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Medicine Year 1 > Case 12 SBA > Flashcards

Case 12 SBA Flashcards

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1
Q

Name the layers of the anterior abdominal wall

A

Skin
Camper’s fascia
Scarpa’s fascia
External oblique
Internal oblique
Transversus abdominus
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum

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2
Q

Origin of external oblique muscles

A

Muscular slips from outer surfaces of lower eight ribs

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3
Q

Insertions of external oblique muscles

A

Lateral lip of iliac crest
Aponeurosis ending in midline raphe

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4
Q

Direction of external oblique muscles

A

Down and out, hands in pockets

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5
Q

Origin of internal oblique muscles (TIL)

A

Thoracolumbar fascia
Iliac crest between origins of external and transversus
Lateral two-thirds on inguinal ligament

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6
Q

Insertion of internal oblique muscles

A

Inferior border of lower three or four ribs
Aponeurosis ending in lines alba
Pubic crest and pectineal line

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7
Q

Direction of internal oblique muscles

A

Diagonally up and in, hands on heart

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8
Q

Transversus abdominus origin

A

Thoracolumbar fascia
Medial lip of iliac crest
Lateral one-third of inguinal ligament
Costal cartilages of lower six ribs

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9
Q

Insertion of transversus abdominus

A

Aponeurosis ending in linea alba
Pubic crest and pectineal line

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10
Q

Direction transversus abdominus

A

Horizontal

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11
Q

Rectus sheath

A

Covering which encloses the rectus abdominus muscle and the pyramidalis muscle

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12
Q

What forms the rectus sheath?

A

Aponeuroses external oblique, internal oblique, and transversus abdominus

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13
Q

Linea alba

A

Midline where rectus sheath fuses

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14
Q

Linea semilunaris

A

Lateral edge of rectus sheath on each side

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15
Q

Anterior portion of superior rectus sheath

A

Aponeuroses of external oblique and half of internal oblique

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16
Q

Posterior portion of superior rectus sheath

A

Aponeuroses of half of internal oblique and transversus abdominus

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17
Q

Anterior portion inferior rectus sheath

A

Aponeuroses of external oblique, internal oblique, transversus abdominus

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18
Q

Posterior portion inferior rectus sheath

A

None as in direct contact with transversalis fasci

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19
Q

Tendinous intersection

A

Fibrous bands separating rectus abdominus muscle

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20
Q

Arcuate line

A

5-6cm below umbilicus
Posterior wall of rectus sheath finishes

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21
Q

What is a hernia?

A

Protrusion of an organ or tissue through its covering into an abnormal position outside its normal compartment

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22
Q

What causes hernias?

