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Medicine Year 1 > Case 12 SBA > Flashcards

Case 12 SBA Flashcards

1
Q

Name the layers of the anterior abdominal wall

A

Skin
Camper’s fascia
Scarpa’s fascia
External oblique
Internal oblique
Transversus abdominus
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum

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2
Q

Origin of external oblique muscles

A

Muscular slips from outer surfaces of lower eight ribs

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3
Q

Insertions of external oblique muscles

A

Lateral lip of iliac crest
Aponeurosis ending in midline raphe

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4
Q

Direction of external oblique muscles

A

Down and out, hands in pockets

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5
Q

Origin of internal oblique muscles (TIL)

A

Thoracolumbar fascia
Iliac crest between origins of external and transversus
Lateral two-thirds on inguinal ligament

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6
Q

Insertion of internal oblique muscles

A

Inferior border of lower three or four ribs
Aponeurosis ending in lines alba
Pubic crest and pectineal line

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7
Q

Direction of internal oblique muscles

A

Diagonally up and in, hands on heart

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8
Q

Transversus abdominus origin

A

Thoracolumbar fascia
Medial lip of iliac crest
Lateral one-third of inguinal ligament
Costal cartilages of lower six ribs

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9
Q

Insertion of transversus abdominus

A

Aponeurosis ending in linea alba
Pubic crest and pectineal line

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10
Q

Direction transversus abdominus

A

Horizontal

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11
Q

Rectus sheath

A

Covering which encloses the rectus abdominus muscle and the pyramidalis muscle

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12
Q

What forms the rectus sheath?

A

Aponeuroses external oblique, internal oblique, and transversus abdominus

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13
Q

Linea alba

A

Midline where rectus sheath fuses

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14
Q

Linea semilunaris

A

Lateral edge of rectus sheath on each side

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15
Q

Anterior portion of superior rectus sheath

A

Aponeuroses of external oblique and half of internal oblique

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16
Q

Posterior portion of superior rectus sheath

A

Aponeuroses of half of internal oblique and transversus abdominus

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17
Q

Anterior portion inferior rectus sheath

A

Aponeuroses of external oblique, internal oblique, transversus abdominus

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18
Q

Posterior portion inferior rectus sheath

A

None as in direct contact with transversalis fasci

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19
Q

Tendinous intersection

A

Fibrous bands separating rectus abdominus muscle

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20
Q

Arcuate line

A

5-6cm below umbilicus
Posterior wall of rectus sheath finishes

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21
Q

What is a hernia?

A

Protrusion of an organ or tissue through its covering into an abnormal position outside its normal compartment

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22
Q

What causes hernias?

A

Weak muscle/surrounding tissue
Increased intra-abdominal pressure

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23
Q

Reducible hernia

A

Can be pushed back into place

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24
Q

Incarcerated hernia

A

Unable to be pushed back to original place

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25
Q

Obstructed hernia

A

Contents compacted
Lumen not patent

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26
Q

Strangulated hernia

A

Squeezing causes ischaemia due to lack of blood flow

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27
Q

Where does a spigelian hernia occcur?

A

Linea semilunaris, around the level of the arcuate line

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28
Q

Describe presentation and risk of spigelian hernia

A

Small tender mass at lower lateral edge of the rectus abdominus
High risk of strangulation

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29
Q

Location of epigastric hernia

A

Midline between xiphoid process and umbilicus

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30
Q

What causes epigastric hernia?

A

Defect in linea alba

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31
Q

What is omphalocele?

A

Defect in abdominal wall

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32
Q

Infantile omphalocele

A

Prematurity

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33
Q

Adult omphalocele

A

Pregnancy, obesity, ascites

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34
Q

Paraumbilical hernia

A

Central swelling above or below umbilicus

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35
Q

Associations with paraumbilical hernias

A

Adults
Women
Obesity
Weak abdominal muscles

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36
Q

What can the sac contain in paraumbilical hernias?

A

Bowel and omentum

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37
Q

Where is the inguinal ligament?

A

From ASIS to pubic tubercle

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38
Q

What forms the inguinal ligament?

A

Formed from the aponeurosis of the external oblique muscle

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39
Q

Clinical significance of midpoint of the inguinal ligament

A

Landmark to find the femoral nerve

40
Q

Mid-inguinal point location

A

Half-way between the pubic symphysis and anterior superior iliac spine (ASIS)

41
Q

Significance of the mid-inguinal point

A

Femoral pulse palpation

42
Q

Anterior boundary inguinal canal

A

Aponeuroses of external and internal oblique

43
Q

Roof inguinal canal

A

Aponeurotic arching of transversus abdominus and internal oblique

44
Q

Posterior wall inguinal canal

A

Transversalis fascia

45
Q

Floor inguinal canal

A

Inguinal and lacunar ligaments

46
Q

What does the inguinal canal contain?

A

Spermatic cord/round ligament of uterus
Genital branch of genitofemoral nerve
Ilio-inguinal nerve

47
Q

Which is the more common inguinal hernia type?

