and anal canal Dr Waseem Ahmad Dept of Jarahat AMU Anatomy Anatomy is the branch of biology concerned with the study of the structure of organisms and their parts Types of Anatomy ID: 914337
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Slide1
Assalamu
alaikum
Slide2Anatomy of the rectum
and anal canal
Dr Waseem Ahmad
Dept. of
Jarahat
,
AMU
Slide3Anatomy
Anatomy is the branch of biology concerned with the study of the structure of organisms and their parts.
Slide4Types of Anatomy 1. macroscopic anatomy2. microscopic anatomy
Macroscopic anatomy, or gross anatomy
, is the examination of an animal's body parts using unaided
eyesight
.
Microscopic anatomy involves the use of optical instruments in the study of the
tissues
of various structures, known as
histology
and also in the study of
cells
.
Slide5Gross Anatomy :
large body parts that are visible to the naked eyeComparative Anatomy :similarities and differencesDevelopmental Anatomy :changes in structure from conception through maturityRegional Anatomy :structures in a particular region of the body as one complete unitSurface anatomy :
Superficial anatomical marking which relates to the structure of internal organ Systemic anatomy :gross anatomy of each system of the body
Pathologic anatomy :
all anatomic changes resulting from disease
Radiographic anatomy :
structures that may be visualized by specific scanning procedures (
xray
, MRI, ultrasound)Surgical anatomy :anatomic landmarks used before and after surgery
DIFFERENT TYPES OF ANATOMY
Slide6Slide7Slide8Slide9Slide10Slide11Slide12Slide13Slide14Slide15Slide16Slide17Slide18Slide19Slide20Slide21Slide22Slide23Slide24Slide25Slide26Slide27Slide28Slide29Slide30Slide31Slide32Slide33Slide34Slide35Slide36Slide37Slide38Slide39ANAL CANAL
DEFINITION:The anal canal is the terminal part of the large gut
Slide40LOCATION:Anal canal is located below the level of pelvic diaphragm between the two ischorectal fossae.Importance of ischiorectal fossae
: ischiorectal
fossae
allow the anal canal to expand during the passage of
feacal
matter.
Slide41DIMENSIONS:
The anal canal is 3.8 cm long
Slide42COURSE AND DIRECTIONS:
The anal canal extends from the anorectal junction to the anus and is directed downwards and backwards.the anorectal junction is situated 2-3 cm in front of and slightly below the tip of the coccyx. The anal canal is surrounded by inner involuntary and outer voluntary sphincters which keeps the anal canal closed in form of anteroposterior slit.
Slide43ANORECTAL JUNCTION:
The anorectal junction is situated 2-3 cm in front of and little below the tip of the coccyx. The anorectal junction is marked by perineal flexure which with forward bendinig males the perineal
flexure represent the apex of the prostate.
Slide44Slide45INTERIORS OF THE ANAL CANAL
:The interiors of the anal canal can be divided into three parts..1. Upper mucus part ( 15 mm long)2. Middle part / transitional zone/ pecten (15 mm long)3. Lower
cutaneous part ( 8mm long)
Slide46Slide47Slide48UPPER MUCUS PART: Upper mucus part shows 6 to 10 vertical folds of mucus membrane called anal column of Morgagni. The lower end of the column are joined by the short transverse fold of mucus membrane called anal valves. Above each anal valve , there is a depression called anal sinus. The anal valves together form the transverse line that runs all round the anal canal. This line is called pectinate line.The pectinate line is situated opposite to the middle of internal anal sphincter. The pectinate line is the junction between the ectodermal
and endodermal
parts.
Occasionally the anal valves show the epithelial projections called anal papillae.
Slide49Slide50MIDDLE
PART/ TRANSITIONAL ZONE/ PECTEN :The area of anal canal which starts from the pectinate line and runs upto 15 mm downwards is referred to as middle part / transitional zone / pecten. Anal columns are absent here. The lower limit of the middle part has whitish appearance due to which it is referred to as white line of Hilton or
Pecten of Jon Stroud. The white line of Hilton or Pecten
of Jon Stroud is situated between the interval of subcutaneous part of external anal sphincter and lower border of internal anal sphincter.
Slide51Slide52LOWER CUTANEOUS PART:Below the level of white line of Hilton or pecten of Jon Stroud starts lower cutaneous part which resembles true skin. It contains stratified squmous
epithelium which are keratinized. Sebaceous and the sweat glands are present here.
Slide53SPHINCTERS OF ANAL CANAL
:Internal anal sphincter2. External anal sphincter I Subcutaneous part, II Superficial part and II Deep part
Slide54INTERNAL ANAL SPHINCTER:The internal anal sphincter extends from the upper end of the anal canal up to the white line of Hilton. That means it covers upper 2/3rd of the anal canal. It is about 30 mm long.Internal anal sphincter is nothing but thickened circular muscle fibers of that part of the gut. Internal anal sphincter is involuntary in nature.
Slide55Slide56EXTERNAL ANAL SPHINCTER
:SUBCUTANEOUS:The subcutaneous part of external anal sphincter lies below the level of internal anal sphincter and surrounds the lower part of the anal canal. This part is in form of thick band about 15 mm broad.SUPERFICIAL PART:The superficial part of external anal sphincter is elliptical in shape and surrounds the lower part of internal anal sphincter. It arises from the posterior surface of terminal segment of coccyx and anococcygeal
ligament and inserted into perineal body.
