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95 Cards in this Set
- Front
- Back
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How long is the anal canal? |
2.5 - 4 cm long
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The Internal sphincter is made of what kind of muscle? and what kind of control? |
Smooth muscle
Involuntary autonomic control |
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The External sphincter is made of what kind of muscle? and what kind of control?
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Striated muscle
Voluntary control |
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What nerves supply the LOWER half of the anal canal?
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Somatic Sensory nerves
Sensitive to painful stimuli |
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What nerves supply the UPPER half of the anal canal?
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Autonomic control
Insensitive to pain |
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Conditions of the lower anal canal cause what, which teh upper canal doesn't cause?
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Pain
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What is anal canal lined with internally?
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Columns of Morgagni
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Columns of Morgagni fuse to form...
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the anorectal junction
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What do the anal glands empty into?
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Crypts
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Inflammation of the crypts can lead to -
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Fistula or fissure formation
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INTERNAL Hemorrhoids result from dilation of -
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the Zona Hemorrhoidalis
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EXTERNAL Hemorrhoids result from dilation of -
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a Venous Plexus in the lower segment of the anal canal, which drains into the Inferior Rectal Veins!
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The rectum lies ______ to the anus.
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Superior
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How long is the rectum?
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12 cm long
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The rectum hits the ____ proximally and ____ distally
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Sigmoid proximally
Anorectal junction distally |
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Is the anorectal junction usually palpabe?
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Nope
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Where is the rectal ampulla located?
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Posteriorly, in the hollow of the coccyx and sacrum
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What are the Houson valves?
Which one(s) can be palpated? |
3 semilunar folds in rectum:
- Superior rectal valve - Middle rectal valve - Inferior rectal valve* - can me palpated. |
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Where is the prostate located?
What does it surround? |
at the base of bladder
Surrounds the urethra |
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Size of the prostate
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4 x 3 x 2 cm
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What does the back of the prostate come in close contact with?
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the Anterior rectal wall
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In women, what lies in contact with the Anterior rectal wall?
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The Vagina
Separated by RectoVaginal Septum! |
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Where does the 3rd (Median) lobe of te prostate lie?
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between the Ejaculatory duct and the Urethra
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What does the anus develop from embyronically?
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Caudal hindgut --> Urogenital sinus --> anus
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When does the urogenital membrane open up and become the anal opening?
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8 weeks
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When is the first meconium passed?
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first 24 - 48 hours after birth
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Newborns have stools after each feeding is called what?
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Gastocolic reflex
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What's special about the internal and external sphincter in the newborn?
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They're both under involuntary control b/c myelination of the spinal cord is incomplete
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How many bowel movements will a 1 year old have per day?
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1 - 2
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When is control of the external sphincter acheived?
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between 18 and 24 months
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When does the prostate begin to develop and mature?
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Puberty
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Pregnant women are predisposed to what condition? |
Hemorrhoids
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What can fiber additives cause as a presenting symptom?
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Rectal Bleeding
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What causes retention of stool of older adults?
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Degeneration of afferent neurons in rectal wall, increasing the pressure threshold for sensation of rectal distention, promoting the internal sphincter to stay closed.
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What causes Fecal incontinence in older adults?
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The auntonomic-controlled internal sphincter loses tone, and the external sphincter can't control the bowels by itself.
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* Risk Factors for Colorectal Cancer *
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- 50+ y.o.
- Family history (FAP, HNPCC, Gardner syndrome) - Personal history (intestinal polyps, Crohns, UC, Gardners) - Personal Hx - ovarial, endometrial, or breast cancer. - Ashkenzi Jews - Diet w/ High beef, & animal fats; Low in fiber - Obesity, smoking, physical inactivity - Alcohol |
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* Risk Factors for Prostate Cancer *
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- 50+
- Race: Blacks 2X↑ than Whites - Nationality: Common in N.Amer., and NW Europe - Family Hx (2x risk with 1 first degree relative) - Diet high in animal fat - Hormones- prostate getting high exposure to androgens - Physical Inactivity |
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What positions can you do the rectal exam in?
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1.) knee to chest
2.) Left lateral w/ hips & knees flexed 3.) Standing with hips flexed, arms resting on examining table |
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What position can women have the rectal exam done?
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Lithotomy position
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Fungal infection of perianal area is common amongst -
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Diabetics
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Pinworms are common in
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Children
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Tenderness and Inflammation of perianal area, think:
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Perianal abcess
Anorectal fistula/fissures Pilonidal cyst Pruritis ani |
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The skin of the anus will normall appear more ___ compared to the perianal area?
