06/03/2021 [hand/foot bones, vagina disease, radiology, stomach anatomy, SVT] Flashcards
Three bone types in the hand
Carpal bones [x8]
Metacarpals [x5]
Phalanges [x14]
= 27
Name the carpals in the hand
Some Lovers Try Positions They Can’t Handle:
[Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate]. Split into distal 4, and proximal 4.
What do the carpal bones form?
Collectively, they form the coronal plane
What covers the carpal bone?
The flexor retinaculum [carpal tunnel]
What forms the wrist joint?
The proximal carpals [scaphoid and lunate] articulating with the wrist joint.
Typical cause and clinical features of a scaphoid fracture
Cause: falling on an outstretch hand [FOOSH]
Feature: pain and tenderness in the anatomical snuffbox.
Particular risk of a scaphoid fracture? Why is this so?
Avascular necrosis; retrograde blood supply to scaphoid which enters distal end.
Pts with missed scaphoid fracture more likely to develop OA later in life.
What are the two common fractures of the metacarpals?
Boxer’s fracture: fracture of the 5th metacarpal neck; usually caused by clenched fist striking a hard object. Distal part of the fracture disaplced anteriorlty, producing shortening of the affected finger.
Bennett’s fracture: fracture of the 1st metacarpal base, caused by forced hyperabduction of the thumb.
Why are the metacarpals concave?
To allow the attachement of the interossei muscles.
How many phalanges in each finger/thiumb?
x3 fingers, x2 thumb
Three groups of bones in the foot?
Tarsals [x7]
Metatarsals [x5]
Phalanges [x14]
= 23 [though apparently 26?]
How are the the tarsal bones organised?
- Proximal group or hind-foot [talus and calcaeneus]
- interrmediate group [the navicular]
- Distal or midfoot [cuboid and cuneiforms]
What are the articulation of the talus in the hindfoot?
- Superiorly: ankle joint [talus and bones of the leg [tibia and fibula]
- Inferiorly: subtalar joint [talus and calcaneus]
- Anteriorly: talonavicular koint [talus and navocular]
Why is there a high risk of avascular necrosis to the talus?
Numerous ligaments attach tot he talus, no muscles originate or insert onto it. So high risk of AN as vascular supply dependent on fascial structures.
Articulations of the calcaneus. Also, what is it?
It is the largest tarsal bone lies underneat the talus where it constitutes the heel.
Articulations:
- superiorly: subtalar joint
- anteriorly: calcaneocuboid joint
Where does the Achilles tendon attach on the foot?
Posterior aspect at the calcaneus tuberosity.
Where does the tibialis posterior attach to the foot?
Plantar surface of the navicular, tuberosity for the attachment of the tendon.
Distal group bones in the foot
Cuboid, three cuneiforms [lateral, intermediate, medial].]
Which muscles attach to the distal tarsals?
Medial cuneiform - tibialis anterior [tibialis posterior and fibularis posterior and longus]
Lasteral cuneiform - flexor hallucis brevis
Commonest fracture types foot
Talus and calcaenues [as where forces transmitted to the ground]
When do talus fractures typically occur?
Neck fractures to the talus; high energy dorsiflexion of the foot.
Body fractures typically occur jumping from high height.
Danger of talus fractures
Avascular necrosis
When is the calcaneus typically fractured?
Axial loading, typically falling from a height.
In axial loading, what should patients also be assessed for?
Associated injuries siuch as fractures of the lumbar spine/lower limb.
Fracture name when bone breaks several pieces?
Comminuted fracture
Cx of calcaneal fracture
Sub-talar joint usually effected, so can become arthritis. Pain on inversion and eversion.
Shape of the metatarsals
Convex dorsally and consist of head, neck and shaft.
How many articulations in the metatarsals?
Proximally = tarsometatarsal joints Laterally = intermetatarsal joints Distally = metatarsophalangeal joint
Common fracture of the metatarsals?
Most common direct flow from heavy object.
Also, stress fracture common in athletes 2/3rd mets.
