MCOMPASS ANAL MANOMETRY AN OVERVIEW
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2 MCOMPASS ANAL MANOMETRY AN OVERVIEW
3 ANAL MANOMETRY MEASURES PRESSURE ALLOWS INTERPRITATION SENSATION RAIR RECTAL COMPLIANCE MOTIVATION OF THE PATIENT FUNCTION OF THE PUDENDAL NERVE
4 WHEN TO USE ANAL MANOMETRY POOR ANAL STRENGTH FROM HISTORY OR FROM EXAMINATION WHEN THIS INFORMATION IS IMPORTANT TO THE PATIENTS CARE WHEN THE SITUATION IS CONFUSING TO THE PHYSICIAN EDUCATION FOR THE PATIENT
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6 ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY
7 ANATOMY: RECTUM
8 ANATOMY: ANAL MUSCLES INTERNAL ANAL SPHINCTER EXTERNAL ANAL SPHINCTER PELVIC DIAPHRAM
9 AUTOMONIC (INVOLUNTARY) NERVOUS SYSTEM PARASYMPATHETIC: CRANEAL NERVES AND SACRAL NERVES SYMPATHETIC: SPINAL NERVES
10 ANATOMY: NEURAL INNERVATION PELVIS, RECTUM & ANUS
11 NERVES TO THE ANUS & RECTUM SOMATIC (VOLUNTARY) PUDENDAL & LEVATOR ANI S 2, 3, 4 AUTOMONIC (INVOLUNTARY) SYMPATHETIC (FIGHT OR FLIGHT) L 1, 2, 3 PARASYMPATHETIC (REST) S 2, 3, 4
12 SOMATIC (VOLUNTARY) PUDENDAL & LEVATOR ANI NERVES S 2, 3, 4 AUTOMONIC (INVOLUNTARY) SYMPATHETIC PRESACRAL L 1, 2, 3 PARASYMPATHETIC S 2, 3, 4
13 PHYSIOLOGY: GASTROCOLIC REFLEX AUTONOMIC NERVOUS SYSTEM PARASYMPATHETIC NERVES VAGUS NERVE CONTROLS GUT FUNTION FROM ESOHAGUS TO APPROXIMATLEY THE MID- TRANSVERSE COLON SACRAL PARASYMPATHETIC NERVES CONTROLS GUT FUNTION FROM MID-TRANSVERSE COLON TO ANAL CANAL SYMPATHETIC NERVES CERVICAL, THORASIC, & LUMBAR PLEXUS
14 GASTROCOLIC REFLEX ANTICIPATION, STOMACH, SMALL INTESTINE, COLON, RECTUM, ANAL CANAL
15 RECTUM & ANUS RECTAL ANAL INHIBITORY REFLEX (RAIR) STOOL IN THE RECTUM DILATES THE RECTUM STIMULATES THE MUCOSA STETCHES THE PELVIC DIAPHRAM INTERNAL ANAL SPHINCTER (AUTONOMIC CONTROL) CONTRACT & RELAX 6 TIMES A MIN RELAXES EXTERNAL ANAL SPHINCTER (SOMATIC CONTROL) CONTRACTS: REFLEX & PURPOSEFUL
16 DEFECATION APPROPRIATE TIME RELAX EXTERNAL ANAL SPHINCTER INCREASE INTRABDOMINAL PRESSURE EVACUATE THE RECTUM
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18 ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY
19 MCOMPASS ANAL MANOMETRY MEASURES PRESSURE INTERNAL ANAL SPHINCTER EXTERNAL ANAL SPHINTER RECTAL ALLOWS INTERPRITATION SENSATION RECTAL COMPLIANCE MOTIVATION OF THE PATIENT FUNCTION OF THE PUDENDAL NERVE CALCULATES RAIR RECTAL COMPLIANCE
20 MCOMPASS TESTING SEQUENCE 1. RESTING PRESSURE INTERNAL ANAL SPHINCTER 2. CONTRACTING PRESSURE & DURATION OF SQUEEZE EXTERNAL ANAL SPHINCTER 3. RAIR (RECTAL ANAL INHIBITORY REFLEX) PARSYMPATHETIC NERVES S2, S3, S4 4. RECTAL BALLOON INFLATION RECTAL COMPLIANCE 5. EXPULSION TEST ANISMUS 6. COUGH EFFORT
