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Gastrointestinal > Faecal Continence > Flashcards

Faecal Continence Flashcards

1
Q

requirements for control of excretion of faeces

A

a holding area
normal visceral afferent nerve fibres
functioning muscle sphincters
normal cerebral function

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2
Q

describe the holding area for control of excretion of faeces

A

the rectum;

stores faeces until appropriate to defecate

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3
Q

describe the normal visceral afferent nerve fibres for control of excretion of faeces

A

senses fullness of the rectum

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4
Q

describe the functioning muscle sphincters for control of excretion of faeces

A

respond to fullness of the rectum;
appropriately contract, preventing defecation
relax, allowing defecation

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5
Q

describe normal cerebral function for control of excretion of faeces

A

controls appropriate time t defecate

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6
Q

what can affect normal excretion of faeces

A

neurological pathology
medications
degeneration of nerve innervation of muscle (age-related)
consistency of stool (diarrhoea)

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7
Q

neurological pathology affecting normal excretion of faeces

A

dementia
stroke
MS
trauma (spina cord injury)

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8
Q

where is pelvic cavity located

A

within boy pelvis
continuous with abdominal cavity
between pelvic inlet and pelvic floor

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9
Q

what does pelvic cavity contain

A

pelvic organs and supporting tissues

rectum

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10
Q

what do openings in the pelvic floor permit

A

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

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11
Q

where does sigmoid colon become rectum

A

anterior to S3;

rectosigmoid junction

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12
Q

where does rectum become anal canal

A

anterior to tip of coccyx prior to passing through pelvic floor

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13
Q

where is anus located

A

distal end of anal canal

in the perineum

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14
Q

describe the anus

A

the orifice through which faeces pass

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15
Q

where is rectum located

A

in the pelvic

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16
Q

where is anal canal located

A

in the perineum

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17
Q

where does rectal ampulla lie

A

immediately superior to elevator ani muscle

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18
Q

role of the rectum

A

walls can relax - accommodating faecal material

functioning muscles and muscle sphincters required to hold faeces in ampulla until appropriate to defecate

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19
Q

what part of the rectum does the peritoneum cover

A

superior rectum

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20
Q

pouches of peritoneum

A

rectouterine (pouch of Douglas)

rectovesical

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21
Q

anatomical relationship between pouches of peritoneum and rectum

A

pouches lie anterior to superior rectum

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22
Q

anatomical relationship between prostate gland and rectum

A

prostate gland anterior to inferior rectum

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23
Q

anatomical relationship between vagina and cervix and rectum

A

vagina and cervix anterior to inferior/middle rectum

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24
Q

proper name for pelvic floor muscles

A

lavator ani msucles

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25
Q

what do pelvic floor muscles form

A

forms most of pelvic diaphragm - floor of pelvis and roof of perineum
together with fascial coverings

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26
Q

what is the pelvic floor made up of

A

a number of small skeletal muscles;
iliococcygeus
pubococcygeus
puborectalis

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27
Q

function of pelvic floor

A

provides continual support for pelvic organs - tonically contracted most of time

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28
Q

further contraction of pelvic floor

A

increases during an increase in intra-abdominal pressure (e.g. coughing, sneezing)

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29
Q

relaxation of pelvic floor

A

allows defecation and urination

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30
Q

nerve supply of pelvic floor

A

the nerve to levator ani

pudendal

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31
Q

describe the nerve of levator ani

A

branch of sacral plexus

32
Q

describe the pudendal nerve

A

from S2, 3, 4

33
Q

what is the puborectalis

A

part of levator ani muscle

skeletal muscle

34
Q

role of puborectalis

A

maintains faecal continence

35
Q

contraction of puborectalis

A

decreases anorectal angle- acting like a sphincter

helps maintain continence

36
Q

describe the anal sphincters

A

2;
internal - smooth muscle
external - skeletal muscle

37
Q

where is internal anal sphincter located

A

superior 2/3 of anal canal

38
Q

how is contraction stimulated in internal anal sphincter

A

sympathetic nerves

39
Q

how is contraction inhibited in internal anal sphincter

A

parasympathetic nerves - in response to distension of rectal ampulla

40
Q

where is external anal canal sphincter located

A

inferior 2/3 of anal canal

superior part of sphincter continuous with puborectalis muscle

41
Q

how is contraction stimulated in external anal sphincter

A

pudendal nerve - in repose to rectal ampulla distension and internal sphincter relaxation

