6: Abdominal Wall & Surgery Flashcards
What are the 2 subdivisions of the Abdominal Wall?
- Anterolateral wall
- Posterior wall
What is the Anterolateral Abdominal Wall bounded by? (4 things)
- Superiorly by:
- 7th & 10th rib cartilages
- Xiphoid process of sternum
- Inferiorly by;
- Inguinal ligament
- Pelvic girdle
What are the layers of the Anterolateral Abdominal Wall? (6 layers) (Superficial → Deep)
- Skin
- Subcutaneous tissue
- Muscles
- Deep fascia
- Extraperineal fat
- Parietal perineum
Sexy Sexy My Dagger Enters Punani
What are these Common landmarks of the abdominal wall?
- Umbilicus
- Epigastric Fossa
- Linea Alba
- Pubic Crest & Symphysis
- Inguinal Groove
- Semilunar Lines
- Tendinous Intersections of Rectus Abdominis
- Arcuate Line (Douglas Line)
What spinal level is the umbilicus at?
L3
What are the 5 pairs of muscles of the Anterolateral Abdominal Wall?
Flat Muscles:
- External Oblique
- Internal Oblique
- Transverus Abdominis
Vertical Muscles:
- Rectus Abdominis
- Pyramidalis
What are the Vertical muscles of the Anterolateral abdominal wall maintained within?
Rectus sheath
What is the Rectus Sheath? (4 points)
- Tough, aponeurotic, tendinous sheath
- The 3 Flat muscles of the Anterolateral abdominal wall
- Formed within mid-clavicular and midline
- Encloses rectus abdominis
What is the Linea Alba made up from?
Flat muscles aponeuroses from rectus sheath → interweave with fellows from opposite side → linea alba
What must surgical incisions of the abdomenal wall be? (3 things)
- Closeable
- Provide long lasting strength
- Minimise incidence of incisional herniae
What are common surgical incisions of the abdominal wall? (3 things)
- Midline incision
* Suture linea alba together → strong closure - Transverse incision
* Suture external oblique aponeuroses together → strong closure - Appendicectomy
* Incision @ McBurrey’s point (2/3rd of distance between umbilicus and asis)
Pic shows McBurrey’s point labelled: 1
What are some consequents of development defects of the abdominal wall? (4 things)
- Gastroschisis
- Patent urachus
- Vitelline duct (persists)
- Ophalacoele
GPOV
What is Patent Urachus?
Opening between bladder and umbilicus
Urine can leak out of umbilicus
What are the different issues of a persisting Vitelline duct? (3 things)
- Meckel’s diverticulum
- Vitelline cyst
- Vitelline fistula
What are the main sites of hernia in the abdominal wall? (3 things)
- Inguinal (inguinal canal)
- Femoral (femoral ring)
- Umbilical
Where does the Inguinal canal extend to and from?
Interior Inguinal Ring → Exterior Inguinal Ring
4cm long
What does the Inguinal canal lie in between?
Muscles of anterolateral abdominal wall
What passes through the Inguinal Canal? (2 things)
- Ilioinguinal nerve
- Men: Spermatic Cord
Women: Round ligament of uterus
What’s the difference between Direct and Indirect Inguinal Hernias?
Direct: Protrudes into ingunal canal through weakened area in Tranversalis Fascia within Inguinal (Hesselbach’s) triangle
Indirect: Protrudes into inguinal canal through Deep Inguinal Ring
What are the borders of the Inguinal (Hesselbach’s) triangle? (3 things)
- Medial: Rectus Abdominis
- Lateral: Inferior Gastric Artery
- Inferior: Inguinal Ligament
What is the main cause of Indirect Inguinal hernias
Failure of embryonic closure of deep inguinal ring after testicles have passed through it
Where do Epigastric Hernias occur? (2 points)
In the epigastric region
In midline between Xiphoid process (just under sternum) & umbilicus (through linea alba)
Where do Umbilical Hernias occur?
Through umbilical ring (belly button innit)
What causes Umbilical Hernias?
Raised Intra-abdominal pressure
What are Femoral Hernias?
Protrusions of abdominal viscera (organs) into femoral canal
Where do Femoral Hernias occur?
Through femoral ring
What do Femoral Hernias appear as?
Tender mass in femoral triangle
What are 2 complications of Hernias?
- Strangulation
* Constriction of blood vessels → prevent blood flowing to tissue - Incarceration
* Hernias can’t be reduced / pushed back into place
What is constipation?
Pooing less than 3 times a week
What are some causes of constipation? (6 things)
- Metabolic imbalance
- Immobility
- Meds (opioid analgesics / tricyclines)
- Diet
- Dehydration
- Diseases (diabetes / colorectal stricture)
Malfunction In Making Doo Doo Doo
What metabolic imbalances can cause constipation? (4 things)
- Hypercalcaemia
- Hypokalaemia
- Hypothyroidism
- Lead poisoning
What are the causes for constpiation in a Neonate? (6 things)
- Milk bolus obstruction
- Intestinal Atresia
- Meconium ileus (causes intestinal obstruction)
- Intestinal Stenosis
- Hirschprung’s
- Hypothyroidism
Malfunction In Making IHH
IHH is da sound babies make when pooing
What are the causes for constpiation in infancy / older kids?
- Hypothyroidism
- Ecorpresis (vol / invol pooing yourself)
- Anal fissure (tear)
- Polyuria
- Severe vomiting
HEAPS
How is constipation managed? (2 things)
- Treat underlying cause
- Symptomatic relief (Hey FML)
- Hydration
- Fibre rich diet
- Mobilise patient
- Laxatives
