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Flashcards in GI Session 3 Deck (88):
1

What is the purpose of the tendinous intersections which divide the rectus abdominis?

Damage less devastating

2

What is the linea alba?

Aponeurotic fibres from the three abdominal muscles where they meet near the midline

3

What are the layers of the abdominal muscle wall from superficial to deep?

External oblique
Internal oblique
Transversalis abdominis

4

What forms the anterior and posterior walls of the rectus sheath?

Anterior: external abdominal oblique +1/2 internal
Posterior: 1/2 internal and transversalis abdominis

5

What is the purpose of the rectus abdominis?

Contain it to prevent it from bowing

6

What are the layers of the abdominal wall fascia from superficial to deep?

Rectus sheath
Transversalis fascia
Peritoneum
Greater omentum

7

What is the function of the greater omentum?

Mobile fat which is can be used to isolate an area of infection e.g. in appendicitis

8

What is the arcuate line?

Line at umbilicus above which the posterior rectus sheath is present and below which only the anterior rectus sheath is present

9

Where is the arcuate line found in relation to the umbilicus?

1/3 of the distance between the umbilicus and pubic symphysis

10

What is a Pfannstiel incision?

1/3 of the distance between umbilicus and pubic symphysis above pubic symphysis where an incision for caesarean is made which will be hidden by pubic hair

11

What is divarication of recti?

Apparent hernia seen in midline actually due to laxity of linea alba after it has been stretched and become thin

12

What can cause divarication recti?

Obesity
Ageing
Post-surgery
Post-partum

13

What is rectus sheath heamatoma?

Blood accumulates in anterior rectus sheath which travels down to arcuate line and up anterior surface --> large visible bruise on abdominal surface darkest at arcuate line

14

How is rectus sheath heamatoma identified?

Pt lies flat and if legs/head raised this is very painful

15

Why do incisions for surgery have to be in aponeurosis fibres?

Sutures 'cut out' so don't hold

16

Where are the surgical bites in midline and transverse incisions?

Midline: linea alba
Transverse: external oblique aponeurosis

17

Where is appendicectomy carried out?

McBurney's point located 2/3 from the umbilicus to the R ASIS

18

What muscle-splitting incision must be used to cut through the abdominal muscles in appendicectomy?

Grid iron

19

What is ectopia cordis?

Uncommon congenital condition where the heart develops on the abdominal wall and is at high risk of fibrillation due to knocks

20

What happens in patent urachus?

Allantois duct fails to close and recede --> urine exiting via umbilicus

21

How does patent urachus present in an older male pt?

BPH --> bladder outflow obstruction --> increased pressure in bladder --> urachus opens

22

How is patent urachus differentiated from patent vitellointestinal duct which presents similarly?

Use small catheter to inject radio-visible dye and see what path it takes

23

What is a urachal cyst?

Urine filled cyst located at the umbilicus

24

What is exomphalos?

Umbilical defect where viscera are covered by peritoneum and amnion but are located outside of the body

25

What is gastoschisis?

Vertical herniation to the R of the umbilicus where viscera are not covered by peritoneum and amnion and are outside of the body

26

What type of pain can the pancreas and aorta cause and why?

Central back pain as they are retroperitoneal

27

What is referred pain?

Pain perceived at a site distant from the site of cause

28

Why is referred pain seen more commonly in children?

Brain is less developed

29

What causes somatic nerve pain?

Pain from noxious stimulus to proximal part of a somatic nerve --> perceived pain in distal dermatome of the nerve

30

Give an example of somatic referred pain.

Causeof pain in flank at T10 level --> felt at umbilicus

31

Give two causes of right iliac fossa pain due to somatic referred pain.

Shingles
R lower lobe pneumonia

32

What causes visceral referred pain?

In thorax and abdomen visceral afferent pain fibres follow sympathetic fibres back to same spinal cord segment that gave rise to preganglionic sympathetic fibres --> CNS perceives it as coming from somatic portion supplied by same spinal cord segment

33

How does appendicitis explain visceral referred pain?

Appendicitis pain --> visceral sensory nerve --> T10 spinal segment --> brain perceives pain as coming from T10 somatic sensory nerves --> umbilical pain

34

What causes visceral pain?

Ischaemia
Abnormally strong muscle contraction
Inflammation
Stretch

35

What stimuli do not cause visceral pain?

Touch
Burning
Cutting
Crushing

36

Where can gallbladder pain be felt?

Epigastrium
RUQ
Back

37

How do the embryonic divisions of the gut determine pain felt?

Foregut --> epigastric
Midgut --> periumbilical
Hindgut --> suprapubic

38

Where does the aorta bifurcate?

At umbilical level

39

How does the pain felt in acute appendicitis change as it progresses?

Early is referred visceral pain but as inflammation spreads to adjacent peritoneum which has somatic nerve supply --> localised somatic pain

40

How is small bowel colic pain felt?

Periumbilical pain which causes pts to double over and hold stomach due to waves which come every 35-40s

41

How is large bowel colic pain felt?

Waves of suprapubic pain every 2-3 mins which causes sufferers to hunch over

42

Why may renal/ureteric colic pain be referred to testicle/labia?

Descent in embryonic development

43

How is uterine and ovarian pain experienced?

Suprapubic pain which is localised to affected side if ovarian

44

Where is bladder pain experienced?

