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The Anatomy of the Rectum and Anal Canal
BASIC SCIENCE identify the rectosigmoid junction with confidence at operation. The anatomy of the rectum The rectosigmoid junction usually lies approximately 6 cm below the level of the sacral promontory. Approached from the distal and anal canal end, however, as when performing a rigid or flexible sigmoid- oscopy, the rectosigmoid junction is seen to be 14e18 cm from Vishy Mahadevan the anal verge, and 18 cm is usually taken as the measurement for audit purposes. The rectum in the adult measures 10e14 cm in length. Abstract Diseases of the rectum and anal canal, both benign and malignant, Relationship of the peritoneum to the rectum account for a very large part of colorectal surgical practice in the UK. Unlike the transverse colon and sigmoid colon, the rectum lacks This article emphasizes the surgically-relevant aspects of the anatomy a mesentery (Figure 1). The posterior aspect of the rectum is thus of the rectum and anal canal. entirely free of a peritoneal covering. In this respect the rectum resembles the ascending and descending segments of the colon, Keywords Anal cushions; inferior hypogastric plexus; internal and and all of these segments may be therefore be spoken of as external anal sphincters; lymphatic drainage of rectum and anal canal; retroperitoneal. The precise relationship of the peritoneum to the mesorectum; perineum; rectal blood supply rectum is as follows: the upper third of the rectum is covered by peritoneum on its anterior and lateral surfaces; the middle third of the rectum is covered by peritoneum only on its anterior 1 The rectum is the direct continuation of the sigmoid colon and surface while the lower third of the rectum is below the level of commences in front of the body of the third sacral vertebra. -
Fecal Incontinence/Anal Incontinence
Fecal Incontinence/Anal Incontinence What are Fecal incontinence/ Anal Incontinence? Fecal incontinence is inability to control solid or liquid stool. Anal incontinence is the inability to control gas and mucous in addition to the inability to control stool. The symptoms range from mild release of gas to a complete loss of control. It is a common problem affecting 1 out of 13 women under the age of 60 and 1 out of 7 women over the age of 60. Men can also be have this condition. Anal incontinence is a distressing condition that can interfere with the ability to work, do daily activities and enjoy social events. Even though anal incontinence is a common condition, people are uncomfortable discussing this problem with family, friends, or doctors. They often suffer in silence, not knowing that help is available. Normal anatomy The anal sphincters and puborectalis are the primary muscles responsible for continence. There are two sphincters: the internal anal sphincter, and the external anal sphincter. The internal sphincter is responsible for 85% of the resting muscle tone and is involuntary. This means, that you do not have control over this muscle. The external sphincter is responsible for 15% of your muscle tone and is voluntary, meaning you have control over it. Squeezing the puborectalis muscle and external anal sphincter together closes the anal canal. Squeezing these muscles can help prevent leakage. Puborectalis Muscle Internal Sphincter External Sphincter Michigan Bowel Control Program - 1 - Causes There are many causes of anal incontinence. They include: Injury or weakness of the sphincter muscles. Injury or weakening of one of both of the sphincter muscles is the most common cause of anal incontinence. -
Rectum & Anal Canal
Rectum & Anal canal Dr Brijendra Singh Prof & Head Anatomy AIIMS Rishikesh 27/04/2019 EMBRYOLOGICAL basis – Nerve Supply of GUT •Origin: Foregut (endoderm) •Nerve supply: (Autonomic): Sympathetic Greater Splanchnic T5-T9 + Vagus – Coeliac trunk T12 •Origin: Midgut (endoderm) •Nerve supply: (Autonomic): Sympathetic Lesser Splanchnic T10 T11 + Vagus – Sup Mesenteric artery L1 •Origin: Hindgut (endoderm) •Nerve supply: (Autonomic): Sympathetic Least Splanchnic T12 L1 + Hypogastric S2S3S4 – Inferior Mesenteric Artery L3 •Origin :lower 1/3 of anal canal – ectoderm •Nerve Supply: Somatic (inferior rectal Nerves) Rectum •Straight – quadrupeds •Curved anteriorly – puborectalis levator ani •Part of large intestine – continuation of sigmoid colon , but lacks Mesentery , taeniae coli , sacculations & haustrations & appendices epiploicae. •Starts – S3 anorectal junction – ant to tip of coccyx – apex of prostate •12 cms – 5 inches - transverse slit •Ampulla – lower part Development •Mucosa above Houstons 3rd valve endoderm pre allantoic part of hind gut. •Mucosa below Houstons 3rd valve upto anal valves – endoderm from dorsal part of endodermal cloaca. •Musculature of rectum is derived from splanchnic mesoderm surrounding cloaca. •Proctodeum the surface ectoderm – muco- cutaneous junction. •Anal membrane disappears – and rectum communicates outside through anal canal. Location & peritoneal relations of Rectum S3 1 inch infront of coccyx Rectum • Beginning: continuation of sigmoid colon at S3. • Termination: continues as anal canal, • one inch below -
