Abdomen Flashcards
What causes extravasation of urine?
rupture of urethra leading to collection of blood and urine in perineal space and scrotum and potentially lower anterior abdominal wall.
What is Rectus sheath haematoma
rupture in inferior epigastric artery which ascends between rectus abdominis and posterior laminae of rectus sheath, common in anticoagulant patients
What is an Inguinal hernia? What are the two types?
protrusion of gut or omentum through the inguinal canal .
Direct- hernial sac formed by transversalis fascia, lies outside process vaginalis parallel to spermatic cord, hernia passes directly through abdominal wall medially to inferior epigastric artery, doesn’t traverse entire inguinal canal, almost never enters scrotum
Indirect- formed by persistent processus vaginalis, passing through length of canal, laterally to inferior epigastric artery, will exit superficial inguinal ring and pass into scrotum/labium majus, traverse entire inguinal canal and exits through superficial inguinal ring
femoral hernia
enter femoral canal
What is a Varicocele?
bag of worms, pampiniform plexus becomes dilated and torturous
What is a Hydrocoele?
collection of fluid in tunica vaginalis, trans-illumination positive
What is Testicular torsion?
twisting of the spermatic cord, cuts of blood supply, medical emergency
Importance of linea alba?
Avascular
Peptic ulcers?
located in oesophagus, gastric and duodenal, caused by H.pylori, NSAIDs and stress
Importance of lesser sac surgically?
allows surgeons to access retroperitoneum and organs within it
Importance of greater omentum?
abdominal police, stops infection spreading
What is a Hiatal hernia? What are the two types?
protrusion of part of the stomach into the mediastinum through oesophageal hiatus of diaphragm- 2 types :
Sliding hiatal hernia = abdominal part of oesophagus, cardia and parts of stomach fundus slide into thorax via oesophageal hiatus. Regurgitation of stomach content into oesophagus possible
Paraesophageal (rolling) hiatal hernia = cardia normal, pouch of peritoneum containing fundus extend through hiatus, no regurgitation of gastric content
What is GORD?
gastro-oesophageal reflux disorder = good/acid in stomach leaks into oesophagus due to weakening of LOS
What is Barret’s oesophagus ?
mucosal lining of oesophagus damaged by gastric reflux, change in cell lining of oesophagus
what is Pyloric stenosis ?
pyloric sphincter malfunction led to projectile vomiting, lethargy and dehydration
What causes Gallstones (cholelithiasis)
cholesterol(yellow)/pigmented (brown/black) crystals, sites of obstruction = hepatopancreatic ampulla, cystic duct, Hartmann’s pouch, jaundice due to bile build-up in gallbladder
if peptic duodenal ulcer ruptures, a false passage between infundibulum and superior duodenum allowing gallstones to enter
What is jaundice and what are the three types?
build-up of bile, there are three types :
- Pre-hepatic = excessive red cell breakdown
- Hepatocellular = dysfunction of hepatic cells
- Post-hepatic = obstruction of biliary drainage = dark urine, pale stools, yellow skin
What is Cholecystitis
inflammation of gallbladder. Murphy’s sign used to identify this
What is murphys sign?
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
Relevance of Referred gallbladder pain?
gallbladder pain can be referred to back of shoulder because pain travels through right phrenic nerve- proximity between diaphragm and liver
What is Annular Pancreas?
2 parts of pancreas can migrate in the wrong orientation- one can migrate anteriorly, the other posteriorly this can constrict duodenum- impeding flow of gastric content
what causes Pancreatic pseudocyst ?
caused by pancreatitis/abdominal trauma, collection of enzyme rich and blood encapsulated in the pancreas
relevance of Cancer of the pancreatic head
accounts for most cases of extrahepatic obstruction of biliary system as head is close to bile ducts. This causes obstructive jaundice resulting in retention of bile pigments, gallbladder enlargement and jaundice
relevance of Cancer of pancreatic neck/body
may cause obstruction of the portal vein or IVC
what is Whipples procedure ?
pancreaticoduodenectomy = cancer in pancreas head = remove pancreas head, duodenum, gallbladder, bile duct
what is Kocker’s manoeuvre?
surgical procedure to get to the retroperitoneum
relevance of Duodenal ulcer
majority in the posterior wall of superior part of duodenum, can lead to haemorrhage of gastroduodenal artery
what is Splenomegaly
may be caused by portal hypertension, 10 times more than normal size, may be palpable in right iliac fossa, treat with splenectomy .; Occurs through splenic vein/ hepatic portal vein
relevance of Splenic artery aneurysm
rupture of this can lead to unexplained severe abdominal pain
what is Pringle’s manoeuvre
clamping of lesser omentum (hepatoduodenal ligament) during surgery interrupting flow through hepatic artery and portal vein- control bleeding from the liver
Clinical importance of bare area in liver?
Associated with right subphrenic space- fluid can accumulate here and lead to abscess. Site of port-systemic anastomoses
Clinical importance of peritoneal recess of liver?
