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GI > 3- clinical anatomy of GI tract herniation & abdominal pain > Flashcards

3- clinical anatomy of GI tract herniation & abdominal pain Flashcards

1
Q

what are 2 requirements to cause herniation?

A
  1. structural weakness
  2. increased pressure (intra-abdominal pressure)
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2
Q

what are normal structural weaknesses that can lead to hernia?

A

some parts of diaphragm, a weakness around umbilicus, inguinal canal, femoral canal

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3
Q

what are some abnormal structural weaknesses that cause hernia?

A

congenital diaphragmatic hernia (stomach moving up to thorax due to development issues), surgical scars/incisional hernia (when wound is still weak)

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4
Q

what are things that cause increased abdominal pressure?

A

chronic cough, pregnancy, strenuous activity, straining during defecation or urination

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5
Q

what is inguinal canal? (reminder)

A
  • inguinal canal formed embryologically (bigger in males as travel further to get to scrotum so more clinically important)
  • formed in medial half of inguinal region
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6
Q

what does inguinal canal contain?

A

spermatic cord or round ligament of uterus

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7
Q

can hernia be unilateral or bilateral?

A

yes - can be unilateral or bilateral

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8
Q

what are direct and indirect inguinal hernias?

A

direct inguinal hernia = directly pushes through anterior abdominal wall (directly pops out)

indirect inguinal hernia = takes a little path through abdominal wall to get out →using inguinal canal as area of weakness to push through

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9
Q

what is route causing indirect inguinal hernia?

A

→to tell apart use inferior epigastric artery (coming off external iliac). just medial to that there’s area of weakness (inguinal triangle) so if medial to epigastric artery, looped bowel can push through abdominal wall (not through inguinal canal) = push through abdominal wall and eventually joins inguinal canal and into scrotum (indirect)

*NOTE - hernial sac lying next (parallel) to spermatic cord

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10
Q

what is route of causing direct inguinal hernia?

A

→loop of intestine push through deep inguinal ring and use inguinal canal to push all the way through and then pops out (hernial sac) within spermatic cord

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11
Q

how do you find deep inguinal ring?

A

in between ASIS and pubic tubercle = half way between is where deep inguinal ring, epigastric artery

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12
Q

why would you push deep inguinal ring?

A
  • if push hernia back in at deep inguinal ring and ask to cough then direct inguinal hernia would go back in as pushing through canal
  • if indirect inguinal hernia, pushing deep inguinal ring blocks it’s route to get back out where it came from
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13
Q

is direct or indirect inguinal hernia more common?

A

indirect more common

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14
Q

what is the site of direct inguinal herniation?

A

Inguinal triangle = hesselbach’s triangle

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15
Q

what arteries line the hesselbach’s/inguinal triangle?

A
  • inferior epigastric artery
  • lateral border of rectus abdominis
  • inguinal ligament
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16
Q

are femoral herniation more common in males or females?

A

females

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17
Q

what is importance of subinguinal space?

A

important area for things to pass from abdomen to thigh e.g. Hip flexors, Femoral artery and vein, Lymphatics, Nerves

18
Q

where is lump (hernia) of inguinal hernia seen?

A

usually medial and superior to tubercle

19
Q

where is lump (hernia) of femoral hernia?

A

lateral and slightly inferior to pubic tubercle

20
Q

what is myopectineal orifice?

A

area of innate weakness (just all of area, femoral canal, inguinal canal, inguinal triangle etc)

21
Q

what are the 4 main questions to ask about abdominal pain?

A
  1. location = what anatomy lies or refers pain there? is it localised?
  2. character = dull, achy, sharp, stabbing?
  3. timing = does it come and go?
  4. pain referral pattern
22
Q

what nerves supply abdominal organs?

A
  • visceral afferents
  • autonomic motor →parasympathetic, sympathetic
  • enteric nervous system (only found in GI tract, can work on it’s own to control GI tract but also under influence of autonomic nervous system)
23
Q

what nerves supply body wall of abdomen?

A
  • from skin to parietal peritoneum
  • somatic sensory
  • somatic motor
  • sympathetic nerve fibres
24
Q

what is route of sympathetic nerves?