The Oesophagus Lined with Gastric Mucous Membrane by P
Thorax: first published as 10.1136/thx.8.2.87 on 1 June 1953. Downloaded from Thorax (1953), 8, 87. THE OESOPHAGUS LINED WITH GASTRIC MUCOUS MEMBRANE BY P. R. ALLISON AND A. S. JOHNSTONE Leeds (RECEIVED FOR PUBLICATION FEBRUARY 26, 1953) Peptic oesophagitis and peptic ulceration of the likely to find its way into the museum. The result squamous epithelium of the oesophagus are second- has been that pathologists have been describing ary to regurgitation of digestive juices, are most one thing and clinicians another, and they have commonly found in those patients where the com- had the same name. The clarification of this point petence ofthecardia has been lost through herniation has been so important, and the description of a of the stomach into the mediastinum, and have gastric ulcer in the oesophagus so confusing, that been aptly named by Barrett (1950) " reflux oeso- it would seem to be justifiable to refer to the latter phagitis." In the past there has been some dis- as Barrett's ulcer. The use of the eponym does not cussion about gastric heterotopia as a cause of imply agreement with Barrett's description of an peptic ulcer of the oesophagus, but this point was oesophagus lined with gastric mucous membrane as very largely settled when the term reflux oesophagitis " stomach." Such a usage merely replaces one was coined. It describes accurately in two words confusion by another. All would agree that the the pathology and aetiology of a condition which muscular tube extending from the pharynx down- is a common cause of digestive disorder. -
Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal. -
Name: David Daniella Christabel Matric Number: 18/MHS03/002 Department: Anatomy College: Medicine and Health Sciences Course Code: Ana 212
Name: David Daniella Christabel Matric Number: 18/MHS03/002 Department: Anatomy College: Medicine And Health Sciences Course Code: Ana 212 Question: Discuss the anal canal. The anal canal is the terminal segment of the large intestine between the rectum and the anus. The anal canal is located within the anal triangle of the perineum between the right and left ischioanal fosse. It is the final segment of the gastrointestinal tract, around 4cm in length. The canal begins as a continuation of the rectum and passes inferoposteriorly to terminate at the anus. Anal canal is traditionally divided into two segments, upper and lower, separated by the pectinate line also known as the dentate line. Except during defecation, the anal canal is collapsed by the internal and external sphincters to prevent the passage of faecal material. The anal canal is surrounded by internal and external anal sphincters, which play a crucial role in the maintenance of the faecal continence. • Internal Anal Sphincters: surrounds the upper 2/3 of the anal canal. It is formed from a thickening of the involuntary circular smooth muscle in the bowel wall. • External Anal Sphincter: voluntary muscle that surrounds the lower 2/3 of the anal canal (and so overlaps with the internal sphincter). It blends superiorly with the puborecrtalis muscle of the pelvic floor. At the junction of the rectum and the anal canal, there is a muscular ring known as the anorectal ring. It is formed by the fusion of the internal anal sphincter, external anal sphincter and puborectalis muscle, and is palpable on digital rectal examination. -
The Digestive System
Connective tissue The Digestive System Part 1 Structure of digestive system Functions Basic Structure of the Alimentary Canal Wall Tube is made up of four layers: 1. Mucosa 2. Submucosa 3. Muscularis externa 4. Serosa (Peritoneum) or Adventitia Mucosa The innermost wall of the alimentary tube. Consists of: • Epithelium - usually simple columnar epithelium with goblet cells; may be stratified squamous if protection is needed (e.g. esophagus) • Lamina propria – loose connective tissue • Muscularis mucosae – takes part in the formation of folds Submucosa Made up of loose connective tissue. Contains submucosal (Meissner’s) nervous plexus and blood vessels, sometimes glands. Muscularis externa Usually two layers of smooth muscle: • inner circular layer • outer longitudinal layer. • Myenteric (Auerbach’s) nervous plexus in between • Responsible for peristalsis (controlled by the nerve plexus) Outer membrane • A serous membrane/peritoneum consisting of the mesothelium (simple squamous epithelium), and a small amount of underlying loose connective tissue. • Or adventitia consisting only of connective tissue is found where the wall of the tube is directly attached or fixed to adjoining structures (i.e., body wall and certain organs). Enteric nervous system The Alimentary Canal Pharynx Common respiratory and digestive pathway (both air and swallowed food and drinks pass through). • Stratified squamous non-keratinized epithelium • Lamina propria contains many elastic fibers • No muscularis mucosae • No submucosa • Striated muscle in the muscularis externa Esophagus Fixed muscular tube that delivers food and liquid from the pharynx to the stomach. Esophagus Epithelium - stratified squamous Mucosal and submucosal glands of the esophagus secrete mucus to lubricate and protect the luminal wall. Esophageal glands proper lie in the submucosa. -
Vestibule Lingual Frenulum Tongue Hyoid Bone Trachea (A) Soft Palate
Mouth (oral cavity) Parotid gland Tongue Sublingual gland Salivary Submandibular glands gland Esophagus Pharynx Stomach Pancreas (Spleen) Liver Gallbladder Transverse colon Duodenum Descending colon Small Jejunum Ascending colon intestine Ileum Large Cecum intestine Sigmoid colon Rectum Appendix Anus Anal canal © 2018 Pearson Education, Inc. 1 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 2 Upper lip Gingivae Hard palate (gums) Soft palate Uvula Palatine tonsil Oropharynx Tongue (b) © 2018 Pearson Education, Inc. 3 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 4 Visceral peritoneum Intrinsic nerve plexuses • Myenteric nerve plexus • Submucosal nerve plexus Submucosal glands Mucosa • Surface epithelium • Lamina propria • Muscle layer Submucosa Muscularis externa • Longitudinal muscle layer • Circular muscle layer Serosa (visceral peritoneum) Nerve Gland in Lumen Artery mucosa Mesentery Vein Duct oF gland Lymphoid tissue outside alimentary canal © 2018 Pearson Education, Inc. 5 Diaphragm Falciform ligament Lesser Liver omentum Spleen Pancreas Gallbladder Stomach Duodenum Visceral peritoneum Transverse colon Greater omentum Mesenteries Parietal peritoneum Small intestine Peritoneal cavity Uterus Large intestine Cecum Rectum Anus Urinary bladder (a) (b) © 2018 Pearson Education, Inc. 6 Cardia Fundus Esophagus Muscularis Serosa externa • Longitudinal layer • Circular layer • Oblique layer Body Lesser Rugae curvature of Pylorus mucosa Greater curvature Duodenum Pyloric Pyloric sphincter antrum (a) (valve) © 2018 Pearson Education, Inc. 7 Fundus Body Rugae of mucosa Pyloric Pyloric (b) sphincter antrum © 2018 Pearson Education, Inc. -
The Small and Large Intestines∗
OpenStax-CNX module: m46512 1 The Small and Large Intestines∗ OpenStax College This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0y Abstract By the end of this section, you will be able to: • Compare and contrast the location and gross anatomy of the small and large intestines • Identify three main adaptations of the small intestine wall that increase its absorptive capacity • Describe the mechanical and chemical digestion of chyme upon its release into the small intestine • List three features unique to the wall of the large intestine and identify their contributions to its function • Identify the benecial roles of the bacterial ora in digestive system functioning • Trace the pathway of food waste from its point of entry into the large intestine through its exit from the body as feces The word intestine is derived from a Latin root meaning internal, and indeed, the two organs together nearly ll the interior of the abdominal cavity. In addition, called the small and large bowel, or colloquially the guts, they constitute the greatest mass and length of the alimentary canal and, with the exception of ingestion, perform all digestive system functions. 1 The Small Intestine Chyme released from the stomach enters the small intestine, which is the primary digestive organ in the body. Not only is this where most digestion occurs, it is also where practically all absorption occurs. The longest part of the alimentary canal, the small intestine is about 3.05 meters (10 feet) long in a living person (but about twice as long in a cadaver due to the loss of muscle tone). -
The Digestive System Overview of the Digestive System • Organs Are Divided Into Two Groups the Alimentary Canal and Accessory
