Abdomen Flashcards
Causes of intususseption?
lumenal pathologies such as polyps, lymphadenopathy and diseases such as cystic fibrosis
Most common site of intususseption?
ileocaecal valve and terminal ileum
Causes of groin masses?
Herniae
Lipomas
Lymph nodes
Undescended testis
Femoral aneurysm
Saphena varix (more a swelling than a mass!)
Key questions for groin lumps?
Is there a cough impulse
Is it pulsatile AND is it expansile (to distinguish between false and true aneurysm)
Are both testes intra scrotal
Any lesions in the legs such as malignancy or infections (?lymph nodes)
Examine the ano rectum as anal cancer may metastasise to the groin
Is the lump soft, small and very superficial (?lipoma)
What key investigations should patients presenting with large bowel obstruction have prior to surgery?
gastrograffin enema, sigmoidoscopy or CT scanning prior to surgery.
Features of PID?
lower abdominal pain associated
vaginal discharge
dysuria
fever
dyspareunia
Peri-hepatic inflammation secondary to Chlamydia (Fitz Hugh Curtis Syndrome) may produce right upper quadrant discomfort
Intestinal causes of malabsorption?
coeliac disease
Crohn’s disease
tropical sprue
Whipple’s disease
Giardiasis
brush border enzyme deficiencies (e.g. lactase insufficiency)
Pancreatic causes of malabsorption?
chronic pancreatitis
cystic fibrosis
pancreatic cancer
Biliary causes of malabsorption?
biliary obstruction
primary biliary cirrhosis
Other causes of malabsorption?
bacterial overgrowth (e.g. systemic sclerosis, diverticulae, blind loop)
short bowel syndrome
lymphoma
Which artery is responsible for blood supply to a meckels?
vitelline artery
Management of Fitz-Hugh Curtis?
Usually medically managed- doxycycline or azithromycin
What are cullens and grey turners sign?
Cullens sign- pancreatitis (other intraabdominal haemorrhage)
Grey-Turners sign- pancreatitis (or other retroperitoneal haemorrhage)
What is a spigelian hernia?
-Interparietal hernia occurring at the level of the arcuate line
-May lie beneath internal oblique muscle. Usually between internal and external oblique
-lateral to rectus abdominis
What is a lumbar hernia?
hernia in area bounded by the lumbar triangle?
Crest of ilium (inferiorly)
External oblique (laterally)
Latissimus dorsi (medially)
Primary lumbar herniae are rare, most are incisional hernias following renal surgery
what is an obturator hernia?
-Herniation through the obturator canal
-Commoner in females
-Usually lies behind pectineus muscle
-most will present acutely with obstruction
When presenting acutely most cases with require laparotomy or laparoscopy (and small bowel resection if indicated)
What is a Richters hernia?
condition in which part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within a hernia (of any type)
What is a bochdalek hernia?
Typically congenital diaphragmatic hernia
85% cases are located in the left hemi diaphragm
Associated with lung hypoplasia on the affected side
More common in males
Associated with other birth defects
May contain stomach
What is a morgagni hernia?
Rare type of diaphragmatic hernia (approx 2% cases)
Herniation through foramen of Morgagni
Usually located on the right and tend to be less symptomatic
More advanced cases may contain transverse colon
As defects are small pulmonary hypoplasia is less common
Direct anatomical repair is performed
What is a paraumbilical hernia?
Usually a condition of adulthood
Defect is in the linea alba
More common in females
Multiparity and obesity are risk factors
Traditionally repaired using Mayos technique - overlapping repair,
What is a Littres hernia?
ernia containing Meckels diverticulum
Resection of the diverticulum is usually required and this will preclude a mesh repair
Borders of the femoral CANAL?
Laterally Femoral vein
Medially Lacunar ligament
Anteriorly Inguinal ligament
Posteriorly Pectineal ligament
