DIGESTIVE SYSTEM, Continued - SMALL and LARGE INTESTINE (Third of Three Laboratories)
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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. -
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. -
48 Anal Canal
Anal Canal The rectum is a relatively straight continuation of the colon about 12 cm in length. Three internal transverse rectal valves (of Houston) occur in the distal rectum. Infoldings of the submucosa and the inner circular layer of the muscularis externa form these permanent sickle- shaped structures. The valves function in the separation of flatus from the developing fecal mass. The mucosa of the first part of the rectum is similar to that of the colon except that the intestinal glands are slightly longer and the lining epithelium is composed primarily of goblet cells. The distal 2 to 3 cm of the rectum forms the anal canal, which ends at the anus. Immediately proximal to the pectinate line, the intestinal glands become shorter and then disappear. At the pectinate line, the simple columnar intestinal epithelium makes an abrupt transition to noncornified stratified squamous epithelium. After a short transition, the noncornified stratified squamous epithelium becomes continuous with the keratinized stratified squamous epithelium of the skin at the level of the external anal sphincter. Beneath the epithelium of this region are simple tubular apocrine sweat glands, the circumanal glands. Proximal to the pectinate line, the mucosa of the anal canal forms large longitudinal folds called rectal columns (of Morgagni). The distal ends of the rectal columns are united by transverse mucosal folds, the anal valves. The recess above each valve forms a small anal sinus. It is at the level of the anal valves that the muscularis mucosae becomes discontinuous and then disappears. The submucosa of the anal canal contains numerous veins that form a large hemorrhoidal plexus. -
Anatomy of Small Intestine Doctors Notes Notes/Extra Explanation Please View Our Editing File Before Studying This Lecture to Check for Any Changes
Color Code Important Anatomy of Small Intestine Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives: At the end of the lecture, students should: List the different parts of small intestine. Describe the anatomy of duodenum, jejunum & ileum regarding: the shape, length, site of beginning & termination, peritoneal covering, arterial supply & lymphatic drainage. Differentiate between each part of duodenum regarding the length, level & relations. Differentiate between the jejunum & ileum regarding the characteristic anatomical features of each of them. Abdomen What is Mesentery? It is a double layer attach the intestine to abdominal wall. If it has mesentery it is freely moveable. L= liver, S=Spleen, SI=Small Intestine, AC=Ascending Colon, TC=Transverse Colon Abdomen The small intestines consist of two parts: 1- fixed part (no mesentery) (retroperitoneal) : duodenum 2- free (movable) part (with mesentery) :jejunum & ileum Only on the boys’ slides RELATION BETWEEN EMBRYOLOGICAL ORIGIN & ARTERIAL SUPPLY مهم :Extra Arterial supply depends on the embryological origin : Foregut Coeliac trunk Midgut superior mesenteric Hindgut Inferior mesenteric Duodenum: • Origin: foregut & midgut • Arterial supply: 1. Coeliac trunk (artery of foregut) 2. Superior mesenteric: (artery of midgut) The duodenum has 2 arterial supply because of the double origin The junction of foregut and midgut is at the second part of the duodenum Jejunum & ileum: • Origin: midgut • Arterial -
Progress Report Anal Continence
Gut: first published as 10.1136/gut.12.10.844 on 1 October 1971. Downloaded from Gut, 1971, 12, 844-852 Progress report Anal continence Anal continence depends on an adaptable barrier formed at the ano-rectal junction and in the anal canal by a combination of forces. These are due in part to the configuration of the region and in part to the action of muscles. The forces are activated in response to sensory information obtained from the rectum and the anal canal. In order to understand some of the concepts of the mechanism of anal continence, some of the features of the anatomy and physiology of the region will be discussed. Anatomy (Fig. 1) The lumen of the rectum terminates at the pelvic floor and is continued, downwards and posteriorly, as the anal canal, passing through the levator ani muscle sheet and surrounded by the internal and external anal sphincters. The anal canal is 2.5 to 5 cm in length and 3 cm in diameter when distended. The axis of the rectum forms almost a right angle (average 820) with the axis of the anal canal. It has been established by radiological studies that the anal canal is an antero-posterior slit in the resting state.' The former concept of http://gut.bmj.com/ the anal canal being surrounded successively craniocaudally by the internal anal sphincter and then the external anal sphincter has been replaced by the knowledge that the two muscles overlap to a considerable extent with the external sphincter wrapped round the internal sphincter2'3. -
Short Bowel Syndrome with Intestinal Failure Were Randomized to Teduglutide (0.05 Mg/Kg/Day) Or Placebo for 24 Weeks