Finally, excessive inversion of the foot.
Foot violently inverted what can happen?
Fibularis brevis muscle can avulse [‘tear off’] and the base of the fifth metatarsal.
How many bones in the phalanges?
bones of the foot. All have three apart from great two which has 2.
Commonest cause to miscarry in the first trimester?
Chromosomal abnormality [50-60%]; autosomal trisomy
Commonest cause to miscarry in the second trimester?
Incompetent cervix [RF previous cervical surgery]
Other potnetial causes for a miscarry?
fetal mlaformations, uterine structure abnormalities, chronic maternal health factors, active infections, iatrogenic causes, social factors like smoking, exposure to envirnomental toxins, advanced paternal age
How are miscarraiges classfied?
According to stage
How many types of miscarriage are there? Name the,m.
5:
- threatened miscarriage
- inevitable miscarriage
- oncomplete miscarriage
- complete miscarriage
- other [missed, blighted ovum, setpic miscarriage, recurrent miscarruage]
Threatened miscarriage what is it?
Fetus is threatened and miscarriage may happen. Some vaginal bleeding, but cervical os is closed and USS viable intrauterine pregnancy.
How many threatened miscarriages go to term?
90%
Inevitable miscarriage?
Bound to happen miscarriage e.g. vaginal bleeding +/- cramping abdominla pain AND cervical os is open but produts of conception not passed
Incomplete miscarriage?
Currently happening, heavy and increased vaginal bleeding, intense lower abdominal pain and passage of some products of conception. Cervical os is OPEN and there arer PRODUCTS OF CONCEPTION present in the canal.
Complete miscarriage
PoC have passed, cervical os is CLOSED.
USS shows a EMPTY uterus.
Missed miscarriage
Miscarriage was missed i.e. NONVIABLE IU pregnancy reminaed inside uteris.
Patient is amenorrhoiec but has not had any vaginal bleedingor abdmoinal pain.
On examination, cervical is is CLOSED. USS confirms a non-viable IU pregnancy.
BLighted ovum
missed miscarriage which embryonic dev elopment stopped before embryoinc pole was visible. Gestartional sac may continue to grow
Septic miscarriage
Miscarriage+sepsis [Sx of fever/significant abdo tenderness]
Recurrent miscarriage
occurence of 3+ miscarriages
Sx of miscarriage
Amenorrhoea, vaginal bleeding, cramping in abdominal region, passage fetal ittuse, fever [usually associated with setpic miscarriage].
Ix for miscarriage?
COmplete blood count with differential
b-hCG
Transvaginal USS
5 points of check on transvaginal USS are wjhat?
dating, location, multiple pregnancy, molar pregnancy, nonviable pregnancy, retained PoC,
Sx of molar pregnancy on scan?
Snowstorm appearance
nonviable pregnancy is what on an ISS?
Gestation sac over 25mm diameter with no yolk sac or embryo
No cardiac activity: fetal heart rate is typically detected at 5.5 to 6w
Gravidity and parity?
g is the total number of pregnancies regardless of outcome.
p is th etotal number of pregnancies over 24w.
What is antiphospholipid syndrome?
Immune system to attack body increasing the risk of blood clots. Pregnant women increased risk miscareriage.
Who’s affected mostly by it?
3/5 more likely women, all ages.
Which condition is it similar to?
MS
Tx for APS
Anticoag like warfarin or an antiplatelet like low dose aspirin.
Tx for retained products of conception?
Misoprostol
What are the four namin anatomical dvision of the stomach?
Cardia, fundus, body, pyolrus
Whihc level is the stomach at?
