外科学教学课件：结直肠肛管疾病
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结直肠肛管疾病
Colorectal & Anal Disease
Anorectum
00-10-17
colorectal & anal disease
2
Anatomy of Anorectum
• Rectum，12cm long，upper1/3、midder 1/3、subber 1/3
• Anus，3cm long
005-140-1-917
colorecAtanlo&reacntuaml disease
11
Anorectal veins
• Internal rec.v.plexus flow to superior rec. v. and to portal venous system. (on the dentate line) Septic emboli may cause pylephlebitis
inguinal lig. ext. iliac a. • Somatic sensory nev.
005-140-1-917
colorecAtanlo&reacntuaml disease
15
Proctologic examination
• Method of anorectal examination inspection, palpation, digital exam, anoscopy, rectoscopy,proctosigmoidascopy
005-140-1-917
colorecAtanlo&reacntuaml disease
9
Anorectum fossa
• Superior lavetor ani. m. Pelvic rectal fossa Posterior rectal fossa
• Inferior lavetor ani. m. Ischiorectal fossa Superficial fossa
int. hemorrhoid • L. drainage
Aorta,int.iliac a. • autonomic nev.
Under dentate line • epithelium • Inferior rec. a. • Inferior rec. v.
ext. hemorrhoid • L. drainage
005-140-1-917
colorecAtanlo&reacntuaml disease
7
Anal sphincter
005-140-1-917
colorecAtanlo&reacntuaml disease
8
Anal sphincter
• Anorectal Sphincter Ring
deeper external
• Inferior rec.v.plexus flow to pudendal v. and to internal iliac v. (under the dentate line)
005-140-1-917
colorecAtanlo&reacntuaorectal lymphatics
sphincter,
levators(puborectalis),
Internal sphincter,
longitudinal muscle
• The intersphincteric groov can be palpated, separated the internal and external sphincter
• Superior L. above the level of anorectal to superior rec.L.
The main way of metastasis in rectal carcinoma
• Midder L. • Inferior L.
005-140-1-917
colorecAtanlo&reacntuaml disease
005-140-1-917
colorecAtanlo&reacntuaml disease
10
Ateries of Anorectum
• Superior rec. a.from inferior mesenteric a.
Divide into 2 main branches: left, right(anterior,posterior) • Middle rec.a.from internal internal iliac a. to lateral lig. • Inferior rec.a. from pudendal a.
colorecAtanlo&reacntuaml disease
6
Anal sphincter
• Anal internal sphincter Longitudinal muscle
Smooth involuntary muscle
• Anal external sphincter Striated voluntary muscle
13
Drainage of anorectal lymphatics
005-140-1-917
colorecAtanlo&reacntuaml disease
14
Different of Dentate Line
Upper dentate line
• mucosa • superior rec. a. • superior rec.v.
5
005-140-1-917
Anatomy of Anorectum
•Anal canal,ectoderm •Rectum,entoderm •dentate line,the juncture of anal and rectum
• Rectal valves • Anal valves • Anal sinus • Anal crypts • Anal papilla
• Anatomic relation of anorectum
005-140-1-917
colorecAtanlo&reacntuaml disease
3
Male
005-140-1-917
colorecAtanlo&reacntuaml disease
4
Female
005-140-1-917
colorecAtanlo&reacntuaml disease
Colorectal & Anal Disease
Anorectum
00-10-17
colorectal & anal disease
2
Anatomy of Anorectum
• Rectum，12cm long，upper1/3、midder 1/3、subber 1/3
• Anus，3cm long
005-140-1-917
colorecAtanlo&reacntuaml disease
11
Anorectal veins
• Internal rec.v.plexus flow to superior rec. v. and to portal venous system. (on the dentate line) Septic emboli may cause pylephlebitis
inguinal lig. ext. iliac a. • Somatic sensory nev.
005-140-1-917
colorecAtanlo&reacntuaml disease
15
Proctologic examination
• Method of anorectal examination inspection, palpation, digital exam, anoscopy, rectoscopy,proctosigmoidascopy
005-140-1-917
colorecAtanlo&reacntuaml disease
9
Anorectum fossa
• Superior lavetor ani. m. Pelvic rectal fossa Posterior rectal fossa
• Inferior lavetor ani. m. Ischiorectal fossa Superficial fossa
int. hemorrhoid • L. drainage
Aorta,int.iliac a. • autonomic nev.
Under dentate line • epithelium • Inferior rec. a. • Inferior rec. v.
ext. hemorrhoid • L. drainage
005-140-1-917
colorecAtanlo&reacntuaml disease
7
Anal sphincter
005-140-1-917
colorecAtanlo&reacntuaml disease
8
Anal sphincter
• Anorectal Sphincter Ring
deeper external
• Inferior rec.v.plexus flow to pudendal v. and to internal iliac v. (under the dentate line)
005-140-1-917
colorecAtanlo&reacntuaorectal lymphatics
sphincter,
levators(puborectalis),
Internal sphincter,
longitudinal muscle
• The intersphincteric groov can be palpated, separated the internal and external sphincter
• Superior L. above the level of anorectal to superior rec.L.
The main way of metastasis in rectal carcinoma
• Midder L. • Inferior L.
005-140-1-917
colorecAtanlo&reacntuaml disease
005-140-1-917
colorecAtanlo&reacntuaml disease
10
Ateries of Anorectum
• Superior rec. a.from inferior mesenteric a.
Divide into 2 main branches: left, right(anterior,posterior) • Middle rec.a.from internal internal iliac a. to lateral lig. • Inferior rec.a. from pudendal a.
colorecAtanlo&reacntuaml disease
6
Anal sphincter
• Anal internal sphincter Longitudinal muscle
Smooth involuntary muscle
• Anal external sphincter Striated voluntary muscle
13
Drainage of anorectal lymphatics
005-140-1-917
colorecAtanlo&reacntuaml disease
14
Different of Dentate Line
Upper dentate line
• mucosa • superior rec. a. • superior rec.v.
5
005-140-1-917
Anatomy of Anorectum
•Anal canal,ectoderm •Rectum,entoderm •dentate line,the juncture of anal and rectum
• Rectal valves • Anal valves • Anal sinus • Anal crypts • Anal papilla
• Anatomic relation of anorectum
005-140-1-917
colorecAtanlo&reacntuaml disease
3
Male
005-140-1-917
colorecAtanlo&reacntuaml disease
4
Female
005-140-1-917
colorecAtanlo&reacntuaml disease