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Updated: Nov 27 2016

Pectinate Line

  • Overview
    • Anal canal
      • divided into upper 2/3 (visceral portion) that belongs to the intestines and lower 1/3 (somatic portion) that belongs to the perineum
      • upper 2/3 is derived from the hindgut, endodermal in origin
      • lower 1/3 is derived from the proctodeum, ectodermal in origin
      • pectinate (dentate) line is the junction between endoderm and ectoderm and is located at the inferior limit of the anal valves
        • pectinate line divides the visceral and somatic portion
    • Upper 2/3
      • above pectinate line
      • simple columnar epithelium
        • upper 2/3 anal canal is the site of adenocarcinoma
      • arterial supply via the superior rectal artery, a continuation of IMA
      • venous drainage
        • superior rectal vein → inferior mesenteric vein → portal system
      • lymphatic drainage to the internal iliac lymph nodes
      • internal hemorrhoids
        • occur above the pectinate line and are covered by the mucous membrane
        • receive visceral innervation and therefore are not painful
        • may be a sign of portal hypertension
    • Lower 1/3
      • below pectinate line
      • stratified squamous epithelium
        • lower 1/3 of the anal canal is the site of squamous cell carcinoma
      • arterial supply via the inferior rectal arteries, branches of the internal pudendal arteries
      • venous drainage
        • inferior rectal vein → internal pudendal vein → internal iliac vein → IVC
      • lymphatic drainage to the superficial inguinal lymph nodes
      • external hemorrhoids
        • occur below the pectinate line and are covered by the skin
        • receive somatic innervation by the inferior rectal nerve, a branch of the pudendal nerve, and therefore are painful
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