21 MCOMPASS ANAL MANOMETRY NORMAL VALUES RESTING PRESSURE MALE & FEMALE: 60 mmhg & GREATER MALE: 200 mmhg & GREATER CONTRACTING PRESSURE FEMALE: 150 mmhg & GREATER DURATION OF SQUEEZE 20 SECONDS RAIR: CAN VARY GREATLY 30-60cc SENSATION: CAN VARY GREATLY 1 st SENSATION: 30cc DESIRE: cc URGE: cc PAIN: cc
22 MCOMPASS ANAL MANOMETRY FEMALE: NORMAL VALUES
23 MCOMPASS ANAL MANOMETRY MALE: NORMAL VALUES
24 HOW TO DO A GOOD ANAL MANOMETRY STUDY
25 PERFORMING A GOOD MANOMETRY RESTING PRESSURE BE STILL: NO TALKING, MOVING CONTRACTING PRESSURE ENCOURAGE THE PATIENT DURATION OF SQUEEZE ENCOURAGE THE PATIENT
26 PERFORMING A GOOD MANOMETRY RAIR DETERMINE THE RAIR VOLUME BEFORE STARTING THE TEST MAKE SURE THE BALLOON IS AS LOW AS IT WILL GO RECTAL COMPLIANCE THE 10cc PRIMING VOLUME IN THE RECTAL BALLOON IS THE CONSIDERED AS ZERO VOLUME IN THE COMPLIANCE TEST
27 RAIR & RECTAL COMPLIANCE KEEP BALLOON LOW BALLOON TOO HIGH
28
29 ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY
30 MCOMPASS ANAL MANOMETRY MEASURES PRESSURE INTERNAL ANAL SPHINCTER EXTERNAL ANAL SPHINTER RECTAL ALLOWS INTERPRITATION SENSATION RECTAL COMPLIANCE MOTIVATION OF THE PATIENT FUNCTION OF THE PUDENDAL NERVE CALCULATES RAIR RECTAL COMPLIANCE
31 MCOMPASS TESTING SEQUENCE 1. RESTING PRESSURE INTERNAL ANAL SPHINCTER 2. CONTRACTING PRESSURE & DURATION OF SQUEEZE EXTERNAL ANAL SPHINCTER 3. RAIR (RECTAL ANAL INHIBITORY REFLEX) PARSYMPATHETIC NERVES S2, S3, S4 4. RECTAL BALLOON INFLATION RECTAL COMPLIANCE 5. EXPULSION TEST ANISMUS 6. COUGH EFFORT
32 MCOMPASS ANAL MANOMETRY NORMAL VALUES RESTING PRESSURE MALE & FEMALE: 60 mmhg & GREATER MALE: 200 mmhg & GREATER CONTRACTING PRESSURE FEMALE: 150 mmhg & GREATER DURATION OF SQUEEZE 20 SECONDS RAIR: CAN VARY GREATLY 30-60cc SENSATION: CAN VARY GREATLY 1 st SENSATION: 30cc DESIRE: cc URGE: cc PAIN: cc
33 MCOMPASS ANAL MANOMETRY FEMALE: NORMAL VALUES
34 MCOMPASS ANAL MANOMETRY MALE: NORMAL VALUES
35 HOW TO DO A GOOD ANAL MANOMETRY STUDY
36 PERFORMING A GOOD MANOMETRY RESTING PRESSURE BE STILL: NO TALKING, MOVING CONTRACTING PRESSURE ENCOURAGE THE PATIENT DURATION OF SQUEEZE ENCOURAGE THE PATIENT
37 PERFORMING A GOOD MANOMETRY RAIR DETERMINE THE RAIR VOLUME BEFORE STARTING THE TEST MAKE SURE THE BALLOON IS AS LOW AS IT WILL GO RECTAL COMPLIANCE THE 10cc PRIMING VOLUME IN THE RECTAL BALLOON IS THE CONSIDERED AS ZERO VOLUME IN THE COMPLIANCE TEST
38 RAIR & RECTAL COMPLIANCE KEEP BALLOON LOW BALLOON TOO HIGH
39
40 ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY
41 GOOD STUDY GOOD PRESSURES
42 DO I HAVE A GOOD STUDY GOOD STUDY 4 CHANNELS NOT WORKING
43 DO I HAVE A GOOD STUDY 3 CHANNELS NOT WORKING 2 CHANNELS NOT WORKING
44 DO I HAVE A GOOD STUDY GOOD STUDY GOOD STUDY RECTAL PROLAPSE
45 DO I HAVE A GOOD STUDY FISSURE MALE SAME PATIENT 2 CHANNELS NOT FUNCTIONING ALL CHANNELS FUNCTIONING