Suprapubic

45

Why can ruptured spleen/ectopic pregnancy/perforated ulcer cause shoulder pain?

If diaphragm is implicated the brain perceives pain as being in the shoulder due to dermatomes of C3,4,5

46

What is rectus abdominis?

Paired muscle which runs from ribs --> pubic symphysis which holds abdominal organs in place and aids posture

47

What is a hernia?

Protusion of part of the abdominal viscus through a defect in the abdominal wall

48

What forms the borders of Hesselbalch's triangle?

Medial: rectus abdominis
Inferior: inguinal ligament
Lateral: inferior epigastric blood vessels

49

Describe the path of the inguinal canal.

Extends inferiorly and medially through inferior abdominal wall, superior and parallel to inguinal ligament from deep to superficial inguinal rings

50

What forms the roof of the inguinal canal?

Transversalis fascia
Internal oblique
Transversus abdominis

51

What forms the posterior wall of the inguinal canal?

Transversalis fascia

52

What forms the flow of the inguinal canal?

Inguinal ligament
Lacunar ligament (medially)

53

What forms the anterior wall of the inguinal canal?

Aponeurosis of external oblique reinforced by internal oblique muscle laterally

54

What forms the superficial inguinal ring?

Evagination of external oblique which contains intercrural fibres parallel to external oblique aponeurosis fibres

55

Where is the mid-inguinal point?

1/2 way between public symphysis and ASIS

56

What is found at the mid-inguinal point?

Femoral artery

57

Where is the mid-point of the inguinal ligament and what is found here?

1/2 way between pubic tubercle and ASIS just below opening to inguinal canal

58

What is the transverse fascial sling?

Antero-superior crus and postero-superior crus which form a U-shaped ring around the deep inguinal ring

59

Where are common abdominal hernias located?

Epigastric
Umbilical
Inguinal
Femoral

60

What is an incisional hernia?

Improper healing of a surgical incision or scar --> site of herniation

61

What is an incarcerated hernia?

Hernia that cannot be massaged back into the abdomen due to swelling

62

What is a strangulated hernia?

Hernia with neck clamped --> necrosis of hernial sac and contents --> medical emergency

63

Are indirect or direct hernias more common?

Indirect

64

What is an indirect hernia?

Occurs at the deep inguinal ring --> through transversalis fascial sling --> extends along inguinal canal --> appears in scrotum or labium majora

65

What is a direct hernia?

Occurs in weak area of Hesselbalch's triangle medial to vessels --> outpouching of strong conjoint tendon --> bulge in inguinal region

66

What causes indirect inguinal hernias?

Congenital due to failure of the processus vaginalis to regress with amount remaining determining degree of herniation

67

What are the S/S of indirect inguinal hernias?

Swelling
Pain in scrotum
Dragging sensation

68

What coverings does the peritoneal sac acquire in indirect inguinal hernia?

Same as the contents of the canal

69

What causes direct inguinal hernias?

Generally acquired seen in elderly with chronic conditions which increase intra-abdominal pressure long term e.g. COPD, bladder outflow obstruction, chronic constipation

70

What is the diagnostic sign of a direct inguinal hernia on CT scan?

Lateral crescent of fat

71

What can femoral hernias contain?

Preperitoneal fat
Omentum
Small bowel

72

Where are femoral hernias more common?

R sided predilection
More common in females

73

Where do femoral hernias arise?

Protrude inferior to epigastric vessels and medial to common femoral vein

74

What can lead to engorgement of distal collaterals veins seen in femoral but not inguinal hernias?

Neck of hernia below inguinal ligament with narrow funnel shape that can compress femoral vein

75

How does the relation to the pubic tubercle compare between inguinal and femoral hernias?

Femoral remain lateral, inguinal don't

76

What can cause diaphragmatic hernias?

Developmental defects which allow any viscus to push through improperly developed diaphragm
Traumatic diaphragmatic rupture
Hiatus hernia

77

Are sliding or rolling hiatus hernias more common?

Sliding ~90%
Rolling ~10%

78

What is a sliding hiatus hernia?

Gastro-oesophageal junction slides into chest

79

What is a rolling hiatus hernia?

Gastro-oesophageal junction is in the normal position but the fundus of stomach moves into chest alongside oesophagus

80

What are the S/S of hiatus hernia?

Usually asymptomatic
Epigastric/chest pain
Post prandial fullness
N+V

81

What causes a congenital umbilical hernia?

Incomplete closure of the anterior abdominal wall after gut returns to the abdominal cavity in the 10th week of gestation

82

What are risk-factors for developing an umbilical hernia in adulthood?

Obesity
Multiparity
Ascites
Large intra-abdominal mass

83

What do umbilical hernias commonly contain?

Fat
Mesentery
Small +/- large bowel

84

What is Richter's hernia?

Terminal ileum through a small defect in abdominal wall --> partial obstruction of bowel --> vomiting

85

What is visible on CT in Richter's hernia?

Bowel loop on middle of the abdominal wall

86

What is Spigelian hernia?

Rare herniation along semilunar line through transversus abdominis aponeurosis close to arcuate line level

87

Why do S/S of Spigelian hernia vary?

Due to contents of hernial sac, degree and type of herniation and there is not typical pain associated

88

What does groin pain without a hernia suggest?

Repetitive strain of inguinal ligament