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Anus is coarser and darkly pigmented
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What are you looking for when u ask the pt. to Bear down?
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Fistulas
Fissures Rectal prolapse Polyps Internal hemorrhoids |
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12 o'clock =
6 o'clock = |
ventral midline
dorsal midline |
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Bearing down relaxes the...
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External sphincter
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A lax sphincter may indicate...
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neurologic deficit
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When the pt. has rectal pain, look for -
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Irritation
Rock hard constipation Rectal fissures Thrombosed hemorrhoids |
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When will Internal hemorrhoids be felt usually?
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They normall won't be palpated unless they are Thrombosed
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How far can the finger palpate into the rectum?
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6-10 cm
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Bidigital Palpation is useful for detecting...
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Perianal abcess
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A healthy prostate should be how big
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4 cm diameter w/ <1 cm protrusion into rectum
↑ protrusion = prostatic enlargement |
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Rubbery, boggy prostate =
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Benign hypertrophy
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Stony, hard nodularity of prostate =
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Carcinoma, prostatic calculi, or chronic fibrosis
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Fuctuant softness of prostate =
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Prostatic abcess
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Grade I prostate enlargement
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1 - 2 cm
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Grade II prostate enlargement
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2 - 3 cm
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Grade III prostate enlargement
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3 - 4 cm
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Grade IV prostate enlargement
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4+ cm
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PSA level of less than 4ng/mL
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Normal
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PSA level greater than 10 ng/mL
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High
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PSA level of 4-10 ng/mL
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Borderline
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Pt. with Borderline PSA level; a (high/low) Free PSA ratio will increase his chance of prostate cancer
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LOW Free PSA ratio increases chances
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The cervix can be palpate thru what structure?
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Anterior rectal wall
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Very light tan or gray stool =
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Obstructive jaundice
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Tarry black stool =
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Upper Intestinal tract bleeding
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Guaiac tests for what?
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Occult blood in stool
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Intermittent, pencil-like stool =
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a Spasmodic contraction in rectal area
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Persistent, pencil-like stool =
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Permanent stenosis from scarring or from pressure of a malignancy
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Pipestem stools and ribbon stools =
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Lower Rectal stricture
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A Large amt. of mucus in fecal matter =
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Intestinal inflammation & mucus colitis
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Small flecks of blood-stained mucus in liquid feces =
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Amebiasis!
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Fatty Stools =
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Pancreatic disorders & malabsorption syndromes
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Stools the color of Aluminum
[caused by a mixture of Melena & Fat] |
- Tropical sprue
- Carcinoma of the hepatopacreatic ampulla - Children taking Sulfonamides for diarrhea |
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Kids: Shrunken buttocks =
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Chronic debilitating disease
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Kid: Asymmetric creases occur with
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Congenital dislocation of the hips
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Kid: Peri rectal redness and irritation =
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pinworms, Candida, or other diaper irritants
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Kid: Rectal prolapse results from
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Constipation
Diarrhea Severe coughing/straining |
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Kid: Hemorrhoids
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(Rare in kids)
If present, = Portal hypertension |
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Kid: Condylomas/smal flat flaps of skin around rectum
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Syphilis
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Kid: Sinuses, tufts of hair, & dimpling =
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Lower spinal deformities
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No anal wink =
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Lower spinal cord lesion
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How do you confirm anal patency in newborn?
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Passage of meconium
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No evidence of stool in newborn =
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Rectal atresia
Hirschsprung disease Cystic fibrosis |
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Greenish-black stool, viscous, contains occult blood =
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Newborn meconium
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Transitional stool: thin, slimy, brown to green
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3-6 days old
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Mushy, loose, golden yellow stool; freq. varies from after each feeding to every few days; nonirritating to skin
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Breast-fed baby
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Light-yellow stool, characteristic odor, IRRITATING to skin
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Formula-fed
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A lax sphincter in baby =
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- lesions of peripheral spinal nerves/SC
- Shigella - Prev. Fecal Impactions |
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Bruises around anus, scars, anal tears and anal dilation =
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sexual abuse
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Kids: Chronic constipation + full/distended rectum =
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Mental deficiency
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Kids: Chronic constipation + Empty bowel =
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Hirschsprung disease
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Kids: Fecal mass in rectum with diarrhea, think -
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Overflow diarrhea
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Are ovaries usually palpable on rectal exam?
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No, ovaries can't be palpated on rectal exam, but cervix and uterus can.
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Kids: Palpable prostate in preadolescent child =
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Precocious puberty or virilizing disease
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