Areas where fluid can build-up e.g., pus leading to abscess formation.
Through what veins may oesophageal varices occur?
portal : left gastric
systemic: azygous veins
Through what veins may anorectal varices occur?
portal: Inferior mesenteic veins
systemic: inferior and middle rectal
Through what veins may Caput medusa occur?
portal: peri-umbilical veins
systemic: epigastric veins
Through what veins may Gastric varices occur?
Portal: Gastric veins
Systemic: Gastrorenal/ gastro caval shunts
Portal hypertension cause and effect?
scarring and fibrosis from cirrhosis obstruct portal vein in the liver, pressure rises in the portal vein leading to hypertension here. PH can cause enlarged varicose veins; these veins will become so dilated that their walls rupture resulting in haemorrhage. Clinical presentation:
What is caput medusa
Caput medusae is the name for a cluster of swollen veins in your abdomen. The swelling usually appears around the belly button, and the veins branch out from a central point. They are typically painless, but they are a symptom of circulatory problems that are often related to liver disease.
What is Omphalocele ?
Gut contents protruding from umbilical ring. Malrotation of midgut. Failure of rectus abdominis to develop
What is Meckel’s diverticulum ?
Vitelline duct connects the growing foetus to the yolk sac. Failure of vitelline duct to degenerate (9th week of gestation) can cause outpouching of ileum. Can lead to ulceration/bleeding
what causes Appendicitis and how to identify?
Inflammation of appendix stretching visceral peritoneum. Caused when appendix becomes blocked causing growth of bacteria within lumen. The pain is referred to peri-umbilical region (T10). Pain can then occur in RUQ. To diagnose this condition use McBurney’s point (which is the lateral 1/3 of line from ASIS to umbilicus)
Diverticulosis vs diverticulitis?
Diverticulosis = outpouching of the colonic mucosa and submucosa through weakness of muscle layers in colon
Diverticulitis = Infections and inflammation of diverticulum. Most often located in sigmoid colon
Haemorrhoids and its grades
occurs due to dilated/varicose veins caused by engorged venous plexus. Patient will only feel pain of this when haemorrhoids move from ANS area to below pectinate line where there is somatic innervation- allowing patient to feel the pain or prolapse (pelvic organ slips down into vagina?).
Grade 1 = contained within anal canal
Grade 2 = prolapse on defection
Grade 3 = remain prolapsed through anal orifice
Referred abdominal pain relevance?
always associated with epigastric, umbilical and hypogastric regions
what is Paralytic Ileus and its cause?
obstruction of intestine = caused by occlusion of vasa recta by an embolus resulting in ischemia of the concerned part of intestine. When ischaemia is severe necrosis of intestine segment occurs causing paralytic ileus
Clinical Importance of 80-degree angle of anorectal flexure?
Helps maintain faecal continence
Clinical Importance of marginal artery of drummond ?
present between the anastomosis between superior and inferior mesenteric arteries. Serves as a collateral supply if one of the main arteries is blocked
Summary of referred Abdominal pain
Pain from foregut is often referred to the epigastric region
Pain from midgut is often referred to the umbilical region
Pain from hindgut is often referred to the hypogastric region
Pain from gallbladder is often referred to back of the shoulder
Staghorn calculi relevance
Staghorn calculi = build-up of struvite leading to complex renal stones = can cause recurrent UTI = leads to increase ammonia production and pH which means decrease phosphate solubility
Renal and ureteric calculi relevance?
can cause distension of muscular tube, complete intermittent obstruction of urinary flow
what is Nephroptosis (dropped kidney)
abnormally mobile kidneys may descend more than 3cm when the body is erect, symptoms include intermittent pain in renal region, relieved by lying down
Congenital anomalies
bifid renal pelvis and ureter, result from division of the ureteric bud (the primordium of the renal pelvis and ureter), can be unilateral/bilateral
what is Horseshoe kidney
congenital anomaly when inferior pole of kidney fuse to form a horseshow kidney
Clinical implication of ureter constrictions?
disrupt flow of urine and cause pain
kidney stone
renal calcus, may pass from the kidney to the renal pelvis and then into ureter causing excessive distension
Ureteric calcus relevance
causes severe rhythmic pain as its forced down ureter, pain may be referred to lumbar region, hypogastric region, external genitalia, or testis. Pain can be referred to cutaneous areas (T11-T12)
what is Vesicovaginal fistula/colovesical fistula
connection between bladder and vagina/rectum. Linked to gynaecological cancer. Injury during surgery
Bladder calcului causes and effect
stones may pass into bladder, stones get larger due to precipitation of salts on stones, insufficient bladder emptying. Urine becomes infected
Bladder cancer relevance
bladder lined with transitional epithelium, suspectable to cancer, cancer can spread to local structures
what is Stress incontinence
weakness of pelvis floor (levator ani) predisposed to pelvic organ prolapse
