2 - Abdominal Wall and Hernias Flashcards
What is the gastrocolic ligament?
Ligament between greater curve of the stomach and the transverse colon. Part of the greater omentum
How do the greater and lesser sacs communicate?
Foramen of Winslow (Eploic foramen)
What is visceral pain and how does it present in general?
- Pain from visceral stretching, inflammation or ischaemia
- Diffuse, poorly defined, midline (even if organ to one side)
- Nausea, vomiting, sweating
- Difficult to diagnose as vague
What is the innervation to the gut that percieves pain?
- Sympathetic T5-L2
Why is pain of the viscera referred?
- Afferent sensory fibres run back along same path as motor fibres so when impulse gets to ganglia will split along all contributing spinal nerves
- e.g stomach T5-T9 innervation so these dermatomes affected so epigastric pain. Bilateral stimuli and brain can’t decide which is more so midline
What would be the pain pattern if a caecal volvulus were to occur?
Midgut - periumbilical pain
Hindgut - suprapubic pain
What is a hernia and what are the signs and symptoms?
- Protrusion of part of the abdominal contents beyond the normal confines of it’s containing cavity (abdoinal wall)
What are the 3 parts of a hernia?
Sac is pouch of peritoneum
Coverings is abdominal wall layers
Where do hernias occur, and what can increase your risk of developing a hernia?
- Congenitally related areas (e.g processus vaginalis)
- Post surgery non healed areas (incisional hernia)
- Points of weakness (femoral, inguinal, umbilical)
What is the inguinal canal?
Oblique passage through lower abdominal wall
Males: abdomen - testes
Females: uterus to labia majora
What are the boundaries of the inguinal canal?
A: External oblique aponeurosis
P: Transversalis fascia and cojoint tendon
Floor: Inguinal ligament and lacunar ligament medially
Roof: arching fibres of internal oblique and transversus abdominis
(deep ring in posterior wall, superficial ring in anterior wall)
What are the two locations of inguinal hernias in the male testes that can occur, and what leaves certain men susceptible to these?
Hernia can only go as far as processus vaginalis, if through superficial ring then scrotal hernia
What is the inguinal ligament made of?
The rolling tendon of extrnal oblique
What are the two types of inguinal hernia?
- Direct: straight through abdominal wall through Hesselbach’s triangle and maybe superficial ring
- Indirect: through inguinal canal and deep inguinal ring
Indirect is more common and these occur in males more
What are the most to least common abdominal hernias?
What is the relationship of inguinal hernias to the inferior epigastric vessels?
What are the boundaries of Hesselbachs triangle? (direct on picture correlates to anatomical area of this triangle)
Area of potential weakness, hernias follow path of least resistance. This hernia will take one more layer with it. Superficial ring in lowest corner
Medial: lateral border of rectus abdominis
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament
What is the basis of femoral hernias?
- More common in females
- Passes through femoral ring to femoral canal
- At risk of incarceration as such small opening, can lead to strangulation and therefore tissue necrosis
What are the borders of the femoral canal?
What is an omphalocele?
- Failure of midgut to return to abdomen during development so viscera grow in umbilical ring
- Viscera covered in peritoneum but may not grow to correct size
- Mortality is high as associated with other genetic problems
What is gastroschisis?
- Defect in ventral abdominal wall, viscera not covered by peritoneum so could be damaged by amniotic fluid
- Gut problems like intestinal atresia
- Issue with feeding unlike omphalocele
- Slow retreat back into abdomen, higher survival rate than omphalocoele as less genetic issues
What is an umbilical hernia and how is it treated?
- Common in infants
- Bulge at umbilicus and not often painful
- Most close by themselves by age of 3 so no intervention
What is an umbilical hernia actually called in an adult?
- Paraumbilical hernia
- Goes through linea albea near umbilicus
- Greater risk in females and if obese
- Risks of strangulation as so small
Why is there a risk of sepsis with a hernia?
- Strangulation can cause the organs to break down leading to necrosis and break down of the viscera
- This is why may feel nauseous and vomit when have a hernia
What is a diverticulum?
- Mainly in the colon
- Outpouching of epithelium into the muscular layer in weakened areas, e.g later parts of colon where faeces is hard
- Faeces can get in the pouches and cause diverticulitis
Where is Vitamin B12 absorbed?
Ileum
Where are some areas in the male peritoneal cavity that abnormal gastric fluid can collect?
- Paracolic gutters
- Rectovesical pouch
What parts of the gut do each of the splanchnic nerves supply?
Enter the abdomen via the diaphragm and synapse at celiac ganglia
What are the two parts of the enteric nervous system, where are they found and what do they do?
- Submucosa: in submucosa, blood flow and secretions
- Myenteric: between two muscle layers, motility
How does the autonomic system communicate with the enteric nerves system?
Where can peptic ulcers form?
Stomach and D1
