Digestive System DIGESTIVE SYSTEM
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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. -
Selecting Different Approaches for Palate and Pharynx Surgery
SPECIAL ISSUE 4: INVITED ARTICLE Selecting Different Approaches for Palate and Pharynx Surgery: Palatopharyngeal Arch Staging System Rodolfo Lugo-Saldaña1 , Karina Saldívar-Ponce2 , Irina González-Sáez3 , Daniela Hernández-Sirit4 , Patricia Mireles-García5 ABSTRACT The examination of the anatomical structures involved in the upper airway collapse in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS) is a key for integrated evaluation of patients. Our proposal is for a noninvasive classification system that guides us about the presence of anatomical differences between the palatopharyngeal muscle (PFM). The functions of the PFM are narrowing the isthmus, descending the palate, and raising the larynx during swallowing; these characteristics give the PFM a special role in the collapse of the lateral pharyngeal wall. Complete knowledge of the anatomy and classification of different variants can guide us to choose the appropriate surgical procedures for the lateral wall collapse. Until now there is not a consensus about description of the trajectory or anatomical variants of the PFM into oropharynx, the distance between both muscles, and the muscle tone. Here we also present the relationship between the lateral wall surgeries currently available (lateral pharyngoplasty by Cahali, expansion sphincteroplasty by Pang, relocation pharyngoplasty by Li, Roman blinds pharyngoplasty by Mantovani, and barbed sutures pharyngoplasty by Vicini) with the proposed classification of the palatopharyngeal arch staging system (PASS). Keywords: -
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 -
Pediatric Oral Pathology. Soft Tissue and Periodontal Conditions
PEDIATRIC ORAL HEALTH 0031-3955100 $15.00 + .OO PEDIATRIC ORAL PATHOLOGY Soft Tissue and Periodontal Conditions Jayne E. Delaney, DDS, MSD, and Martha Ann Keels, DDS, PhD Parents often are concerned with “lumps and bumps” that appear in the mouths of children. Pediatricians should be able to distinguish the normal clinical appearance of the intraoral tissues in children from gingivitis, periodontal abnormalities, and oral lesions. Recognizing early primary tooth mobility or early primary tooth loss is critical because these dental findings may be indicative of a severe underlying medical illness. Diagnostic criteria and .treatment recommendations are reviewed for many commonly encountered oral conditions. INTRAORAL SOFT-TISSUE ABNORMALITIES Congenital Lesions Ankyloglossia Ankyloglossia, or “tongue-tied,” is a common congenital condition characterized by an abnormally short lingual frenum and the inability to extend the tongue. The frenum may lengthen with growth to produce normal function. If the extent of the ankyloglossia is severe, speech may be affected, mandating speech therapy or surgical correction. If a child is able to extend his or her tongue sufficiently far to moisten the lower lip, then a frenectomy usually is not indicated (Fig. 1). From Private Practice, Waldorf, Maryland (JED); and Department of Pediatrics, Division of Pediatric Dentistry, Duke Children’s Hospital, Duke University Medical Center, Durham, North Carolina (MAK) ~~ ~ ~ ~ ~ ~ ~ PEDIATRIC CLINICS OF NORTH AMERICA VOLUME 47 * NUMBER 5 OCTOBER 2000 1125 1126 DELANEY & KEELS Figure 1. A, Short lingual frenum in a 4-year-old child. B, Child demonstrating the ability to lick his lower lip. Developmental Lesions Geographic Tongue Benign migratory glossitis, or geographic tongue, is a common finding during routine clinical examination of children. -
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. -
Lower Gastrointestinal Tract
Lower Gastrointestinal Tract Hemorrhoids—Office Management and Review for Gastroenterologists Mitchel Guttenplan, MD, FACS 1 and Robert A Ganz, MD, FASGE 2 1. Medical Director, CRH Medical Corp; 2. Minnesota Gastroenterology, Chief of Gastroenterology, Abbott-Northwestern Hospital, Associate Professor of Medicine, University of Minnesota Abstract symptomatic hemorrhoids and anal fissures are very common problems. This article provides a review of the anatomy and physiology of the anorectum along with a discussion of the diagnosis and treatment of hemorrhoids and the commonly associated matters of anal sphincter spasm and fissures. The various office treatment modalities for hemorrhoids are discussed, as are the specifics of rubber band ligation (rBL), and a strategy for the office treatment of these problems by the gastroenterologist is given. The crh o’regan system™ is a technology available to the gastroenterologist that provides a safe, effective, and