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Flashcards in Abdo Deck (39)
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1
Q

Anatomy of the inguinal canal

A

Anterior: external oblique and internal oblique for the lateral third
Posterior: transversalis fascia and conjoint tendon for medial third
Floor: inguinal ligament
Roof: arching fibre of transversus and internal oblique

2
Q

Contents of the spermatic cord

A
Three layers of fascia:
1. External spermatic fascia 
2. Cremestatic fascia
3. Internal spermatic 
Three ateries and three viens 
1. Testicular
2. Cresmenteric 
3. Vas 
Two nerves
1. Sympathetic 
2. Gential branch of gen fem nerve 
Lymphatic 
Vas 
Process vaginalis
3
Q

Contents of inguinal canal

A

M: spermatic cord and illoinguinal nerve
F: round ligament, illoinguinal nerve , gen branch of gen fem nerve

4
Q

Hesselbach’s triangle

A

Medial: rectus abdominis
Lateral: inferior epigastric artery
Inferior: inguinal ligament

5
Q

Classification of inguinal hernia

A
Indirect - 80% 
- patent processus vaginalis 
- arise lateral to inferior epigastric artery 
Direct -20% 
- emerge through hesselbach's triangle 
- due to acquired weak wall of canal
6
Q

Laparoscopic techniques for inguinal hernia

A

TEP: totally extra peritoneal
TAPP: transabdominal pre- peritoneal

7
Q

Complications of inguinal hernia repair

A
Early 
- urinary retention 
- haematoma/ seroma formation - 10% 
- infection - 1% 
- intrabdominal Injury - lap 
Late 
- reoccurrence
8
Q

Borders of the femoral canal

A

Medial: lacunar ligament
Lateral: femoral vien
Anterior: inguinal ligament
Posterior: pectineal ligament of cooper

9
Q

Operative management of a femoral hernia

A

Elective: Lockwood low approach
Emergency: McEvedy high approach

10
Q

Definition of an inguinal hernia

A

Extrusion of peritoneum and abdominal contents through a previously acquired defect

11
Q

Risk factors for incscional hernias

A

Pre-op: increased age, co-mobrdities ( malignancy and obesity )
Intra - op: surgical technique ( width of suture bites, suture material, midline, placing drain through wounds )
Post op: incensed IAP, infection, heamatoma

12
Q

Cause of a paraumbilcal hernia

A

Acquired defect in linea Alba just above or below the umbilicus

13
Q

Definition of a hernia

A

Protrusion of a viscus or part of a viscus into an abnormal position through a defect in its containing cavity

14
Q

Risk factor for umbilical hernias

A

Afro-carribean
Trisomy 21
Congenital hypothyroidism

15
Q

Definition of a hydroele

A

Accumulation of fluid within the tunica vaginalis

Tunica vaginalis is a rememant of the processus vaginalis

16
Q

Anatomical classification of hydroele

A

Vaginal: accumulation in the tunica vaginalis that does not extend up the cord
Congenital: proximal part of the processus has not obliterated and sac communicates directly with preitoneum
Infantile: processus is obliterated at the deep ring but still extend up the cord
Hydroele of the cord: fluid accumulate around the ductus deferens

17
Q

Cause of hydroceles

A

Primary: patent processus vaginalis
Secondary: testicualr tumours, epidymo-orchitis, trauma, torsion

18
Q

Surgical treatment of hydrocele

A

Lords repair: plication of the tunica vaignalis

Jaboulay’s repair: eversion of the sac

19
Q

Definition of a varicocele

A

Dilated viens of the pampinifrom plexus

20
Q

Operation for varicocele

A

Palomo operation

21
Q

Risk factor for testicualr cancer

A

Undescended testis
Infant hernia
Infertility

22
Q

Royal marsden classification of testicualr cancer

A
  1. Disease only in testis
  2. Sub diaphragmatic para-aortic node involvement
  3. Supra and infra diaphragmatic lymph nodes involved
  4. Extra lymphatic spread - lungs liver
23
Q

No scars and stoma =

A

Colonoscopy assisted trephine colostomy

24
Q

Definition of a stoma

A

Artificial union between conduits or between a conduit and the outside

25
Q

Fistula definition

A

Abnormal connection between two hollow epithelial surface

26
Q

Indication for a stoma

A
Exteriorisation 
- perforated or contaminated bowel 
- permenant 
Diversion
- protection of distal anastomosis
- acute chrons 
- urinary diversion following cystectomy 
Decompression: bypass of distal obstructing lesion 
Feeding: gastrostomy/ jejunostomy 
Laveage: appendecictomy
27
Q

How to site a stoma

A

Avoid: bony prominences, skin folds/creases, waistline, old wounds, umbilicus
Chose
- a site that is easily accessible to the patient
- ideally below the belt line for concealment
- within the rectus: decreased risk of hernia or prolapse

28
Q

Complication of a stoma

A
Early 
- haemorrhage 
- ischemia 
- hight out put leading to electrolyte disturbances 
- parastomal abscess 
- stoma retraction 
Delayed 
- parastomal hernia - more common on the lateral side 
-obstruction: adhesion or herniation through lateral space around stoma 
- dermatitis 
- stoma prolapse 
- stenosis or stricture 
- fistula 
- psychosexual dysfunction
29
Q

Layers of tissues around abdomen

A
Skin 
Campers fascia 
Scarpas fascia 
Linea Alba 
Transversalis fascia 
Pre-peritoneal fat 
Preitoneum 

Some catholic sluts like to practise phallactio

30
Q

Jenkins rule

A

Length of suture should be 4 times the length of the incscion

31
Q

Indication for midline stenotomy

A

Trauma
Vascular: AAA, Vascualr bypass
Gastro: perforated Dueodenal ulcer, Hartmann, colectomy

32
Q

Indications for a roof top incscion

A
Hepatobillary: 
- liver transplant 
- whipples 
- liver resection 
Gastric surgery
33
Q

Lateral layers of the abdominal wall

A
Skin 
Campers fascia 
Scarpas fascia 
External oblique 
Internal oblique 
Transversus 
Transversalis fascia 
Pre-peritoneal fat 
Preitoneum
34
Q

Nerves at risk in appendicetomy

A

Ilioinguinal

Iliohypogastric

35
Q

Cause of post op jaundice

A

Pre-hepatic: heamolysis after a transfusion
Hepatic: halogenated anaesthetic, sepsis, intra-post operative hypotension
Post hepatic: billary injury in lap Chloe

36
Q

Cause of gynecomastia

A

Drugs
- recreational: marijuana, diazepam, anabolic steroid
- prescription: spirolactone, digoxin, catopril, verapamil, ranitidine
Physiological
- puberty resolve by adulthood
Pathological
- decreased androgen production: hypogoandism: hyperprolactinemia, renal failure, testicualr atrophy, post-orchitis, bilateral torsion, klienfelter XXY
- increased oestrogen
- increased production: sex-cord stromal tumours, lung ca
- increased peripheral aromatisation: CLD, thyrotoxicosis

37
Q

Risk factors for oesophageal cancer

A
GORD
EtOH 
Smoking 
Achalasia 
Plummer Vinson syndrome
38
Q

What’s is a pharyngeal pouch

A

Outpouching between crico and thyro pharyngeal components of the inferior pharyngeal constrictiors

Pulsion diverticulum

Area of weakness is called killians dehiscnse

39
Q

Riglers triad

A

Small bowel obstruction
Pneumobillia
Gallstone in right iliac fossa