AnorectalDisease

AnorectalDisease - Anorectal Disease Vic Vernenkar D.O St...

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Anorectal Disease Vic Vernenkar, D.O. St. Barnabas Hospital Dept of Surgery
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Anatomy Wall consists of mucosa, submucosa, and two complete muscle layers, inner circular, outer longitudinal. 12-15cm in length, reflection is 6-8cm above anus.
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Anatomy Upper 1/3 ant/lat covered by peritoneum, middle 1/3 only anteriorly covered, lower 1/3 completely retroperitoneal.
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Anatomy The rectum starts where tenia coli coalesce to form a complete layer of longitudinal muscle at level of sacral promontory. Three distinct curves, proximal and distal curve to the right, middle curves to the left. These folds are called Valves of Huston. This area is great for biopsy purposes as they do not contain all layers so risk of perforation is less.
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Anatomy Waldeyer’s fascia is a dense connection between sacrum and rectum at 4 th sacral body goes anteriorly to rectum, covering sacrum and overlying vessels and nerves. Dennonviller’s fascia is a retrovesical septum in men, rectovaginal in women. Pelvic floor is musculotendinous sheet formed by the levator ani muscle and is innervated by S4.
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Anatomy The pubococcygeus, iliococcygeus, and puborectalis make the levator ani. These are paired muscles that are intertwined and act as a unit. The anal canal starts at pelvic diaphragm and ends at anal verge. Approximately 4cm long. The anatomic anal canal extends from anal verge to dentate line. Surgical anal canal is anal verge to anorectal ring, the circular upper border of puborectalis that is palpable by rectal exam. It is 1-1.5 cm from dentate line.
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Anatomy The anal verge is the junction between anoderm and perianal skin. The dentate line is a true mucocutaneous junction located 1-1.5 cm from anal verge. A 6- 12mm transitional zone exists above the line where squamous becomes cuboidal, then columnar. Anal sphincter mechanism made by internal and external sphincters.
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Anatomy The internal sphincter is a specialized continuation of the circular smooth muscle layer of the rectum. It is involuntary, and contracted at rest. The intersphincteric plane is a fibrous continuation of the longitudinal smooth muscle layer of the rectum
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Anatomy The external sphincter is a voluntary, striated muscle divided into three u-shaped loops (subcutaneous, superficial, and deep). Acts as a single functional unit. It is a continuation of the levator ani muscle, specifically of the puborectalis muscle .
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Anatomy The puborectalis starts at the pubis and joins posterior to the rectum. It is normally contracted, making a 80 degree angulation of the anorectal junction.
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Puborectalis
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Anatomy The Columns of Morgnani consist of 8-14 longitudinal mucosal folds just above dentate line and forming the anal crypts at their distal end. Small glands empty into these crypts. The ducts of some of these glands penetrate the internal sphincter, the body of the gland resides in
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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AnorectalDisease - Anorectal Disease Vic Vernenkar D.O St...

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