Anorectum

Question 1

how long is the rectum?

Answer 1

12-15cm

Question 2

what are the two flexures in the anorectum?

Answer 2

1. sacral flexure
2. anorectal flexure

Question 3

what sphincter makes the resting pressure?

Answer 3

internal anal sphincter

Question 4

what type of muscle is the external anal sphincter?

Answer 4

skeletal muscle (voluntary)

Question 5

what is the anal sphincter an extension of?

Answer 5

puborectalis muscle

Question 6

what are hemorroids?

Answer 6

swollen vascular structure

Question 7

what can cause hermerroids

Answer 7

constipation, increase in abdominal pressure

Question 8

where are internal haemorrhoids and how painful are they?

Answer 8

above the dente line not painful

Question 9

where are external haemorrhoids?

Answer 9

bellow the dentate line - more painful and somatic innervation via the pudendal nerve

Question 10

what is included in the pelvic floor?

Answer 10

puborectalis muscle, IAS and EAS

Question 11

what group of muscles support the rectum, bladder other organs in that area?

Answer 11

pelvic floor

Question 12

what is the main muscle in the pelvic floor?

Answer 12

levator ani muscle:
(Iliococcygeus muscle, pubococcygeus muscle and the puborectalis)

Question 13

what three nervous systems can control voiding?

Answer 13

enteric, autonomic, and central

Question 14

what is the use of the central nervous system in defacating?

Answer 14

amplify/synchronise an enteric response

Question 15

which plexus innervates the muscularis layer and crypts to ensure sectretions?

Answer 15

Submucosal plexus

Question 16

which plexus is involved in propulsion of faeces by stimulating the circular and longitudinal layers?

Answer 16

myenteric plexus

Question 17

what are the two parts of the enteric nervous system?

Answer 17

submucosal and myenteric plexus

Question 18

where is the sympathetic innervation of the spinal cord from?

Answer 18

T11-L2 (thoracolumbar)

Question 19

what are the two key actions of the sympathetic nervous system in relation to the anorectum?

Answer 19

hypogastric nerve = rectum relax
internal anal sphincter = contract
=resting

Question 20

what are the two key actions of the parasympathetic nervous system in relation to the anorectum?

Answer 20

pelvic splanic nerve = rectum contract
internal sphincter = relax
pudendal nerve = external anal sphincter and puborectalis muscle contract

Question 21

function of the rectum?

Answer 21

• stoor or expel stool

Question 22

function of anal canal?

Answer 22

• maintain faecal incontinence
• control defecation

Question 23

what does RAIR stand for?

Answer 23

rectoanal inhibitory reflex

Question 24

does RAIR occur in people with hirschprungs?

Answer 24

no

Question 25

how many times an hour does RAIR occur?

Answer 25

4 times

Question 26

what is an obstetric injury?

Answer 26

injury through childbirth

Question 27

when does faecal inconitance occur?

Answer 27

when the resting pressure exceeds the anal canal pressure

Question 28

Name 5 causes of faecal incontinence

Answer 28

1. gastrointestinal (faecal impaction, IBD) 2. neurological (dementia or MS) 3. metabolic ( diabetes) 4. traumatic (childbirth or surgery) 5. congenital abnormalities

Question 29

what degree of tears is FI associated with?

Answer 29

3rd or 4th

Question 30

Name two non pharmacological treatments for fi

Answer 30

1. PTNS 2. Surgery

Question 31

Name 2 medications for FI

Answer 31

1. loperamide 2. bulking

Question 32

what does ODS stand for?

Answer 32

obstructed defaecation syndrome

Question 33

name three indications for ODS

Answer 33

1. fragmented stools 2. straining for defecation 3. incomplete evacuation

Question 34

name three treatments for ODS

Answer 34

1. conservative (increase fibre and water ) 2. biofeedback 3. surgery

Question 35

what results from an infection that starts in the anal gland?

Answer 35

fistulas

Question 36

what can identify fistulas?

Answer 36

MRI or ultrasound

Question 37

what is a small tear in the anal lining?

Answer 37

fissures

Question 38

what does a ultrasound use to take images?

Answer 38

non-ionising radiation (high frequency sound waves )

Question 39

what frequency of sound wave is used to look at larger disitances?

Answer 39

lower frequency

Question 40

what classification is used for anorectal manomtery?

Answer 40

London classification

Question 41

what happens with a low resting pressure?

Answer 41

leakage, anal sphincter injury, diabetic neuropathy

Question 42

what happens of resting pressure is too high?

Answer 42

constant engagement of puborectalis, constipation, fissures

Question 43

what are ultra slow waves associated with?

Answer 43

constipation and haemorrhoids

Question 44

what indicates anal dyssynergia

Answer 44

increase in anal pressure, so that anal pressure is higher than rectal pressure at all time points during the manoeuvre (recto-anal pressure gradient is negative)

Question 45

what should been seen in a cough?

Answer 45

anal canal pressure greater than rectal pressure

Question 46

when is normal cough pressures not seen?

Answer 46

cauda equina or pudendal neuropathy