42
Q

where do sympathetic nerve fibres of rectum/anal canal leave the spinal cord

A

T12-L2

43
Q

course of sympathetic nerve fibres of rectum/anal canal

A

synapse at inferior mesenteric ganglia

reach rectum via periarterial plexuses around branches of IMA

44
Q

where do visceral afferents of rectum/anal canal leave spinal cord

A

S2-S4

45
Q

visceral afferents of rectum/anal canal

A

run with parasympathetics

sense stretch

46
Q

where do parasympathetic nerve fibres of rectum/anal canal leave spinal cord

A

S2-S4

47
Q

course of parasympathetic nerve fibres of rectum/anal canal

A

leave spinal cord via splanchnic nerves

synapse in walls of rectum

48
Q

function of parasympathetic nerve fibres of rectum/anal canal

A

inhibits internal anal sphincter

stimulates peristalsis

49
Q

somatic motor nerve of rectum/anal canal

A

come from pudendal nerve (S2-S4) and nerve to levator ani (S3-S4)

50
Q

function of somatic motor nerve of rectum/anal canal

A

contraction of external anal sphincter and puborectalis

51
Q

what is the pudendal nerve a branch of

A

branch of sacral plexus

S2, S3, S4 anterior rami

52
Q

what does the pudendal nerve supply

A

supplies external anal sphincter

53
Q

how does pudendal nerve exit pelvis

A

via greater sciatic foramen

54
Q

how does pudendal nerve enter perineum

A

via lesser sciatic foramen

55
Q

branches of pudendal nerve

A

branches to supply structures of perineum

56
Q

how can pudendal nerve/sphincter be damaged

A

during labour;
stretched
torn - weakened muscles

can cause faecal incontinence

57
Q

what is the pectinate line

A

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

58
Q

arterial supply superior to pectinate line

A

from inferior mesenteric artery

59
Q

venous drainage superior to pectinate line

A

to portal venous system (IMV)

60
Q

nerve supply superior to pectinate line

A

autonomic

61
Q

lymphatic drainage superior to pectinate line

A

inferior mesenteric nodes (internal iliac nodes)

62
Q

arterial supply inferior to pectinate line

A

from internal iliac artery

63
Q

venous drainage inferior to pectinate line

A

to systemic venous system (internal iliac)

64
Q

nerve supply inferior to pectinate line

A

somatic

pudendal

65
Q

lymphatic drainage inferior to pectinate line

A

superficial inguinal nodes

66
Q

describe the lymphatics of the pelvis

A

lie alongside the arteries

67
Q

what do internal iliac lymph nodes drain

A

inferior pelvic structures

68
Q

what do external iliac lymph nodes drain

A

lower limb

superior pelvic structures

69
Q

what do common iliac lymph nodes drain

A

lymph from external and internal iliac nodes then onto lumbar nodes

70
Q

arterial supply of rectum and anal canal

A

internal iliac artery - degree of anastomoses

71
Q

how do rectal varies form

A

in relation to portal hypertension

dilation of collateral veins between portal and systemic venous system

72
Q

what are haemorrhoids

A

prolapses of rectal venous plexuses

73
Q

how do haemorrhoids form

A

raised pressure (e.g. chronic constipation, training, pregnancy)

74
Q

where are ischionanal fossae found

A

lie on each side of anal canal (left and right)

75
Q

what are ischioanal fossae filled with

A

fat and loose connective tissue

76
Q

how do the 2 ischionanal fossae communicate with each other

A

posteriorly

77
Q

infeciton within ischioanal fossa

A

ischioanal abscess

Gastrointestinal (71 decks)

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