efficient option for the non-surgical treatment of hemorrhoids in the office setting. Keywords hemorrhoids, anal fissure, rubber band ligation, crh o’regan system™ Disclosure: Mitchel guttenplan is Medical Director of crh Medical Products corporation, the manufacturer of the crh o’regan system™. robert A ganz is a consultant to and holds equity in crh Medical Products corporation. Received: 2 november 2011 Accepted: 30 november 2011 Citation: Touchgastroentorology.com ; December, 2011. Correspondence: Mitchel guttenplan, MD, fAcs, 3000 old Alabama rd, suite 119 #183, Alpharetta, gA 30022-8555, us. e: [email protected] Diseases of the anorectum, including hemorrhoids and anal fissures, are experience also makes it clear that hemorrhoid sufferers frequently very common. The care of these entities is typically left to general and have additional anorectal issues that may both confuse the diagnosis colorectal surgeons. -
Anal Cancer Anal Cancer, Also Known As Anal Carcinoma, Is Cancer of the Anus
Anal Cancer Anal cancer, also known as anal carcinoma, is cancer of the anus. To help diagnose this condition, your doctor will perform a digital rectal exam and anoscopy. An MRI, CT, PET/CT, or an endoanal ultrasound may also be ordered by your doctor. Depending on the size, location, and extent of the cancer, treatments may include surgery, radiation therapy and chemotherapy. What is anal cancer? Anal cancer is a cancer that begins in the anus, the opening at the end of the gastrointestinal tract through which stool, or solid waste, leaves the body. The anus begins at the bottom of the rectum, which is the last part of the large intestine (also called the colon). Anal cancer usually affects adults over age 60 and women more often than men. More than 8,000 people in the U.S. are diagnosed with anal cancer each year. Anal cancer symptoms may include changes in bowel habits and changes in and around the anal area, including: bleeding and itching pain or pressure unusual discharge a lump or mass fecal incontinence fistulae. Some patients with anal cancers do not experience any symptoms. Some non-cancerous conditions, such as hemorrhoids and fissures, may cause similar symptoms. How is anal cancer diagnosed and evaluated? To diagnose the cause of symptoms, your doctor may perform: Digital rectal examination (DRE): Digital Rectal Exam (DRE): This test examines the lower rectum and the prostate gland in males to check for abnormalities in size, shape or texture. The term "digital" refers to the clinician's use of a gloved lubricated finger to conduct the exam. -
Salivary Glands
GASTROINTESTINAL SYSTEM [Anatomy and functions of salivary gland] 1 INTRODUCTION Digestive system is made up of gastrointestinal tract (GI tract) or alimentary canal and accessory organs, which help in the process of digestion and absorption. GI tract is a tubular structure extending from the mouth up to anus, with a length of about 30 feet. GI tract is formed by two types of organs: • Primary digestive organs. • Accessory digestive organs 2 Primary Digestive Organs: Primary digestive organs are the organs where actual digestion takes place. Primary digestive organs are: Mouth Pharynx Esophagus Stomach 3 Anatomy and functions of mouth: FUNCTIONAL ANATOMY OF MOUTH: Mouth is otherwise known as oral cavity or buccal cavity. It is formed by cheeks, lips and palate. It encloses the teeth, tongue and salivary glands. Mouth opens anteriorly to the exterior through lips and posteriorly through fauces into the pharynx. Digestive juice present in the mouth is saliva, which is secreted by the salivary glands. 4 ANATOMY OF MOUTH 5 FUNCTIONS OF MOUTH: Primary function of mouth is eating and it has few other important functions also. Functions of mouth include: Ingestion of food materials. Chewing the food and mixing it with saliva. Appreciation of taste of the food. Transfer of food (bolus) to the esophagus by swallowing . Role in speech . Social functions such as smiling and other expressions. 6 SALIVARY GLANDS: The saliva is secreted by three pairs of major (larger) salivary glands and some minor (small) salivary glands. Major glands are: 1. Parotid glands 2. Submaxillary or submandibular glands 3. Sublingual glands. 7 Parotid Glands: Parotid glands are the largest of all salivary glands, situated at the side of the face just below and in front of the ear. -
Bowel Function Anatomy