DEEP PART:
The deep part of external anal sphincter surrounds the upper part of the internal anal sphincter and is fused with the puborectalis.
Slide57Slide58ANORECTAL RING:The anorectal ring is present at anorectal junction and is formed by the fusion of deep part of external anal sphincter, internal anal sphincter and puborectalis. The anorectal ring can easily be felt with the finger on P/R examination. The anorectal ring is less marked interiorly where the fibers of puborectalis are absent.Surgical division of the anorectal ring causes rectal incontinence.
Slide59Slide60ARTERIAL SUPPLY OF ANAL CANAL:Above the pectinate line: by superior rectal artery Below the pectinate line : by inferior rectal artery
Slide61VENOUS DRAINAGE OF ANAL CANAL:Internal rectal venous plexus that drains into superior rectal vein . superior rectal vein vein drains into inferior mesenteric vein.External rectal venous plexus.Upper part drains in to superior rectal vein and then into inferior mesenteric vein.Middle part
drains into middle rectal vein and then into internal iliac veinLower part drains into inferior rectal vein and then into internal pudendal vein.
Internal rectal venous plexus and external rectal venous plexus communicate freely and therefore internal rectal venous plexus is the site of communication between the portal and the systemic circulation.
Slide62Slide63LYMPHATIC DRAINAGE:Above the pectinate line: internal iliac lymph nodes ( drain with those of the rectum)Below the pectinate line: medial group of superficial inguinal lymph nodes.
Slide64NERVE SUPPLY OF ANAL CANAL:
Above the pectinate line: autonomic nervous system Sympathetic nerves L1 L2 (inferior hypo gastric plexus)Parasympathetic S2 S3 S4 (splanchic )pain sensations are carried by both sympathetic and parasympathetic nervesbelow the pectinate line: somatic nervous system by inferior rectal nerve S2 S3 S4.
Slide65NERVE SUPPLY OF SPHINCTERS :
INTERNAL SPHINTER:Contracts – by sympathetic nervesRelaxes – by parasympathetic nervesEXTERNAL SPHINCTER:By inferior rectal nerve and somatic fibers of second sacral nerves
Slide66Clinical anatomy of the rectum and anal canal.
P/R examinationProctoscopySigmoidoscopy
Slide67Positions of the patient during P/R examination
.1. Left lateral position (sim’s position)2. Dorsal position 3. Right lateral position
4. Knee-elbow position5. Lithotomy position
Slide68Left lateral position(sim’s position):
The patient lies on the left side and both hip joint and knee joint are flexed so that knees are taken near to the chest.This position is suitable for the inspection of the perianal region and P/R examination.
Slide69DORSAL POSITION:
The position is used when the patient is too ill to alter his position on the bed.The patient lies on the bed with his hips flexed.The index finger of the right hand remains in the rectum and the left hand over the lower abdomen. There fore in this way bimanual examination is done to know the characteristics of pelvic swelling, recto uterine pouch and rectovesicle pouch.
Slide70DORSAL POSITION:
Slide71RIGHT LATERAL POSITION:
The position is used in case of carcinoma of pelvirectal junction when it tends to spread towards the anus.KNEE-ELBOW POSITION:The position is used to examine the prostate and seminal vesicle. A prone position in which the patient rests on the knees and elbows, assumed for a rectal or gynecologic examination or an operation. Also called genucubital position
.
Slide72KNEE-ELBOW POSITION:
Slide73LITHOTOMY POSITION
:Bimanual examination can be done using this position. The lithotomy position involves the positioning of an individual's feet above the level as the hips with the perineum positioned at the edge of an examination table.
Slide74Slide75P/R Examination
Slide76Slide77Slide78Sigmoidoscopy
Slide79Applied anatomy of rectum and anal canal
1.Rectal prolapse2. Rectal carcinoma3.Rectal incontinance4.Haemorrhoides5.Fissure in ano6. Fistula in ano
Slide80Slide81Slide82Slide83Slide84Slide85Bowel incontinence, anal incontinence, accidental bowel leakage, or (in some forms)
encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus
, or solid feces
.
Rectal incontinence
Slide86Slide87Slide88Slide89Primary
haemorroides
Slide90Slide91Slide92Slide93Fissure in ano
Fissure in ano is the tear in the continuity of the mucus membrane of anal canal. It occurs mostly in posterior wall of the anal canal.Causes :Primary causes1. Posterior angulations of the anal canal.2. Divergence of the external sphincter muscle posteriorly3. Elliptical shape of the anal canal.Secondary causes
1. constipation.2. stenosis of the anal canal after haemorrhoidectomy
3. crohn’s disease
4. Ulcerative colitis
5. tuberculosis
Slide94Fissure in ano
Slide95Fistula in ano
Fistula in ano is an inflammatory tract which has secondary opening in the perianal skin and primary opening in rectum or anal canal. The tract is lined by unhealthy granulation tissueCauses:1. Infection of the peri-anal gland resulting in abscess formation leading to the fistula formation.2. Crohn’s disease
3. Ulcerative colitis4.Tuberculosis
Slide96CLASSIFICATION:
1. low level fistulaThe internal opening is below the anorectal ringsubtypessubmucucs typesubcutaneous typeintersphinteric typetransphincteric type
suprasphincteric type
Slide972. High level fistula
The internal opening is situated at or above the level of anorectal ring.Subtypestransphincteric typesuprasphinteric typepelvirectal type
Slide98Fistula in ano
Slide99Goodsal’s
rule
Slide100Thanks