C H A P T E R 23 The Digestive System 1 Overview of the Digestive System • Organs are divided into two groups • The alimentary canal • Mouth, pharynx, and esophagus • Stomach, small intestine, and large intestine (colon) • Accessory digestive organs • Teeth and tongue • Gallbladder, salivary glands, liver, and pancreas 2 The Alimentary Canal and Accessory Digestive Organs Mouth (oral cavity) Parotid gland Tongue Sublingual gland Salivary glands Submandibular gland Esophagus Pharynx Stomach Pancreas (Spleen) Liver Gallbladder Transverse colon Duodenum Descending colon Small intestine Jejunum Ascending colon Ileum Cecum Large intestine Sigmoid colon Rectum Anus Vermiform appendix Anal canal Figure 23.1 3 1 Digestive Processes • Ingestion • Propulsion • Mechanical digestion • Chemical digestion • Absorption • Defecation 4 Peristalsis • Major means of propulsion • Adjacent segments of the alimentary canal relax and contract Figure 23.3a 5 Segmentation • Rhythmic local contractions of the intestine • Mixes food with digestive juices Figure 23.3b 6 2 The Peritoneal Cavity and Peritoneum • Peritoneum – a serous membrane • Visceral peritoneum – surrounds digestive organs • Parietal peritoneum – lines the body wall • Peritoneal cavity – a slit-like potential space Falciform Anterior Visceral ligament peritoneum Liver Peritoneal cavity (with serous fluid) Stomach Parietal peritoneum Kidney (retroperitoneal) Wall of Posterior body trunk Figure 23.5 7 Mesenteries • Lesser omentum attaches to lesser curvature of stomach Liver Gallbladder Lesser omentum -
Structure of the Human Body
STRUCTURE OF THE HUMAN BODY Vertebral Levels 2011 - 2012 Landmarks and internal structures found at various vertebral levels. Vertebral Landmark Internal Significance Level • Bifurcation of common carotid artery. C3 Hyoid bone Superior border of thyroid C4 cartilage • Larynx ends; trachea begins • Pharynx ends; esophagus begins • Inferior thyroid A crosses posterior to carotid sheath. • Middle cervical sympathetic ganglion C6 Cricoid cartilage behind inf. thyroid a. • Inferior laryngeal nerve enters the larynx. • Vertebral a. enters the transverse. Foramen of C 6. • Thoracic duct reaches its greatest height C7 Vertebra prominens • Isthmus of thyroid gland Sternoclavicular joint (it is a • Highest point of apex of lung. T1 finger's breadth below the bismuth of the thyroid gland T1-2 Superior angle of the scapula T2 Jugular notch T3 Base of spine of scapula • Division between superior and inferior mediastinum • Ascending aorta ends T4 Sternal angle (of Louis) • Arch of aorta begins & ends. • Trachea ends; primary bronchi begin • Heart T5-9 Body of sternum T7 Inferior angle of scapula • Inferior vena cava passes through T8 diaphragm T9 Xiphisternal junction • Costal slips of diaphragm T9-L3 Costal margin • Esophagus through diaphragm T10 • Aorta through diaphragm • Thoracic duct through diaphragm T12 • Azygos V. through diaphragm • Pyloris of stomach immediately above and to the right of the midline. • Duodenojejunal flexure to the left of midline and immediately below it Tran pyloric plane: Found at the • Pancreas on a line with it L1 midpoint between the jugular • Origin of Superior Mesenteric artery notch and the pubic symphysis • Hilum of kidneys: left is above and right is below. • Celiac a. -
Subserosal Haematoma of the Ileum
Arch Dis Child: first published as 10.1136/adc.35.183.509 on 1 October 1960. Downloaded from SUBSEROSAL HAEMATOMA OF THE ILEUM BY ANTONIO GENTIL MARTINS From the Department of Surgery, Alder Hey Children's Hospital, Liverpool (RECEIVED FCR PUBLICATION DECEMBER 21, 1959) Angiomas of the ileum are rare. Their association communicate with the lumen of the small bowel. with a duplication cyst has not so far been described. Opposite, the mucosa had a small erosion'. The unusual mode of presentation, with intestinal Microscopical examination (Figs. 3, 4 and 5) showed and a palpable mass (subserosal that 'considerable haemorrhage had occurred in the obstruction serous, muscular and mucous coats. The mucosa, haematoma) simulating intussusception, have however, was viable and the maximal zone of damage prompted the report of the present case. was towards the serosa. Numerous large capillaries were present in the coats. The lining of the diverticulum Case Report formed by glandular epithelium suggesting ileal mucosa N.C., a white male infant, born June 18, 1958, was was partly destroyed, but it had a well-formed muscular admitted to hospital on May 18, 1959, when 11 months coat': it was considered to be probably a duplication. old, with a five days' history of being irritable and appar- The main diagnosis was that of haemangioma of the ently suffering from severe colicky abdominal pain for ileum. the previous 24 hours. On the day of admission his bowels had not moved and he vomited several times. He looked pale and ill and a mass could be felt in the copyright.