A

Indirect

48
Q

Indirect inguinal hernia

A

Peritoneal sac and potentially bowel enter the inguinal canal via the deep inguinal ring

49
Q

What dictates the degree of herniation of an indirect inguinal hernia?

A

Amount of processus vaginalis still present

50
Q

Where does an indirect inguinal hernia occur?

A

Lateral to inferior epigastric vessels

51
Q

What can indirect inguinal hernias cause?

A

Bowel obstruction and strangulation

52
Q

Direct inguinal hernia

A

Peritoneal sac bulges into the inguinal canal via the posterior wall and can enter the superficial inguinal ring

53
Q

Where does a direct inguinal hernia occur?

A

Medial to inferior epigastric vessels

54
Q

What causes direct inguinal hernias?

A

Weakened musculature

55
Q

Femoral hernia

A

Abdominal viscera or omentum pass through femoral ring into femoral canal. Rare.

56
Q

Where does a femoral hernia occur?

A

Inferolateral to the pubic tubercle

57
Q

Routes of IBD treatment

A

Oral, rectal, systemic

58
Q

What do aminosalicates contain?

A

5-ASA and sulfasalazine/mesalazine

59
Q

Action of aminosalicates in IBD

A

Limit inflammation to mucosa

60
Q

Why are aminosalicates less useful in Crohn’s?

A

Just limit mucosal inflammation

61
Q

Aminosalicate dosing in IBD

A

2.4g per day
Continue as maintenance

62
Q

What effects do aminosaliates have on developing cancer?

A

Chemopreventative so reduce risk

63
Q

Aminosalicates in proctitis?

A

1g suppository at night

64
Q

Which corticosteroid is used in IBD?

A

Prednisolone

65
Q

Corticosteroid dosing in IBD

A

40mg initially weaning over 6-8 weeks

66
Q

Corticosteroid use in UC?

A

Clipper/cortiment in moderate/severe

67
Q

Corticosteroid use in Crohn’s

A

Budesonide in colonic Crohn’s

68
Q

What is taken as an accompaniment with corticosteroids in IBD?

A

Calcium and vitamin D twice daily

69
Q

Administration corticosteroids in IBD

A

Oral

70
Q

Are corticosteroids good for long-term use in IBD

A

No

71
Q

Actions of thiopurine and methotrexate

A

Modify immune activity or reduce cell number to decrease inflammatory response

72
Q

Which IBD is methotrexate used for?

A

Crohn’s

73
Q

Monotherapy thiopurine/methotrexate use in IBD?

A

Induction and maintenance of remission

74
Q

Why are thiopurines and methotrexate used with anti-TNF drugs?

A

Protect from immunogenicity

75
Q

Combination of what with thiopurine leads to higher remission rates in IBD?

A

Infliximab

76
Q

Biologic drugs action

A

Bind to target and make it harmless

77
Q

Infliximab

A

Anti-TNF monoclonal antibody, chimeric

78
Q

Vedolizumab action

A

Gut-selective anti alpha-4 beta-7 integrin therapy

79
Q

Pros of using Vedolizumab in IBD

A

Favourable safety profile
Low immunogenicity

80
Q

Cons of using Vedolizumab in IBD

A

Expensive compared to biosimilar drugs

81
Q

Biologics used in IBD

A

Infliximab, Vedolizumab, Ustekinumab

82
Q

What is ustekinumab used for?

A

Crohn’s
UC
psoriasis
Psoriatic arthritis

83
Q

Pros of ustekinumab in IBD

A

Favourable safety profile
Low immunogenicity

84
Q

Cons of ustekinumab in IBD

A

Lack of safety data in pregnancy
Expensive compared to biosimilar drugs

85
Q

JAK inhibitors in UC

A

Tofactinib and filgotinib

86
Q

How to JAK inhibitors act?

A

With variable affinities for JAK1, JAK2, and JAK3 pathways

87
Q

Non-selective JAK inhibitor

A

Tofactinib

88
Q

Risks associated with tofactinib

A

Shingles
Venous thromboembolism (VTE)

89
Q

What are the risk factors for shingles and VTE in tofactinib use?

A

Major surgery
Immobilisation
MI in previous three months
Heart failure
HRT
Combined pill
Coagulation disorder
Malignancy

90
Q

Non-pharmacological treatments of IBD

A

Research studies, clinics, nurse specialist appointments

91
Q

Definition of diarrhoea

A

three or more loose stools per day with >500ml fluid and electrolytes lost

92
Q

Causes of osmotic diarrhoea

A

laxatives, non-absorbable food, congenital/acquired disorders of digestion

93
Q

what is osmotic diarrhoea?

A

malabsorption

94
Q

what is secretory diarrhoea?

A

ion transport defect, imbalance between secretion and absorption

95
Q

causes of secretory diarrhoea

A

enterotoxins, laxatives, hormone secreting tumours, medication, allergy

96
Q

how does motility disturbance cause diarrhoea?

A

insufficient time for absorption

Medicine Year 1 (23 decks)

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