A

Weak muscle/surrounding tissue
Increased intra-abdominal pressure

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23
Q

Reducible hernia

A

Can be pushed back into place

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24
Q

Incarcerated hernia

A

Unable to be pushed back to original place

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25
Obstructed hernia
Contents compacted Lumen not patent
26
Strangulated hernia
Squeezing causes ischaemia due to lack of blood flow
27
Where does a spigelian hernia occcur?
Linea semilunaris, around the level of the arcuate line
28
Describe presentation and risk of spigelian hernia
Small tender mass at lower lateral edge of the rectus abdominus High risk of strangulation
29
Location of epigastric hernia
Midline between xiphoid process and umbilicus
30
What causes epigastric hernia?
Defect in linea alba
31
What is omphalocele?
Defect in abdominal wall
32
Infantile omphalocele
Prematurity
33
Adult omphalocele
Pregnancy, obesity, ascites
34
Paraumbilical hernia
Central swelling above or below umbilicus
35
Associations with paraumbilical hernias
Adults Women Obesity Weak abdominal muscles
36
What can the sac contain in paraumbilical hernias?
Bowel and omentum
37
Where is the inguinal ligament?
From ASIS to pubic tubercle
38
What forms the inguinal ligament?
Formed from the aponeurosis of the external oblique muscle
39
Clinical significance of midpoint of the inguinal ligament
Landmark to find the femoral nerve
40
Mid-inguinal point location
Half-way between the pubic symphysis and anterior superior iliac spine (ASIS)
41
Significance of the mid-inguinal point
Femoral pulse palpation
42
Anterior boundary inguinal canal
Aponeuroses of external and internal oblique
43
Roof inguinal canal
Aponeurotic arching of transversus abdominus and internal oblique
44
Posterior wall inguinal canal
Transversalis fascia
45
Floor inguinal canal
Inguinal and lacunar ligaments
46
What does the inguinal canal contain?
Spermatic cord/round ligament of uterus Genital branch of genitofemoral nerve Ilio-inguinal nerve
47
Which is the more common inguinal hernia type?
Indirect
48
Indirect inguinal hernia
Peritoneal sac and potentially bowel enter the inguinal canal via the deep inguinal ring
49
What dictates the degree of herniation of an indirect inguinal hernia?
Amount of processus vaginalis still present
50
Where does an indirect inguinal hernia occur?
Lateral to inferior epigastric vessels
51
What can indirect inguinal hernias cause?
Bowel obstruction and strangulation
52
Direct inguinal hernia
Peritoneal sac bulges into the inguinal canal via the posterior wall and can enter the superficial inguinal ring
53
Where does a direct inguinal hernia occur?
Medial to inferior epigastric vessels
54
What causes direct inguinal hernias?
Weakened musculature
55
Femoral hernia
Abdominal viscera or omentum pass through femoral ring into femoral canal. Rare.
56
Where does a femoral hernia occur?
Inferolateral to the pubic tubercle
57
Routes of IBD treatment
Oral, rectal, systemic
58
What do aminosalicates contain?
5-ASA and sulfasalazine/mesalazine
59
Action of aminosalicates in IBD
Limit inflammation to mucosa
60
Why are aminosalicates less useful in Crohn’s?
Just limit mucosal inflammation
61
Aminosalicate dosing in IBD
2.4g per day Continue as maintenance
62
What effects do aminosaliates have on developing cancer?
Chemopreventative so reduce risk
63
Aminosalicates in proctitis?
1g suppository at night
64
Which corticosteroid is used in IBD?
Prednisolone
65
Corticosteroid dosing in IBD
40mg initially weaning over 6-8 weeks
66
Corticosteroid use in UC?
Clipper/cortiment in moderate/severe
67
Corticosteroid use in Crohn’s
Budesonide in colonic Crohn’s
68
What is taken as an accompaniment with corticosteroids in IBD?
Calcium and vitamin D twice daily
69
Administration corticosteroids in IBD
Oral
70
Are corticosteroids good for long-term use in IBD
No
71
Actions of thiopurine and methotrexate
Modify immune activity or reduce cell number to decrease inflammatory response
72
Which IBD is methotrexate used for?
Crohn’s
73
Monotherapy thiopurine/methotrexate use in IBD?
Induction and maintenance of remission
74
Why are thiopurines and methotrexate used with anti-TNF drugs?
Protect from immunogenicity
75
Combination of what with thiopurine leads to higher remission rates in IBD?
Infliximab
76
Biologic drugs action
Bind to target and make it harmless
77
Infliximab
Anti-TNF monoclonal antibody, chimeric
78
Vedolizumab action
Gut-selective anti alpha-4 beta-7 integrin therapy
79
Pros of using Vedolizumab in IBD
Favourable safety profile Low immunogenicity
80
Cons of using Vedolizumab in IBD
Expensive compared to biosimilar drugs
81
Biologics used in IBD
Infliximab, Vedolizumab, Ustekinumab
82
What is ustekinumab used for?
Crohn’s UC psoriasis Psoriatic arthritis
83
Pros of ustekinumab in IBD
Favourable safety profile Low immunogenicity
84
Cons of ustekinumab in IBD
Lack of safety data in pregnancy Expensive compared to biosimilar drugs
85
JAK inhibitors in UC
Tofactinib and filgotinib
86
How to JAK inhibitors act?
With variable affinities for JAK1, JAK2, and JAK3 pathways
87
Non-selective JAK inhibitor
Tofactinib
88
Risks associated with tofactinib
Shingles Venous thromboembolism (VTE)
89
What are the risk factors for shingles and VTE in tofactinib use?
Major surgery Immobilisation MI in previous three months Heart failure HRT Combined pill Coagulation disorder Malignancy
90
Non-pharmacological treatments of IBD
Research studies, clinics, nurse specialist appointments
91
Definition of diarrhoea
three or more loose stools per day with >500ml fluid and electrolytes lost
92
Causes of osmotic diarrhoea
laxatives, non-absorbable food, congenital/acquired disorders of digestion
93
what is osmotic diarrhoea?
malabsorption
94
what is secretory diarrhoea?
ion transport defect, imbalance between secretion and absorption
95
causes of secretory diarrhoea
enterotoxins, laxatives, hormone secreting tumours, medication, allergy
96
how does motility disturbance cause diarrhoea?
insufficient time for absorption

Medicine Year 1 (23 decks)

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