Flashcards in Week 3 - Surgical anatomy of abdo Deck (29):
Which way do the external and internal oblique fibres run?
-External is inferio-medially
-Internal is superiomedially
Where do the aponeurosis of abdominal wall muscles join?
What fascia separate muscle and parietal perioneum?
Where are linea semilunaris?
-Lateral to rectus abdominus
How are the fibres arranges in rectus abdominus
-Into vertical squares separated by tendinous intersections
What is the rectus sheath?
-A sheath which covers rectus abdominus formed by aponeurosis of surrounding muscles
Where is the arcuate line and what is its significance?
-Horizontal line on the abdomen which denotes the lower limit of the posterior layer of the rectus sheath (3rd of the way between umbilicus and pubic synthesis
-c-section performed here
What is Divarication of Recti? When does it present?
-Separation of two sides of rectus abdominus due to stretching of linea alba
-Common in pregnancy and only shows upon laying to sitting
What is a rectus sheath haematoma? How does it present?
-Bleeding into rectus sheath from damage to superior/inferior epigastric vessels or a tear in the muscle
-Very painful with slow bruising
Where is the most appropriate place to make abdominal incisions?
-In an area which can be closed and provide long-lasting strength ie the connective tissue
What is Mcburneys point?
-2/3 between umbilicus and ASIS
-Place of appendectomy
What is ectopia cordis?
-Congenital malformation where heart is partially/fully out of the chest
What is a patent urachus?
-Failed closure of urachus (a conenction between bladder and umbilicus) to form median umbilical ligament
-Urine leaks out of umbrilicus
What is meckel's diverticulitis and the rule of 2's?
-Congenital diverticulum in the small intestine which is a remnant of the vitelline duct
-2 Inches long
-2 feet from ileocecal valce
-2% of pop
-2xcommon in males
-2types of tissue (gastric and panreatic)
Is meckel's diverticulum always a problem?
-No it is only when it becomes inflammed due to ectopic pancreatic tissue
Describe small intestinal colic
-Every 35-40 seconds pain around the umbilicus
Describe large intestinal colic
-Pain in the suprapubic region every 2-3 minutes
Describe renal/ureteric colic
-Loin to groin pain
What is referred diaphragmatic irritation? Name 3 causes
Pain felt on superior of left shoulder due to irritation of phrenic nerve. Elicits pain in C3, C4, C5 dermatome
Explain diffuse pain
-The viscera have a low density of sensory afferents, these afferents diverge and excite many secondary neurones in the spinal cord which generates a diffuse pain
Explain the pattern of pain in appendicitis
-The appendix is part of the midgut and the visceral nerves of the midgut produce a diffuse periumbilical pain. As the appendix becomes more inflamed and starts to irritate the parietal peritoneum the pain becomes localised to right iliac fossa as the parietal peritoneum has somatic nerve fibres
What types of pain can/cannot cause visceral pain?
-Ischaemia, inflammatin and stretch can
-Touching, burning and crushing cannot
Name the abdominal muscles from superficial to deep
What is visceral referred pain?
-Pain in visceral structures felt in distant dermatomes due to the somatic and visceral afferents at the same spinal level converging on the same secondary neurone within the dorsal horn spinal cord. The pain is then felt in the corresponding dermatome
What are the most common abdominal incisions?
What is a patent vitelline duct?
-Failure of closure of vitelline duct -> Abnormal connection between gut tube and umbilucus
What is exampholos?
-Failure of completeion of embryological herniation
-Viscera remain out of the body covered by peritoneum and amnion
What is gastroschisis?
-Vertical defect to right side of umbilicus
-viscera protrude out of body
-Not covered by peritoneum or amnion