Anterior Abdominal Wall Flashcards by Abdelrahman Unknown

What are the four abdominal quadrants?

Upper left
Upper right
Lower left
Lower right

Formed by two intersecting lines at the umbilicus

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How are the abdominal regions divided?

Divided into 9 regions by two pairs of planes: vertical planes (left and right lateral planes) and horizontal planes (transpyloric plane and intertubercular plane)

Vertical planes are midclavicular, and horizontal planes include the transpyloric plane (midway between jugular notch and pubic symphysis) and intertubercular plane (through tubercles of iliac crests)

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What does the right hypochondrium contain?

Contains the liver

Along with the left hypochondrium which also contains the liver

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What does the epigastric region contain?

Liver
Stomach
Pancreas

It is located above the umbilical region

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What does the right lumbar region contain?

Contains the ascending colon

Left lumbar contains the descending colon

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What does the umbilical region contain?

Small intestine
Transverse colon

Central region of the abdomen

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What does the right iliac region contain?

Ileocecal junction
Appendix

Left iliac region contains the sigmoid colon

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What does the hypogastric region contain?

Small intestine
Urinary bladder (full)
Pregnant uterus

Located below the umbilical region

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What is the linea alba?

A fibrous band extending from the xiphoid process to the symphysis pubis, separating the rectus sheaths

It plays a critical role in the structure of the anterior abdominal wall

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Where does lymph drainage of the skin above the umbilicus go?

Upward to the anterior axillary (pectoral group of nodes)

Below the umbilicus, it drains downward and laterally to the superficial inguinal nodes

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What are the types of hernias according to development?

Congenital: Occurring in neonates and early childhood
Acquired: Occurring in adulthood
Incisional: At the site of previous incision
Recurrent: After previous hernia repair

Each type has distinct characteristics and management strategies

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Define reducible hernia.

Contents can be returned to body cavity of origin

This is a non-complicated type of hernia

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What is an incarcerated hernia?

Irreducible hernia where the contents cannot be pushed back into the peritoneal cavity

Commonly due to a smaller size of the abdominal wall defect

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What does strangulated hernia mean?

Blood vessels are compressed, leading to ischemia

This can result in gangrene if not treated promptly

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What are external hernias?

Inguinal (Direct/Indirect/Dual)
Ventral (many types)
Femoral
Obturator
Lumbar (Dorsal)
Perineal
Sciatic
Gluteal

These hernias occur through the abdominal wall

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What are the clinical features of incisional hernias?

Pain and swelling in the vicinity of previous scar, bulging more prominent on standing and coughing, reduces spontaneously on lying down

Attacks of subacute intestinal obstruction may occur

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What is the treatment for larger defects in hernias?

Mesh repair (open or laparoscopic)

Larger defects are considered to be greater than 2 cm

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What are the risk factors for incisional hernias?

Old age
Male sex
Obesity
Bowel surgery
Suture type
Chest infection
Abdominal distension
Wound infection

These factors contribute to the development of incisional hernias

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What is the common complication of hernias?

Loss of abdominal domain, respiratory dysfunction, bowel edema and constipation, acute abdominal compartment syndrome, and respiratory failure

These complications can arise if hernias are not managed properly

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What is the definition of ventral hernia?

Protrusion of a viscera or part of it through the anterior abdominal wall

Can be spontaneous or acquired

What is a para-umbilical hernia?

A protrusion through the linea alba just above or occasionally below the umbilicus

More common in females and associated with multiparity

What is the primary symptom of a para-umbilical hernia?

Swelling increases with cough or straining

Pain increases on prolonged standing or heavy exercise

What diagnostic tools are used for hernias?

Abdominal plain films
Abdominal ultrasonography
CT abdomen and pelvis

These tools help in the assessment and diagnosis of hernias

What is the recommended management for elderly patients not fit for surgery?

Conservative management

Includes careful monitoring and addressing any underlying health issues

What is the main concern during postoperative care to prevent wound infection?

Very careful closure of abdomen ## Footnote All precautions to prevent immediate postoperative wound infection should be taken.

What is the conservative management approach for elderly patients not fit for surgery?

Not fit for surgery due to bad general condition.

What is the onlay technique in prosthetic mesh repair?

Mesh is placed over the anterior fascia after primary closure of the fascial defect.

What are the advantages of the onlay technique?

* No direct contact with viscera

What are the disadvantages of the onlay technique?

* Large subcutaneous dissection * More chances of seroma formation * Superficial location of mesh leading to increased risk for infection

What is the inlay technique in prosthetic mesh repair?

Interposition of prosthetic mesh between the fascial edges.

What is a significant drawback of the inlay technique?

Very high recurrence rates.

What does the sublay/underlay technique involve?

Placement of prosthetic mesh below the fascial components.

What is the retromuscular technique in hernia repair?

Placement of mesh under the rectus muscle and above the posterior rectus sheath.

What is the advantage of the retromuscular technique?

Intraabdominal forces hold the prosthesis against the muscles.

What is the Rives-Stoppa-Wantz retrorectus repair also known as?

Stoppa technique.

Where does a spigelian hernia occur?

Along the semilunar line.

What does the semilunar line represent?

The line of transition from muscular fibers of the transversus abdominis muscle to the posterior aponeurosis of the rectus.

What is the most common type of interparietal hernia?

Spigelian hernia.

What are the types of pelvic hernias?

* Obturator hernia * Sciatic hernia * Perineal hernia

What are the types of posterior hernias?

* Lumbar hernia * Superior triangle * Inferior triangle

What is a notable characteristic of rare hernias?

Difficult to diagnose.

What indicates the presence of an obturator hernia?

Hernia becomes apparent only when the hip is flexed, abducted, and rotated outwards.

What is the Howship-Romberg sign associated with?

Compression of obturator nerve causing pain in the anteromedial surface of the thigh.

What are the three types of lumbar hernias?

* Superior lumbar hernia * Inferior lumbar hernia * Incisional lumbar hernia

What demographic is commonly seen with lumbar hernias?

Commonly seen in the 5th decade.

What is the male to female ratio in lumbar hernias?

2:1

Which side are lumbar hernias more commonly found?

Left sided hernias are more common.

Are congenital lumbar hernias common or rare?

Congenital types are rare.

What are acquired hernias commonly associated with?

* Back or flank trauma * Poliomyelitis * Back surgery * Infected kidney * Drainage of lumbar abscess * Use of iliac crest as donor site for bone grafts.