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Kelainan Lainnya Pada Anus Dan Rektum Serta Fungsi Anorectal
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---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- CHAPTER 104 Other Disordersof the Anus andRectum, AnorectalFunction Risto J. Rintala and Mikko P. Pakarinen Anatomy The anal canal measures 2.5 to 4 cm in length (Fig. 104-1). 1 Itisthe areabetween theanalvergeandthejunction ofthestrat-ified cuboidal and columnar epithelium (dentate line). 2 It islined by squamous epithelium in the lower anal canal belowwhich sebaceous glands and hair follicles arise but changes tostratified cuboidal and, finally, columnar epithelium of therectum. Sensitive sensory receptors in this epithelium andin the more proximal anal mucosa respond to a variety of stimuli, permitting discrimination of solid, liquid, and gas.The mucosa of the rectum meets the epithelial lining of theanal canal at the dentate or pectinate line, marking the oralextension of the anal columns and valves. High in the analcanal, the mucosa forms four to six longitudinal folds.The smooth muscle of the internal anal sphincter (IAS)is continuous with the inner circular muscle of the rectum.Itbecomesmore prominent lowinthe analcanal.Itisapprox-imately 3cm long and 5 mm thick. 3 IAS isbound to voluntary external sphincter and perianal skin by muscular strands. It isinvoluntarily in a tonic state of contraction, providing at least85%oftherestinganalcanalpressurethatkeepstheanalcanalclosed. 4 The IAS can increase contraction only slightly, but itrelaxes completely by reflex in response to rectal distention. 5 This reflex, mediated by the myenteric plexus, is intrinsic andthus remains independent from extrinsic innervation.Both sympathetic and parasympathetic nerves innervatethe internal sphincter. 6 Sympathetic innervation is primarily excitatory, contracting the IAS, and is supplied by the lumbarsplanchnicnervesfromL2toL4gangliaandbythehypogastricnerves from the inferior mesenteric ganglion. a -Adrenergicstimulation is excitatory, but b -adrenergic stimulation isinhibitory. The continuous tonic state of IAS appears to bemediated by excitatory fibers of both adrenergic and choliner-gic innervation. Parasympathetic innervation comes from theS2 to S4 ganglia through the pelvic nerves and is generally inhibitory, causing the IAS to relax. 7,8 The IAS also has an important intrinsic innervation, whichis responsible for reflex relaxation in response to rectal disten-tion. These intrinsic nerves lie in intramural plexuses and inthe myenteric (Auerbach), deep submucosal (Henke), andsubmucosal (Meissner) RELATED SEARCH plexuses and are nonadrenergic andnoncholinergic in srcin. 6,7 The external anal sphincter is a striated muscle that ispartially under voluntary control. The muscle surrounds theanus Konsep Dan Fungsi Budaya STRUKTUR DAN FUNGSI EKOSISTEM (/search/konsep+dan+fungsi+budaya) (/search/struktur+dan+fungsi+ekosistem) below the dentate line and is attached anteriorly to theperineal body and posteriorly to the FUNGSI DAN KEDUDUKAN HADITS TERHADAP AL-QUR`A anococcygeal raphe.The external anal sphincter has traditionally been divided inthree (/search/fungsi+dan+kedudukan+hadits+terhadap+al+qur+an) anatomic components: subcutaneous, superficial, anddeep. It is innervated by rami of the Bank Dan Lembaga Keuangan Lainnya Perencanaan Dan Pengelolaan Waduk Serta Kapas (/search/bank+dan+lembaga+keuangan+lainnya) (/search/perencanaan+dan+pengelolaan+waduk+serta+kapasitas+tampungan+da pudendal and perinealnerves, which srcinate from sacral roots 2 to 4. 9 Although capable of Fungsi vektor dan Kurva vektor Konsep Dan Praktik Demokrasi Serta Pendidikan phasic contraction, the external analsphincter may also have tonic contraction. 10 Unlike the (/search/fungsi+vektor+dan+kurva+vektor) (/search/konsep+dan+praktik+demokrasi+serta+pendidikan+demokrasi) IAS,the tonic contraction of the external sphincter dependson extrinsic efferent innervation. Segitiga dan Dalil-Dalil Pada Segitiga Pengertian Dan Fungsi Bahasa (/search/segitiga+dan+dalil+dalil+pada+segitiga) (/search/pengertian+dan+fungsi+bahasa) The phasic contractionsare born voluntary and involuntary; thus the external analsphincter Makalah Struktur dan Fungsi Tubuh Tumbuhan (/search/makalah+struktur+dan+fungsi+tubuh+tumbuhan) provides part (10% to 15%) of the resting analsphincter tone. 11 The pelvic floor muscles consist of the levator ani musclegroup,one part of which, the puborectalmuscle,formsaslingaround the anorectaljunction. Although astriated muscle, thepuborectalis remains in tonic contraction. 12 This creates anangle between the anus and
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