46 DO I HAVE A GOOD STUDY FISSURE MALE SAME PATIENT 2 CHANNELS NOT FUNCTIONING ALL CHANNELS FUNCTIONING
47 READING THE STUDY FOLLOW THE SEQUENCE RESTING PRESSURE CONTRACTING PRESSURE DURATION OF SQUEEZE RAIR (RECTAL ANAL INHIBITORY REFLEX) RECTAL COMPLIANCE EXPULSION TEST COUGH
48 READING THE STUDY FOLLOW THE SEQUENCE
49 WHEN YOU THOUGHT NOTHING COULD GO WRONG
50 READING THE STUDY POTENTIAL PROBLEM AREAS RAIR RECTAL COMPLIANCE ANISMUS
51 RAIR CALCULATED AS NORMAL
52 RAIR HARD TO INTERPRET
53 RAIR NEGATIVE ON CALCULATION RAIR PROBABLY PRESENT
54 RAIR NEGATIVE ON CALCULATION RAIR PRESENT GOOD PRESSURES, FISSURE
55 RAIR PRESENT EAS CONTRACTS WITH RAIR
56 RAIR PRESENT EAS CONTRACTS WITH RAIR
57 RAIR EASY TO SEE STARTS BEFORE 1 ST SENSATION
58 READING THE STUDY POTENTIAL PROBLEM AREAS RAIR RECTAL COMPLIANCE ANISMUS
59 RECTAL COMPLIANCE NORMAL MALE
60 RECTAL COMPLIANCE BALLOON VOLUME EXCEEDED
61 NORMAL FEMALE VARIATION IN RECTAL VOLUME
62 READING THE STUDY POTENTIAL PROBLEM AREAS RAIR RECTAL COMPLIANCE ANISMUS
63 ANISMUS PRESENT FEMALE WITH SPASTICITY
64 ANISMUS NOT PRESENT MALE WITH FISSURE
65
66 ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY
67 EXAMPLES OF PATIENTS POOR ANAL STRENGTH ON EXAMINATION OR HISTORY WHEN THIS INFORMATION IS IMPORTANT TO THE PATIENTS CARE WHEN THE SITUATION IS CONFUSING TO THE PHYSICIAN EDUCATION FOR THE PATIENT FECAL INCONTINENCE CONSTIPATION PRE-OP EVALUATION ANORECTAL SURGERY COLONIC SURGERY
68 INCONTINENT FEMALE MODERATE PRESSURES
69 CONSTIPATED MALE NORMAL STRENGTH
70 FISSURE MALE GOOD PRESSURES
71 FISSURE FEMALE GOOD TO BORDERLINE STRENGTH
72 DIVERTICULITIS FEMALE GOOD PRESSURES
73 DIVERTICULITIS FEMALE MODERATE PRESSURES
74 RECTAL CANCER FEMALE POOR PRESSURES
75 RECTAL CANCER FEMALE POOR PRESSURES
76 ULCERATIVE COLITIS MALE POOR PRESSURES
77 RECTAL PROLAPE FEMALE POOR PRESSURES: CASE #1
78 RECTAL PROLAPE FEMALE POOR PRESSURES: CASE #1
79 RECTAL PROLAPSE POOR PRESSURES: CASE #2
80 RECTAL PROLAPSE POOR PRESSURES: CASE #2
81 COLOSTOMY CLOSURE FEMALE GOOD PRESSURES
82 COLOSTOMY CLOSURE FEMALE GOOD PRESSURES
83 COLOSTOMY CLOSURE FEMALE POOR PRESSURES
84 RAIR BEFORE 1 ST SENSATION CONFUSING TO PHYSICIAN #1
85 RAIR BEFORE 1 ST SENSATION CONFUSING TO PHYSICIAN #1
86 RAIR BEFORE 1 ST SENSATION CONFUSING TO PHYSICIAN #2
87 RAIR BEFORE 1 ST SENSATION CONFUSING TO PHYSICIAN #2
88
89 WHEN TO USE ANAL MANOMETRY POOR ANAL STRENGTH FROM HISTORY OR FROM EXAMINATION WHEN THIS INFORMATION IS IMPORTANT TO THE PATIENTS CARE WHEN THE SITUATION IS CONFUSING TO THE PHYSICIAN EDUCATION FOR THE PATIENT
90 ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY
91 MCOMPASS ANAL MANOMETRY KEITH D. MUNSON MD FACS, FASCRS
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