versailles

Anus and Rectum

Exam
 Anal canal
 2.5-4cm long
 Surrounded by two concentric
striated muscles:
External sphincter--voluntary
Internal sphincter--involuntary
 rectum

 Terminal 12cm of colon

 Rectosigmoid junction →rectal ampulla
→entrace to the anal canal
 Three semilular transverse fold—valves of
Houston
 Upper two-thirds:covered by peritoneum
 Anterior peritoneal reflection:
 Men—rectovesical pouch: 7.5cm to anal
orifice
 Women—rectouterine pouch: 5.5 cm to
Examination of anus and
rectum
 Examine position..\..\
教学相关 图片 \常用检查 体位 .rm

 Left lateral prone (Sims)

 Bent-over-table position
 Lithotomy position
 Knee-chest or knee-elbow position
Knee-chest or knee-elbow
position
Left lateral prone (Sims)
Lithotomy position
Bent-over-table position
inspection..\..\教学相 关图片 \肛门 视诊 .rm
♣ Patient position and preparation
Left lateral decubitus position
Assistant or patient spreads glutei
♠ Findings on Inspection
Anal Fissures肛裂
Anal fistula瘘
Perianal dermatitis
Anal mass
External Hemorrhoid 外痔
Condyloma 湿疣
… ..
 Anal palpation..\..\教学相 关图片 \
肛门触 诊 .rm

First step:
 Gloving booth hands
 Palpate for:
 Perineum around orifice of sinuses
and fistula →subcutaneous cords →
direction of tracks
 Bulges in perineal tissue
 Fluctuant or tender abscess
 Anal palpation
 Secondly:
 Lubricate gloved examining finger
 Place pad on anal sphincter
 Exert gentle pressure, direct inward
and somewhat anteriorly, until
sphincter relaxes, admitting the pad
followed by the tip of finger
 Gradually insert finger as far as
possible
Anal palpation
 attention
 The anal canal slants anteriorly, so
remember, when inserting a finger or
instrument, the axis of entry sould
point toward the umbilicus
 Proper examination-not painful
 To feel abscess causing a fistula:use
bidigital palpation between index
finger in canal and thumb on the skin
of perineum
 Rectal palpation
 Continuation of palpation of the anal
canal
 male: rectoanal junction → ampulla
→anterior wall (prostate gland,
seminal vesicles, rectovesical pouch)
→poterior wall (sacrum and coccyx)
→lateral walls
 Female: rectoanal junction → ampulla
→anterior wall (uterine cervix,
uterine fundus, rectouterine pouch)
→poterior wall (sacrum and coccyx)
WHAT IS AN ANAL FISSURE?
An anal fissure is a small
tear or cut in the skin lining
the anus which can cause
pain and/or bleeding.
A thin slit-like tear in the anal
tissue, an anal fissure is likely to
cause itching, pain, and bleeding
during a bowel movement.
ANAL FISSURE
ANAL FISSURE
The typical symptoms of
an anal fissure are
extreme pain during
defecation and red blood
streaking the stool.
Patients may try to avoid
defecation because of
the pain.
 How is it diagnosed?

The diagnosis of an anal

fissure is made by
examination of the anus
and anal canal. The tear
usually is easy to see,
although occasionally a
small viewing instrument,
called an anoscope, may be
used in the evaluation.
What Are Hemorrhoids
痔?
The term hemorrhoids refers to a
condition in which the veins
around the anus or lower rectum
are swollen and inflamed.
Hemorrhoids may result from
straining to move stool. Other
contributing factors include
pregnancy, aging, chronic
constipation or diarrhea, and anal
intercourse.
Hemorrhoids are either inside the
anus (internal) or under the skin
around the anus (external).
Inflammatory hemorrhoids
Thrombotic hemorrhoids
Mixed hemorrhoids
Incarcerated mixed
hemorrhoids
What Are the
Symptoms of
Hemorrhoids?
Although many people have
hemorrhoids, not all
experience symptoms. The
most common symptom of
internal hemorrhoids is bright
red blood covering the stool,
on toilet paper, or in the toilet
bowl. However, an internal
hemorrhoid may protrude
through the anus outside the
body, becoming irritated and
painful. This is known as a
protruding hemorrhoid.
 Internal hemorrhoids occur higher
up in the anal canal, out of sight.
Bleeding is the most common
symptom of internal hemorrhoids,
and often the only one in mild cases.
 Sometimes, internal hemorrhoids will
come through the anal opening when
straining to move your bowels. This is
called a prolapsed 脱垂 internal
hemorrhoid; it is often difficult to
ease back into the rectum, and is
Symptoms of external
hemorrhoids may include
painful swelling or a
hard lump around the
anus that results when a
blood clot forms. This
condition is known as a
thrombosed external
hemorrhoid.
In addition, excessive
straining, rubbing, or
cleaning around the anus
may cause irritation with
bleeding and/or itching,
which may produce a
vicious cycle of
symptoms. Draining
mucus may also cause
itching.
External hemorrhoids are visible-
occurring out side the anus. They are
basically skin-covered veins that
have ballooned and appear blue.
Usually they appear without any
symptoms. When inflamed, however,
When a blood clot forms inside an
external hemorrhoid, it often causes
Severe pain. This thrombosed
external hemorrhoid can be felt as a
firm, tender mass in the anal area,
 Fistula in Ano
 Arise from abscess in the anal crypts
and track to the perianal skin
 Internal orifices of the track—above
the pectinate line
 Can be probed
 palpation--subcutaneous cord
 Multiple fistulas suggest Crohn
disease
Fistula in Ano
endoscope
endoscope
endoscope
Operation of anal fistula
Operation of anal fistula
Operation of anal fistula
Caneration of fistula
 Rectal prolapse
 Mucosa evert below sphincter
( when defecate)
 To demonstate: squat and strain
in the position for defecation
Rectal prolapse of child
Rectal prolapse
Rectal prolapse
Perianal abscess
Cancer of anal canal