T11 is the cardia, L1 is the pylorus
Describe the greater curvature of the stomach
orms the long, convex, lateral border of the stomach. Arising at the cardiac notch, it arches backwards and passes inferiorly to the left. It curves to the right as it continues medially to reach the pyloric antrum. The short gastric arteries and the right and left gastro-omental arteries supply branches to the greater curvature
Describe the lesser curve
forms the shorter, concave, medial surface of the stomach. The most inferior part of the lesser curvature, the angular notch, indicates the junction of the body and pyloric region
Which ligament attaches to the lesser curvature?
hepatogastric ligament
Blood supply greater curve
gastro-omental arteries
Bloood supply lesser curve
Left gastric artery and right gastric branch of the hepatic artery
Superior to the stomach
Oesophagus and diaphragm
Anterior to stomach
greater omentum, diaphragm, left lobe liver, gall bladder
Posterior to the stomach
Lesser sac, pancreas, left kidney, left adrenal gland, spleen, splenic artery, transverse mesocolon
Sphincters of the stomach
inferior oesophageal sphincter
pyloric sphincter
What is chyme?
Food and gastric acid mixture formt eh stomach
What part does the stomach attach to?
Duodenum
Muscle type of each sphincter
Anatomical sphincter pylorus with smoothj muscle
When does emptying of the stomach occur?
When intragastric pressure overcomes resistance of the pylorus.
What is the peritoneum?
Doubl elayered mambrane that supports msot of teh abdominal viscera and assists with their attachment to the abdominal wall
What is the omentum?
Split into greater and lesser, with peritoneum folded over itself.
Where does the omentum attach
the stomach [greater omentum greater curve stomach]
What does the greater omentum contain lots of?
LN and may adhere to inflamed areas, therefore playing key role in GI immmunity
Whhere does th elesser omentum arise/atach?
Continuous with peritoneal layers of the stomach and duodenum, arises from the lesser curvature and ascend to attach to the liver
What do the omenta divide the abdominal cavity into?
greater andf lesser sacs
Where does the stomach lie in relation to the omenta?
immediately anterior to the lesser sdac
How do the sacs communicate?
Epiploic formane, a hole in the lesser omentum
Arterial supply to the stomach comes from where?
Coeliac trunk and its branches.
Innervation o fthe stomach?
Autonomic NS:
- parasympathetic nerve supply: anterioer and posterio vagal trunks, derived from teh vagus nerve.
- sympathetic nerve supply arises form the T6-T9 spinal cord segments and passes tot he coeliac plexus via the greater splanchic nerve. Also contains some pain tranistting fibres.
Lymphatics stomach
gastric lymphatic vessels travel with the arteries along the greater and lesser curves stomach.
Where does lymph fluid drai into
Gastric and gastro-omental LN found on the curves
What do the efferent lymphatic vessels form these nodes connect to?
Coelaic LN, located posterior abdominal wall
3 maion causes for GORD?
dysfinction of the LES
delayed gastric emptying
hiatal hernia
How common is GORD?
5-7% population
Sx of GORD
dyspepsia, dysphagia, inupleasant taste mouth.
Whatv is a hital hernia?
Part of the stomach protrudes into teh chest through the oesophageal hiatus int eh diaphragm.
Two mian types of HH?
Sliding HH: LES slides superiorly, reflux common Cx as diaphragm no longer reinforcing sphincgter
Rolling HH
LES reamins in pllace, but a part of the stomach herniates into the chest next to it. This type is more likely to require surgery.
What effect does stimulation vagus nerve have?
Relxation of pyloric sphincter
What is SVT?
ocndiiton where heart beats suddenly much faster than normal [above 100bpm]
Can SVT happen during exercise?
Yes, jsut means it suddenly goes up
Sx of SVT?
heart beats faster usually for few minutes [can be several hours though]
can happen several times a day or once a year
- chest pain, feel weak, feel tired, feel sick can be associated Sx
Can be triggered by what SVT?
caffeine, tiredness, alcohol, drugs, often no obvious
Tx for SVT?
Medicine to control
Cardioversion
Catheter ablation
What are the 4 main types of SVT?
Atril fibrillation, paroxysmal supraventricilar tachycardia, atrial flutter, WpW syndrome
Where does SVT stasrt from?
Either atria or AVN
Generally, cause of SVT?
Re-entry or increased automaticity.
Are they life threatening?
mostly unpleasant not life threatening. Risky if have IHD.
