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Anorectal ExamAka: Rectal Anatomy, Dentate Line, Pectinate Line

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  1. Physiology
    1. Rectum is lower 10 to 15 cm of large intestine
  2. 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
  3. Examination
    1. Patient position and preparation
      1. Left lateral decubitus position
      2. Assistant or patient spreads glutei
    2. Findings on Inspection
      1. Anal Fissures
      2. Anal fistula
      3. Perianal dermatitis
      4. Anal mass
      5. External Hemorrhoid
      6. Condyloma
    3. Rectal examination
      1. Digital Rectal Exam
      2. Anoscopy

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