BOWEL FUNCTION ANATOMY Most of America gives little thought to bowel control. However, bowel control is actually a complex process involving the coordination of many different muscles and nerves. The bowel is considered to be a part of the digestive or gastrointestinal system. It is designed to help the body absorb nutrients and fluids from the foods we eat and drink. After taking out everything the body needs, the bowel then expels the leftover waste. The beginning of the bowel is the small intestine, sometimes referred to as the small bowel. This is where the useful nutrients are absorbed from what you eat. The small bowel delivers the waste to the colon, or large bowel. The colon is a 5-6 foot long muscular tube that delivers stool to the rectum. As the stool moves through the colon, the fluids are removed and absorbed into the body. The consistency of the stool is dependent upon many things, including how long the stool sits in the colon, how much of the water has been absorbed from the waste, and the amount of fiber and fluids in your diet. Stool consistency can vary from hard lumps to mushy to very loose, watery stool. The best and easiest consistency of stool is soft, like toothpaste; this consistency may be attained by adding fiber to your diet. Fiber helps move waste through the colon because it is indigestible by the human body. In other words, fiber adds ‘bulk’ to the stool. It is important to eat a diet high in fiber, however, most Americans lack fiber in their diet. -
Absence of Uvula: an Accidental Or an Incidental Finding. J Human Anat
Journal of Human Anatomy ISSN: 2578-5079 Is Uvula Important? Absence of Uvula: An Accidental or an Incidental Finding 1 2 3 4 Vivek J *, Safeer K , Sanjib D and Bhargavi Joshi 1Department of Biochemistry & Basic sciences, Kentucky College of Osteopathic Case Report Volume 3 Issue 2 Medicine, USA Received Date: September 12, 2019 2Department of Anatomy & Embryology, Windsor University School of Published Date: October 21, 2019 Medicine, Saint Kitts and Nevis DOI: 10.23880/jhua-16000142 3Department of Pharmacology, Govt Medical College, Ratlam, India 4Research Volunteer, Windsor University School of Medicine, St Kitts and Nevis *Corresponding author: Vivek Joshi, MD, Associate Professor Biochemistry, Department of Basic Science, Kentucky College of Osteopathic Medicine, 147 Sycamore Street, Hambley Blvd, University of Pikeville (UPike), Pikeville, KY, 41501, USA, Tel : 606-218-5552; Email: [email protected] Abstract Introduction: Absence of the uvula is very rare in the general population, which is mostly acquired secondary to surgery or is rarely congenitally absent since birth. Uvula is a small band of connective tissue, gland and small muscle fibers and is documented to be useful in speech, lubrication and central support of the palatopharyngeal arch during swallowing. Cultural practice of uvulectomy is very common in African countries as a treatment or prophylactic measure for chronic cough or frequent respiratory infection. Congenital absence of uvula is a rare condition and is also accompanied by other genetic abnormalities such as cleft lip or cleft palate. Case Report: This case report is based on an accidental finding in a 20-year-old African-American male who was acting as a standardized patient in a clinical course at a medical college. -
Appendix B: Muscles of the Speech Production Mechanism
Appendix B: Muscles of the Speech Production Mechanism I. MUSCLES OF RESPIRATION A. MUSCLES OF INHALATION (muscles that enlarge the thoracic cavity) 1. Diaphragm Attachments: The diaphragm originates in a number of places: the lower tip of the sternum; the first 3 or 4 lumbar vertebrae and the lower borders and inner surfaces of the cartilages of ribs 7 - 12. All fibers insert into a central tendon (aponeurosis of the diaphragm). Function: Contraction of the diaphragm draws the central tendon down and forward, which enlarges the thoracic cavity vertically. It can also elevate to some extent the lower ribs. The diaphragm separates the thoracic and the abdominal cavities. 2. External Intercostals Attachments: The external intercostals run from the lip on the lower border of each rib inferiorly and medially to the upper border of the rib immediately below. Function: These muscles may have several functions. They serve to strengthen the thoracic wall so that it doesn't bulge between the ribs. They provide a checking action to counteract relaxation pressure. Because of the direction of attachment of their fibers, the external intercostals can raise the thoracic cage for inhalation. 3. Pectoralis Major Attachments: This muscle attaches on the anterior surface of the medial half of the clavicle, the sternum and costal cartilages 1-6 or 7. All fibers come together and insert at the greater tubercle of the humerus. Function: Pectoralis major is primarily an abductor of the arm. It can, however, serve as a supplemental (or compensatory) muscle of inhalation, raising the rib cage and sternum. (In other words, breathing by raising and lowering the arms!) It is mentioned here chiefly because it is encountered in the dissection.