Short Bowel (Gut) Syndrome LaTasha Henry February 25th, 2016 Learning Objectives • Define SBS • Normal function of small bowel • Clinical Manifestation and Diagnosis • Management • Updates Basic Definition • A malabsorption disorder caused by the surgical removal of the small intestine, or rarely it is due to the complete dysfunction of a large segment of bowel. • Most cases are acquired, although some children are born with a congenital short bowel. Intestinal Failure • SBS is the most common cause of intestinal failure, the state in which an individual’s GI function is inadequate to maintain his/her nutrient and hydration status w/o intravenous or enteral supplementation. • In addition to SBS, diseases or congenital defects that cause severe malabsorption, bowel obstruction, and dysmotility (eg, pseudo- obstruction) are causes of intestinal failure. Causes of SBS • surgical resection for Crohn’s disease • Malignancy • Radiation • vascular insufficiency • necrotizing enterocolitis (pediatric) • congenital intestinal anomalies such as atresias or gastroschisis (pediatric) Length as a Determinant of Intestinal Function • The length of the small intestine is an important determinant of intestinal function • Infant normal length is approximately 125 cm at the start of the third trimester of gestation and 250 cm at term • <75 cm are at risk for SBS • Adult normal length is approximately 400 cm • Adults with residual small intestine of less than 180 cm are at risk for developing SBS; those with less than 60 cm of small intestine (but with a -
Gastrointestinal Motility Disorders of the Small Intestine, Large Intestine, Rectum, and Pelvic Floor
IFFGD International Foundation for PO Box 170864 Functional Gastrointestinal Disorders Milwaukee, WI 53217 www.iffgd.org Lower GI Motility (162) © Copyright 2001 by William E. Whitehead. Published here with permission. Gastrointestinal Motility Disorders of the Small Intestine, Large Intestine, Rectum, and Pelvic Floor By: William E. Whitehead, Ph.D. Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC Each part of the gastrointestinal tract has a unique function to perform in digestion, and as a result each part has a distinct type of motility and sensation. When motility or sensations are not appropriate for performing this function, they cause symptoms . IFFGD PO Box 17086 kee, WI 53217 Gastrointestinal Motility Disorders of the Small Intestine, Large Intestine, Rectum, and Pelvic Floor By: William E. Whitehead, Ph.D., Director, Center for Functional GI and Motility Disorders; Professor, Division of Gastroenterology and Hepatology; and Adjunct Professor, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC Normal Gastrointestinal Motility and Function Between meals, the intestine shows cycles of activity “Motility” is a term used to describe the contraction of the that repeat about every 90–120 minutes. These are easiest to muscles in the gastrointestinal tract. Because the see at night when there is a longer period between meals, gastrointestinal tract is a circular tube, when these muscles because meals suppress these cycles. The cycle consists of a contract, they close off the tube or make the opening inside short period of no contractions (Phase I), followed by a long smaller – they squeeze. -
Anatomy of the Small Intestine
Anatomy of the small intestine Make sure you check this Correction File before going through the content Small intestine Fixed Free (Retro peritoneal part) (Movable part) (No mesentery) (With mesentery) Duodenum Jejunum & ileum Duodenum Shape C-shaped loop Duodenal parts Length 10 inches Length Level Beginning At pyloro-duodenal Part junction FIRST PART 2 INCHES L1 (Superior) (Transpyloric Termination At duodeno-jejunal flexure Plane) SECOND PART 3 INCHES DESCENDS Peritoneal Retroperitoneal (Descending FROM L1 TO covering L3 Divisions 4 parts THIRD PART 4 INCHES L3 (SUBCOTAL (Horizontal) PLANE) Embryologic Foregut & midgut al origin FOURTH PART 1 INCHES ASCENDS Lymphatic Celiac & superior (Ascending) FROM L3 TO drainage mesenteric L2 Arterial Celiac & superior supply mesenteric Venous Superior mesenteric& Drainage Portal veins Duodenal relations part Anterior Posterior Medial Lateral First part Liver Bile duct - - Gastroduodenal artery Portal vein Second Part Liver Transverse Right kidney Pancreas Right colic flexure Colon Small intestine Third Part Small intestine Right psoas major - - Superior Inferior vena cava mesenteric vessels Abdominal aorta Inferior mesenteric vessels Fourth Part Small intestine Left psoas major - - Openings in second part of the duodenum Opening of accessory Common opening of bile duct pancreatic duct (one inch & main pancreatic duct: higher): on summit of major duodenal on summit of minor duodenal papilla. papilla. Jejunum & ileum Shape Coiled tube Length 6 meters (20 feet) Beginning At duodeno-jejunal flexur -
Studies of the Reflex Activity of the External Sphincter Ani in Spinal Man