A

brain →spinal cord (only exit between T1 and L2) - in abdomen T5-L2 are ones we’re interested in (T1-T4 are for thorax or up to head). they don’t synapse straight away but go through sympathetic trunk and reach abdominal aorta →they form peri-arterial plexus around arteries then leave sympathetic chain as splanchnic nerves and head to ganglia sitting around aorta →they use the arteries to get to organs they need to go to (in plexus also parasympathetic and visceral afferents)

25
Q

what is the exception nerve that doesn’t take part in periarterial plexus on abdominal aorta?

A

adrenal nerves = comes out at same level and move into sympathetic trunks then branch out as splanchnic nerves but then continue to adrenal glands and ole synapse at cells of adrenal glands

26
Q

at what level of spinal cord does the following nerves leave
a) abdominal sympathetic nerves
b) thoracic sympathetic nerves
c) sympathetic nerves for adrenal glands

A

a) T5-L2
b) T1-T4
c) T10-L2

27
Q

what is route of parasympathetic nerves?

A

= vagus nerve (only going to distal part of transverse colon), the rest is supplied by sacral division (s2,3,4) *not pudendal nerve but same level

28
Q

what is nerve outflow for
a) sympathetic
b) parasympathetic

A

a) thoracolumbar
b) craniosacral

29
Q

what is route of vagus nerve once it is in abdominal cavity?

A
  • presynaptic parasympathetic nerve fibres enter abdominal cavity on surface of the oesophagus (“vagal trunks”)
  • travel into the periarterial plexuses around the abdominal aorta
  • carried to the walls of the organs where they synapse in ganglia
  • supply parasympathetic nerve fibres to the GI tract + abdominal organs up to the distal end of the transverse colon
30
Q

what are pelvic splanchnic nerves and what do they supply?

A

= parasympathetic nerves from sacral region

  • Presynaptic parasympathetic nerve fibres
  • supply smooth muscle/glands of the descending colon to anal canal
31
Q

where is pain of foregut felt and what organs are in foregut?

A

= pain felt in epigastric region

foregut = oesophagus to mid-duodenum, liver, gallbladder, spleen and 1/2 pancreas

32
Q

where is pain of midgut felt and what organs are in foregut?

A

= pain felt in umbilical region

midgut = mid-duodenum, proximal 2/3 transverse colon, 1/2 pancreas

33
Q

where is pain of hindgut felt and what organs are in foregut?

A

= pain felt in pubic region

hindgut = distal 1/3 of transverse colon to proximal 1/2 of anal canal

34
Q

what is route for visceral afferent nerve fibres in abdominal cavity?

A

pain fibres from the vast majority of the abdominal organs run alongside sympathetic fibres back to the spinal cord

35
Q

what level do visceral afferents nerves supplying foregut structures enter spinal cord?

A

enter the spinal cord at approx T6-T9

36
Q

what level do visceral afferents nerves supplying midgut structures enter spinal cord?

A

enter spinal cord at approx T8-T12

37
Q

what level do visceral afferents nerves supplying hindgut structures enter spinal cord?

A

enter the spinal cord at approx. T10-L2

38
Q

why can liver and gallbladder pain have referred pain at shoulder?

A

liver & gallbladder →right next to diaphragm which can get irritated if they’re irritated →phrenic nerve supplies diaphragm (c3,4,5) which supplies skin at shoulder

39
Q

what nerves are conveyed within thoracoabdominal nerves?

A

somatic motor, somatic sensory, sympathetic nerve fibers (which supplies abdominal body wall structures)

40
Q

what is route of thoracoabdominal nerves?

A

7th - 11th intercostal nerves that continue and travel anteriorly then leave intercostal spaces and travel in plane in between internal oblique & transversus abdominis where they’re then called thoracoabdominal nerves

41
Q

what nerve supplies body wall from
a) T12 anterior ramus
b) half of L1 anterior ramus
c) other half of L1 anterior ramus

A

a) subcostal nerve
b) iliohypogastric nerve
c) ilioinguinal nerve

42
Q

what is pain like for appendicitis?

A
  • appendix found in right iliac fossa (part of midgut)
  • midgut pain usually first felt in dull achy pain in umbillical region (T8-T10)
  • then sore, sharp stabbing in right iliac fossa (from visceral to somatic) →started to irritate lining of abdominal cavity (parietal perineum) so can then feel directly in that area

GI (56 decks)

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