Anorectal Exam

Aka: Anorectal Exam, Anorectal Anatomy, Rectal Anatomy, Dentate Line, Pectinate Line, Rectum, Rectum Anatomy, Anal Anatomy, Anorectal Condition, Anorectal Disorder

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II. Physiology

  1. Rectum is lower 10 to 15 cm of Large Intestine

III. Anatomy: Images

  1. giRectumGrayBB1078.gif Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
  2. giAnusGrayBB1080.gif Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)

IV. Anatomy

  1. Perianal skin
    1. Typical skin that bears hair and glands
  2. Anal Verge
    1. Analogous to vermillion border of lips
  3. Squamous Epithelium
    1. Exquisitely sensitive
    2. Shiny white mucosa
    3. External Hemorrhoids start here
  4. Dentate Line (Pectinate Line)
    1. Divides squamous epithelium from columnar epithelium
    2. Delineates end of pain sensory fibers
    3. Contains Anal glands (4 to 8)
      1. Drain into Crypts of Morgagni
      2. Responsible for most rectal abscesses and fistulae
  5. Mucosal Glandular Epithelium
    1. No Pain Sensation (stretch nerve fibers present)
    2. Deeper pink or red mucosa
    3. Internal Hemorrhoids start here
  6. Valves of Houston (superior, middle, and inferior)
    1. Prominent mucosal folds within Rectum

V. History

  1. Lower Gastrointestinal Bleeding (Bright Red Blood Per Rectum)
  2. Pruritus Ani
  3. Anorectal Pain
  4. Stool Incontinence
  5. Rectal Prolapse
  6. Rectal Foreign Body

VI. Examination

  1. Patient position and preparation
    1. Left lateral decubitus position
    2. Assistant or patient spreads buttocks
  2. Findings on Inspection
    1. Anal Fissures
    2. Anorectal Fistula
    3. Perianal Dermatitis
    4. Anal mass
    5. External Hemorrhoid
    6. Anogenital Wart
    7. Perirectal Abscess
    8. Fecal Impaction
  3. Rectal examination
    1. Digital Rectal Exam
      1. Rectal Mass
      2. Fecal Occult Blood
    2. Anoscopy
      1. Internal Hemorrhoid

VII. References

  1. Cohee (2020) Am Fam Physician 101(1):24-33 [PubMed]

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Related Studies

Ontology: Rectum (C0034896)

Definition (MSHCZE) Distální součást STŘEVA TLUSTÉHO vymezená esovitou kličkou (COLON SIGMOIDEUM) a ANÁLNÍM KANÁLEM.
Definition (NCI_NCI-GLOSS) The last several inches of the large intestine closest to the anus.
Definition (NCI_CDISC) The terminal portion of the gastrointestinal tract, extending from the rectosigmoid junction to the anal canal. (NCI)
Definition (NCI) The terminal portion of the gastrointestinal tract, extending from the rectosigmoid junction to the anal canal.
Definition (MSH) The distal segment of the LARGE INTESTINE, between the SIGMOID COLON and the ANAL CANAL.
Concepts Body Part, Organ, or Organ Component (T023)
MSH D012007
SnomedCT 34402009
HL7 RECTU
LNC LP7540-0, MTHU001439, LA16840-3
English Rectum, Rectums, Hemorrhoidal, rectum, rectums, LARGE INTESTINE, RECTUM, RECTUM, Rectum structure, Rectum structure (body structure), Rectum, NOS
Swedish Ändtarm
Czech rektum, konečník
Finnish Peräsuoli
Russian KISHKA PRIAMAIA, PRIAMAIA KISHKA, КИШКА ПРЯМАЯ, ПРЯМАЯ КИШКА
Croatian REKTUM
Latvian Taisnā zarna
Polish Odbytnica, Prostnica
Norwegian Endetarm, Rektum
Spanish estructura del recto (estructura corporal), estructura del recto, recto, Recto
French Rectum
German Rectum, Rektum, Mastdarm
Italian Retto
Dutch Endeldarm, Rectum
Portuguese Reto
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Anorectal structure (C0459883)

Concepts Body Part, Organ, or Organ Component (T023)
SnomedCT 281088000
English Anorectal structure, Anorectal structure (body structure)
Spanish estructura anorrectal (estructura corporal), estructura anorrectal
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Anorectal disorder (C0687707)

Definition (CSP) disturbance of structure, function, or both of the anus and/or rectum.
Concepts Disease or Syndrome (T047)
SnomedCT 426867001
Italian Patologia anorettale, Patologia ano-rettale NAS, Patologia anorettale (NAS)
Dutch anorectale aandoening (NAO), anorectale aandoening NAO, anorectale aandoening
French Trouble anorectal SAI, Affection anorectale SAI, Trouble anorectal
German anorektale Erkrankung NNB, anorektale Erkrankung (NNB), anorektale Erkrankung
Portuguese Afecção anorrectal NE, Afecção ano-rectal
Spanish Trastorno anorrectal NEOM, Trastorno anorrectal (NEOM), trastorno anorrectal, trastorno anorrectal (trastorno), Trastorno anorrectal
Japanese 肛門直腸障害ＮＯＳ, 肛門直腸障害, 肛門直腸障害（ＮＯＳ）, ｺｳﾓﾝﾁｮｸﾁｮｳｼｮｳｶﾞｲNOS, ｺｳﾓﾝﾁｮｸﾁｮｳｼｮｳｶﾞｲ
English Anorectal disorder (disorder), Anorectal disorder, Ano-rectal disorder NOS, Disorder anorectal (NOS), anorectal disorders, anorectal disorder, Anorectal diseases
Czech Anorektální porucha, Anorektální porucha NOS, Anorektální porucha (NOS)
Hungarian Ano-rectalis betegség k.m.n., Anorectalis betegség, Anorectalis betegség (k.m.n.)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pectinate line (C0821671)

Concepts Body Location or Region (T029)
English Linea pectinata, Pectinate line, pectinate line, Pectinate Line
Derived from the NIH UMLS (Unified Medical Language System)

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