STUDIES OF THE REFLEX ACTIVITY OF THE EXTERNAL SPHINCTER ANI IN SPINAL MAN By J. MELZAK, M.D. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury and N. H. PORTER, F.R.C.S. Department of Surgery, Guy's Hospital, London INTRODUCTION IN normal man, the anus remains closed unless faeces or wind are to be evacuated. Anal closure is maintained by the tone of the anal sphincters. The importance of the internal and external anal sphincters in maintaining anal closure has for long been a controversial subject. Gowers (I877) made classical contributions to the understanding of visceral reflexes and sphincter activity. He postulated a complex lumbar reflex centre controlling the function of the rectum and anal sphincter. He demonstrated tonic contraction of the anal sphincter in paraplegic patients, pro vided the lumbar segments of the cord and the corresponding motor and sensory nerves were intact. Starling (I900) considered that both sphincters were tonically contracted. Frankl-Hochwart and Frohlich (I900) found that 60 per cent. of the tonic closure of the anus in dogs was due to the activity of the external sphincter. Matti (I 909, I9I 0) considered that both sphincters were tonically contracted in man and dogs. Denny-Brown and Robertson (I935) concluded from their studies that the postural tone of the internal anal sphincter was a local phenomenon and related to the peripheral nervous plexus. They also held the view that the external sphincter on the other hand was not tonically contracted. The external anal sphincter has repeatedly been the subject of electromyo graphic investigation. In I930, Beck, using steel needle electrodes and a string galvanometer, observed action potentials on contraction and relaxation of this muscle in a number of dogs and in one man. -
Macrophage Density in Pharyngeal and Laryngeal Muscles Greatly Exceeds That in Other Striated Muscles: an Immunohistochemical Study Using Elderly Human Cadavers
Original Article http://dx.doi.org/10.5115/acb.2016.49.3.177 pISSN 2093-3665 eISSN 2093-3673 Macrophage density in pharyngeal and laryngeal muscles greatly exceeds that in other striated muscles: an immunohistochemical study using elderly human cadavers Sunki Rhee1, Masahito Yamamoto1, Kei Kitamura1, Kasahara Masaaki1, Yukio Katori2, Gen Murakami3, Shin-ichi Abe1 1Department of Anatomy, Tokyo Dental College, Tokyo, 2Department of Otorhinolaryngology, Tohoku University School of Medicine, Sendai, 3Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan Abstract: Macrophages play an important role in aging-related muscle atrophy (i.e., sarcopenia). We examined macrophage density in six striated muscles (cricopharyngeus muscle, posterior cricoarytenoideus muscle, genioglossus muscle, masseter muscle, infraspinatus muscle, and external anal sphincter). We examined 14 donated male cadavers and utilized CD68 immunohistochemistry to clarify macrophage density in muscles. The numbers of macrophages per striated muscle fiber in the larynx and pharynx (0.34 and 0.31) were 5–6 times greater than those in the tongue, shoulder, and anus (0.05–0.07) with high statistical significance. Thick muscle fibers over 80 μm in diameter were seen in the pharynx, larynx, and anal sphincter of two limited specimens. Conversely, in the other sites or specimens, muscle fibers were thinner than 50 μm. We did not find any multinuclear muscle cells suggestive of regeneration. At the beginning of the study, we suspected that mucosal macrophages might have invaded into the muscle layer of the larynx and pharynx, but we found no evidence of inflammation in the mucosa. Likewise, the internal anal sphincter (a smooth muscle layer near the mucosa) usually contained fewer macrophages than the external sphincter. -
Anatomy of Anal Canal
Anatomy of Anal Canal Dr Garima Sehgal Associate Professor Department of Anatomy King George’s Medical University, UP, Lucknow DISCLAIMER: • The presentation includes images which are either hand drawn or have been taken from google images or books. • They are being used in the presentation only for educational purpose. • The author of the presentation claims no personal ownership over images taken from books or google images. • However, the hand drawn images are the creation of the author of the presentation Subdivisions of the perineum • Transverse line joining the anterior part of ischial tuberosities divides perineum into: 1. Urogenital region / triangle- ANTERIORLY 2. Anal region / triangle - POSTERIORLY Anal canal may be affected by many conditions that are not so rare, not necessarily serious and endangering to life but on the contrary very INCAPACITATING Haemorrhoids Anal fistula Anal fissure Perianal abscess Learning objectives At the end of this teaching session on anatomy of Anal canal all the MBBS 1st Year students must be able to correctly: • Describe the location, extent and dimensions of the anal canal • Enumerate the relations of the anal canal • Enumerate the subdivisions of anal canal • Describe & Diagrammatically display the special features on the interior of the anal canal • Discuss the importance of pectinate / dentate line • Write a short note on the arterial supply, venous drainage, nerve supply & lymphatic drainage • Write a short note on the sphincters of the anal canal • Describe the anatomical basis of internal