately superior to the levator ani muscle

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15
Q

why does the rectum have three folds

A

create staggering effect, allow for expansion

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16
Q

what part of rectum in under conscious control

A

the sphincters

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17
Q

what covers the superior rectum

A

peritoneum

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18
Q

what lies anterior to the superior rectum

A

rectouterine (pouch of douglas) /retrovesical pouch

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19
Q

what lies anterior to the inferior rectum in males

A

prostate

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20
Q

what lies anterior to the middle/inferior rectum in females

A

the vagina

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21
Q

what type of muscles make up the levator ani

A

skeletal- controlled consciously

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22
Q

where does the puborectalis go between

A

both pubic bones- most medial

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23
Q

where does the pubococcygeus go between

A

from pubic bone to coccyx

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24
Q

where does the illiococcygeus go between

A

inner side of ischium to coccyx

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25
Q

what muscles makes up the levator ani

A

puborectalis
illiococcygeus
pubococcygeus

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26
Q

when does the levator ani reflexively contract

A

during increased intra-abdominal pressure (coughing sneezing)

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27
Q

what innervates the levator ani

A

‘nerve to levator ani’ (branch of sacral plexus) and pudenal (main nerve of perineum) S2,3,4 (keeps the poo off the floor)

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28
Q

what does the pubrorectalis do to maintain faecal continence

A

acts like a sphincter by contracting and decreasing the anorectal angle (skeletal so under voluntary control)

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29
Q

what are the two anal sphincters

A

interal (smooth muscle) and external (skeletal)

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30
Q

what stimulates the internal anal sphincter to contract

A

sympathetic stimulation

31
Q

where is the internal anal sphincter

A

superior two thrids

32
Q

contraction of the internal anal is inhibited by what

A

parasympathetic nerves

33
Q

when is the internal anal sphincter normally contracted and relaxed

A

contracted all the time- relaxes reflexively in response to distension (filling) of the rectal ampulla

34
Q

where is the external anal sphincter

A

inferior two thirds of the anal canal (superior part continuous with the puborectalis muscle)

35
Q

what stomulates the external anal sphincter to contract

A

pudendal nerve

36
Q

when does the external anal sphincter voluntarily contract

A

in response to rectal ampulla distention and internal sphincter relaxation

37
Q

what separates the pelvis from the perineum

A

the levator ani- above pelvis, below perineum

38
Q

what type of nerves supply structures in the pelvis

A

body cavity- sympathetic, parasympathetic, visceral afferent

39
Q

what type of nerves supply structures in the perineum

A

body wall- somatic motor and sensory

40
Q

what are the important spinal chord levels for nerve supply to the rectum/ anal canal

A

T12-L2 and S2-4

41
Q

what is the path and role of the sympathetic fibres from T12- L2

A

travel to inferior mesenteric ganaglia- synapse- then travel via parietal plexus around branches of the IMA

  • contraction of internal anal sphincters
  • inhibit peristalsis
42
Q

what is the path and role of the visceral afferent coming back to S2-4

A

run with the parasympathetics

-sense stretch, ischaemia etc

43
Q

what is the path and role of the parasympathetic fibres from S2-4

A

via pelvic splanchnic nerves, synapse in walls of rectum

  • inhibit internal anal sphincter
  • stimulate peristalsis
44
Q

what is the role of the somatic motor from pudendal nerve S2-4 and nerve to levator ani

A

contraction of external anal sphincter and puborectalis

45
Q

what is the pudendal nerve a branch of

A

the sacral plexus

46
Q

what anterior ramis makes up the pudendal nerve

A

S2,3,4

47
Q

via what does the pudendal nerve exit the pelvis

A

greater sciatic foramen

48
Q

how does the pudendal nerve enter the perineum

A

via lesser sciatic foramen

49
Q

what damage could result to loss of pelvic control during labour

A

tear of perineum, stretch of pudendal nerve, tear of puborectalis or external anal sphincter muscle fibres

50
Q

what is the pectinate line

A

marks the junction between the part of the embryo that formed the GI tract (endoderm) and the part that formed the skin (ectoderm)

51
Q

what changes when you cross the pectinate line

A

arterial supply, venous drainage, nerve supply, lymphatic drainage (superior= visceral inferior = parietal)

52
Q

describe the nerve supply above and below the pectinate line

A

above- autonomic

below- somatic and pudendal

53
Q

describe the arterial supply above and below the pectinate line

A

above- from IMA

below- from internal iliac artery

54
Q

describe the venous drainage above and below the pectinate line

A

above- to hepatic portal sysetm (via IMV)

below- to systemic venous system (internal iliac)

55
Q

describe the lymphatic drainage above and below the pectinate line

A

above- inferior mesenteric nodes (internal iliac nodes)

below- superficial inguinal nodes

56
Q

why may cancer above the pectinate line not be felt

A

as visceral sensory only

57
Q

where do lymph vessels tend to lie

A

alongside the arteries

58
Q

what are the main groups of lymph nodes draining the pelvic organs and what does each drain

A

internal iliacs- inferior pelvic structures

external iliacs- lower limb, more superior pelvic structures

common iliac- drains external and interbal iliac nodes

lumbar nodes- lymph from common iliac nodes then goes to here

59
Q

what artery supply with hindgut organs

A

IMA

60
Q

what is the hindgut

A

distal 1/3rd of the transverse colon to proximal ½ of the anal canal (the ½ superior to the pectinate line)

61
Q

what supplies the GI past the pectinate line (past the hindgut)

A

internal iliac artery (branches into middle and inferior rectal artery)

62
Q

what vein drains the hindgut organs

A

superior rectal vein-

IMV- portal venous system

63
Q

what vein drains below the pectinate line

A

middle and inferior rectal vein- internal iliac vein-

systemic venous system

64
Q

when do rectal varices from

A

when there is portal hypertension- dilatation of collateral veins between portal and systemic systems

65
Q

what are haemorrhoids and what causes them

A

prolapses of the rectal venous plexuses- NOT RELATED TO PORTAL HYPERTENSION- but caused by raised pressure (chronic hypertension, straining, pregnancy)

66
Q

where are the ischioanal fossae

A

lie on either side of the anal canal

67
Q

what are the ischioanal fossae filled with

A

fat and loose connective tissue

68
Q

where do the ischioanal foscae communicate

A

posteriorly

69
Q

what in an ischioanal abscess

A

an infection within the ischioanal fossa

70
Q

what do you assess in an digital rectal exam

A

anal tone- strength/ effectiveness of the anal sphincter

palpate the prostate/ cervix

71
Q

what is a proctoscopy

A

viewing the interior of the rectum

72
Q

what is a sigmoidoscopy

A

viewing the interior of the sigmoid colon

73
Q

what is a colonoscopy

A

viewing the interior of the colon

GI (64 decks)

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