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Flashcards in GI S3 (Done) Deck (91)
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1

Describe the basic features of the abdominal wall

Continuous

Subdivided into:

Anterior

Lateral walls (left and right)

Posterior wall

Lateral and anterior wall boundary is indefinite therefore the term 'anterolateral abdominal wall' is used to describe them together

2

Describe the boundaries of the anterolateral abdominal wall

Superiorly:

Xiphoid process

Cartilages of the 7th - 10th ribs

Inferiorly:

Inguinal ligament

Superior margin of the pelvic girdle (iliac crests, pubic crests and pubic symphisis)

 

3

What are the layers of the abdominal gut wall?

Skin

Subcutaneous tissue (superficial fascia and fat)

Muscles and their apneurosis

Deep fascia

Extraperitoneal fat

Parietal peritoneum

 

4

Label the black boxes

Top to bottom, right column first:

Skin

Superficial fatty layer of subcutaneous tissue

Deep membranous layer of subcutaneous tissue

Investing (Deep) fascia - superficial, intermediate and deep

2nd Column:

External oblique

Internal oblique

Transversus abdominus

Extraperitoneal fat

Endoabdominal fascia

Parietal peritoneum

5

What is the umbilicus?

Center of anterolateral abdominal wall

L3

6

What is the Epigastric Fossa?

Slight depression in epigastrum

Just inferior to xiphoid process

Heartburn commonly felt at this site

7

What is the linea alba?

What is a common abnormality?

Apneuroses of abdominal muscles

Separates the left and right rectus abdominis

Visible in lean individual

Apneuroses of right and left, Intermediate and deep layers of the gut wall interweave here

If lax then rectus abdominis spread apart on contraction  (Divercation of recti)

 

8

What is the inguinal groove?

Skin crease parallel and just inferior to inguinal ligament

Marks the division between abdominal wall and thigh

9

What are the Semilunar lines?

Slightly curved, tendinous lines on either side of the rectus abdominis

10

What are the tendinous intersections of the rectus abdominis?

Clearly visible (in lean individuals) horizontal lines through the rectus abdominis

11

What are the Arcuate lines?

Where the inferior limit of the posterior rectus sheath ends 

1/3 of the way between the umbilicus and the pubic crest

12

Label the Boxes

Top to bottom:

1st column:

Xiphoid process

Right costal margin

Umbilicus

Iliac crest

ASIS

Inguinal ligament

Pubic tubercle

2nd Column:

Epigastric fossa

Linea alba

Semilunar lines

Pubic symphysis

3rd Column

Serratus anterior

Ext. Oblique

Rectus abdominis

Linea alba

Umbilicus

Inguinal ligament

 

13

There are two types of muscle in the abdominal wall, what are they and what are the muscles in each category?

 

Flat:

External oblique

Internal oblique

Transversus abdominis

Vertical:

Rectus abdominis

Pyrimidalis

14

What directions do the fibres of the flat muscles of the abdominal wall run?

What is the order of the flat muscles in the abdominal wall?

External oblique:

Posterior to anterior

Superficial

Internal oblique:

Anterior to posterior

Middle

Transversus abdominis:

Transverse

Deep

15

What is the rectus sheath?

3 flat muscles are continued antero-medially as the the rectus sheath (apneuroses) that enclose the rectus abdominis and Pyrimidalis

16

Label the boxes

1st Column:

Rectus sheath

Rectus abdominis

Linea alba

Rectus sheath

2nd Column:

Apneuroses of TA

Parietal peritoneum

Transversalis fascia

TA muscle

Int. Oblique

Ext. Oblique

Subcutaneous tissue

Apneuroses of Ext. Oblique

Lamina of apneuroses of Int. Oblique

Skin

Parietal peritoneum

Extraperitoneal fat

Transversalis fascia

Membranous and Fatty layers of Subcutaneous tissue

17

What are the major considerations when designing a surgical abdominal insicion

Capable of closing

Strong and long lasting

Minimise incidence of insicional herniae

Not directly through muscle (Sutures will 'cut out')

18

List the major abdominal incisions

Midline

Transverse

Appendicectomy

Gridiron

19

Breifly describe a midline surgical incision

Insicion through linea alba

20

Briefly describe a transverse surgical incision

Cut through the external oblique apneuroses

21

Describe an appendicectomy incison

Incision at McBurney's point

2/3 the distance between umbilicus and ASIS

Through a Gidiron muscle splitting incision

22

What is a Gidiron incision?

Separation of the muscle fibres of the flat muscles with scissors to get through to the peritoneum

23

What is a 'patent urachus' and what is a common consequence?

What are the common causes?

Urachus connects the bladder and umbilicus, when patent allows urine to leak from the umbilicus

Causes:

Congenital

Benign prostatic hypertrophy in older men

24

What is the vitelline duct?

What are the abnormalities that can be caused by it's persistence?

A duct that connects the midgut to the yolk sac in the embryo

Abnormalities:

Meckel's Diverticulum

Vitelline Cyst

Vitelline Fistula

Omphalocoele

Gastoschisis

25

Describe a Meckel's Diverticulum?

Most common GI abnormality

Cul-de-sac in the ileum

Rule of 2's:

- 2% of pop. affected
- 2ft from ileocecal valve
- 2 inches long
- Usually detected in <2's
- 2:1 Male:Female

Can be asymptomatic

OR

Can contain ectopic gastric/pancreatic tissue that secretes enzymes and acid causing ulceration

26

What is a vitelline cyst?

The vitelline duct forms a cyst connected to the lieum and abdominal wall via thin fibrous strands

27

What is a vitelline fistula?

Direct communication between umbilicus and intestinal tract

This can result in faecal matter coming out of the umbilicus

28

What is an Omphalocoele?

Persistence of physiological herniation

Part of the gut tube fails to return to the abdominal cavity following its normal herniation into the umbilical cord

Epithelial layer around the umbilical cord (Amnion) covers the defect

29

What is Gastroschisis?

Failure of closure of the abdominal wall during embryo folding

Leaves the gut tube and its derivatives outside the body

There is no covering of the gut tube as they herniate directly through the abdominal wall into the amniotic cavity

30

Label these 3 abnormal structures

Meckel's Diverticulum

Vitelline cyst

Vitelline fistulla