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MET3A > A lump in the groin (plus anatomy) > Flashcards

A lump in the groin (plus anatomy) Flashcards

1
Q

Label this image

A
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2
Q

List all the muscles found in the lateral abdominal wall in order and state the direction that the fibers run in

A
  1. External oblique -

Fibers run anterior - inferior

  1. Internal oblique

Fibers run- Anterior superior

  1. Transverse abdominis

Fibers run- transverse direction

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3
Q

List all the muscles found in the anterior abdominal wall in order

A

External oblique, internal oblique, transversus abdominis, rectus abdominis

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4
Q

What is the significance of the arcuate line in the naterior abdominal wall?

A

Rectus abdominis muscle is enclosed by an aponeurotic sheath, which is derived from the aponeuroses of external oblique, internal oblique and transversus abdominis

Above the arcuate line the rectus abdominis is enclosed in the internal oblique aponeurosis

Below the acruate rectus abnominis is behind the fascia of the transversis abdominis - enclosed by the transversalis fascia

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5
Q

What are the attachments of the rectus abdominis

A

Xiphoid process and costal cartilages to the pubic symphysis

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6
Q

What is the rectus sheath composed of?

A

aponeurosis of the external oblique, internal oblique and the transversus abdominis

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7
Q

What are the inferior attachements of the External oblique, internal oblique and transver abdominis?

A

Iliac crest and ASIS

down to pubic tubercle

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8
Q

What is the conjoined tendon?

A

Where the internal oblique and transversus abdominis meet to attach onto the pubic tubercle

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9
Q

Which arteries supply blood to the anterior abdominal wall?

A

Superior epigastric artery (branch of internal thoracic)

Inferior epigastric artery (branch of external iliac)

These run within the rectus cheath

Lower intercostal

and lumbar arteries

Supply lateral abdominal muscles

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10
Q

Label this image

A
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11
Q

What is McBurneys Point?

A

Surface anatomy land mark for the appendix

Right side of the body. Two-thirds the distance between the umbilicus and anterior superior iliac spine (ASIS)

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12
Q

Which dematomes correlate with the Umbillicus, subcostal nerve, Iliohypogastric nerve and Ilioinguinal nerve?

A

Umbillicus- T10

subcostal nerve- t12

Iliohypogastric nerve and Ilioinguinal nerve- L1

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13
Q

What is the ingunal ligament composed of?

A

The free boarder of the external oblique muscle

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14
Q

In which order is the nerve, vein and artery found in the femoral triangle?

A

NAV

Nerve, Artery, vein

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15
Q

What can be foudn in the femoral canal?

A

efferent lymphatic vessels and a lymph node

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16
Q

Which ligament reinfoces the inguinal ligament and formes the medial border of the femoral canal?

A

Lacunar ligament

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17
Q

The deep inguinal ring is lateral to which artery?

A

Inferior epigastric artery

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18
Q

At which fascia does the deep inguinal ring originate?

A

Transversalis Fascia

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19
Q

Where does the testicular artery originate from?

A

Abdominal aorta - L2-L3 region

Below the renal arteries

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20
Q

Which muscle does the cremaster muscle come from? What is its nerve supply? Where the cremaster muscle loacted?

A

Internal oblique

genital branch of the genitofemoral nerve (L1,2)

It surrounds the spertic cord

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21
Q

Name the 4 different layers of the spertaic cord and list their origin

A
  • Transversalis fascia → internal spermatic fascia
  • Internal oblique muscle → cremasteric muscle and fascia
  • External oblique aponeurosis → external spermatic fascia
  • Superficial fascia (Scarpas fascia – membranous layer of fascia) → dartos muscle (smooth muscle)
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22
Q

Which nerves can be found within the spermatic cord? In which layer of the spertaic cord are they located?

A

Ilioinguinal- Outside the external spertci fascia , in superficial fascia

Genitofemoral (cremaster never)- cremasteric fascia

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23
Q

What is the function of the dartos and cremaster muscle?

A

They both contract for temperature control

Dartos muscle- ilioinguinal (L1)- autonomic control

Cremaster- genitofemoral (L1 and L2) somatic control

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24
Q

What are the nerve routes for the cremasteric reflex? How can it be activated?

A

L1 and L2- genitofemoral nerve

By striking the superior/medial aspect of the thigh near the testicals. Contraction should occur

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25
Q

Which lymphatic vessels drain into the superficial inguinal lymph nodes?

A

Lympahtics from the penis, scrotum, labium and anal canal

26
Q

From where do the testes decend?

A

Posterior abdominal wall

27
Q

Where does testicular cancer often metastasis to and why?

A

The para aortic lymph nodes next to the kidneys

because testis originate from the posterior abdominal wall near the kidneys and there lymphatics and blood supply comes from the same area

28
Q

What is a hernia?

A

•A hernia is an abnormal weakness or hole in an anatomical structure which allows something inside to protrude through.

29
Q

Hernias are usually harmless, when do they become harmful?

A

When they become strangulated- blood supply us cut off

30
Q

What is an inguinal hernia?

A

hernia passes through the inguinal canal for a variable distance and exits through the superficial inguinal ring.

31
Q

What are the risk factors for the development of a hernia? Explain the rational behind these risk factors

A

Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia.

Obesity

Heavy lifting

Coughing

Straining during a bowel movement or urination

Chronic lungg disease

Fluid in the abdominal cavity

Hereditary

32
Q

What is the difference between a direct and indirect inguinal hernia

A

Direct- through adominal wall straight down. Passes inferior to the epigastric artery in the inguinal triangle. May pass through the superficial inguinal ring.

Rarely enters the srotum

Indircet- through the inguinal canal. Enters the deep inguinal ring, lateral to the inferior epigastric artery, travels down the external inguinal ring. Hernia lies within the coverings of the sperpatic cord

Often enters the scrotum

33
Q

What is the difference between congenital and aquired inguinal hernias?

A

Congenital- through patent processus vaginalis Follows pathway that testes made during pre-birth development.

Acquired passes through deep inguinal ring initially and exits through the superficial ring.

34
Q

What is the mid inguinal point? Which pulse is it lateral to?

A

Mid-point of the inguinal ligament

Lateral to the femoral pulse

35
Q

What is a hydocele?

A

Patent processus vaginalis

36
Q

At what age do direct inguinal hernias often occur and why?

A

Middle aged and elderly

•their abdominal walls weaken as they age.

37
Q

At what age does an indirect inguinal hernia occur?

A

Can occur at ang age but becomes more common as people age

38
Q

What is the exact tract of the direct inguinal hernia?

A
  • Bulges through Hesselbach’s Triangle in hernial sac formed by transversalis fascia
  • inferior to the epigastric artery
  • Traverses the medial portion of the inguinal canal

•

•Emerges around conjoint tendon to reach the superficial inguinal ring

•

•Gains an outer covering of external spermatic fascia

39
Q

Why is a direct hernia likely to occur at the Hasselbach triangle?

A

Muscles layers are weak here

40
Q

What are the borders of the hasselback triangle?

A

Superior - inferior epigastric vessels

Lateral- inguinal ligament

lmedial- lateral border of rectus abdominis

41
Q

Where does a femoral hernia occur?

Where can it be sean

A

Femoral canal-

bulge below the inguinal crease in roughly the middle of the thigh.

42
Q

Why do umbilical hernias occur?

A

•caused when an opening in the abdominal wall, which normally closes before birth, doesn’t close completely.

43
Q

What are 5 features of a lump to look out for on examination?

Hint - 6 ‘S’

A

Site
Size
Shape
Surface
ConSistency
FicSity (fixity)

44
Q

There are 5 things to keep in mind when describing a hernia, what are they?

A
  1. Location
  2. Reducible or irreducible?
  3. Incarcerated
  4. Strangulated
  5. Special hernias
45
Q

What is an obstructed/ incarcerated hernia?

A

Hernia is irreducible but the content is viable

46
Q

What is a strangulated hernia?

A

Visceral contents becomes trapped with a compromised blood supply.

47
Q

List 2 main complications of a hernia

A

Bowel obstruction

Strangulation

48
Q

How may someone with a stragulated hernia present? Indlude features of there full blood count.

A

Tender, irreducible, red

Tachycardia, pyrexia

WCC raised

49
Q

In someone with a congential indirect inguinal hernia, what does the hernia pass through?

A

Hernia passes through patent processus vaginalis (which
should close before birth) following path of the testes
during intra uterine development.

50
Q

In a direct inguinal hernia, what formes the hernia sac?

A

Transversalis fascia

51
Q

Where does an indirect hernia usually end up in men and women?

A

Men- scrotum

Women- labium majus

52
Q

Which type of hernia is more common in women?

A

Femoral hernia

53
Q

Which type of hernia is most common in women in general?

A

Inguinal hernia

54
Q

Which type of surgical managment is used for inguinal hernias? Briefly describe the procedure

A

Open mesh repaire- Lichtenstein

Can be performed under
local anaesthesia

Hernia sac is reduced or
excised

Mesh is inserted to
reinforce the posterior
inguinal canal

55
Q

Under which conditions is a inguinal hernia repaired Laparoscopicly?

A

Recommended
for recurrent
and bilateral
herniae

56
Q

What does a femoral hernia protrude through?

A

Femoral canal and femoral ring

57
Q

What is the mode of treatment if the hernia sac of a femoral hernia contains bowel?

A

Immediate surgery

It is an emergency

58
Q

When a hernia is stragulated, state the 2 negtiave outcomes this can lead to if untreated?

A

Ischaemia

Perfortaion

59
Q

What is the treatment stratergy for a femoral hernia?

A

Prompt elective surgery

60
Q

List the 3 types of eponymous hernias

A

Spigelian
Maydl’s
Littre’s
Amyand’s

61
Q

What is a Richter’s hernia?

A

Part of bowel wall
incarcerated in hernia
and can strangulate

62
Q

What is the most common type of hernia in men and women?

A

Inguinal hernia

MET3A (14 decks)

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