Clinical Topic 4: Abdominal Pain Flashcards
What are the contents of the Inguinal Canal?
- Spermatic cord (males)
- Round ligament of uterus (females)
- Ilioinguinal nerve
- Genitofemoral nerve
What structure is at most risk of damage during an Inguinal hernia repair?
Ilioinguinal nerve
What are some risk factors of hernia formation?
Previous history of hernia, older age, male sex, chronic cough, chronic constipation, smoking
What is the relation of the Ilioinguinal nerve to the spermatic cord in males?
The ilioinguinal nerve is anterior to the spermatic cord
What are the medial, lateral and inferior borders of the Hasselbach triangle?
Medial: Rectus abdominus
Inferior: Inguinal ligament
Lateral: Inferior epigastric vessels
What are the five sets of tissue, anterior to posterior, separating the bowel from herniation?
- External Oblique Aponeurosis
- External Oblique
- Internal Oblique
- Transversus Abdominus
- Transversalis Fascia
What are the anterior and posterior borders of the Inguinal Canal?
Anteriorly: External Oblique Aponeurosis
Posteriorly: the Transversalis Fascia
What is the floor of the Inguinal Canal?
Inguinal Ligament
What is the roof of the Inguinal Canal?
Internal Oblique, Transversalis Fascia, Transversus Abdominus
What is the cause of an Indirect Inguinal Hernia? What is the fate of the peritoneal sac?
Failure of the processus vaginalis to regress. The peritoneal sac enters the inguinal canal through the deep inguinal ring and out the superficial inguinal ring
What is the cause of a Direct Inguinal Hernia? What is the fate of the peritoneal sac?
Weakening of the abdominal musculature. The peritoneal sac enters the inguinal canal through the Hasselbach’s triangle / posterior wall and out the superficial inguinal ring
Where is the Indirect inguinal hernia with reference to the inferior epigastric artery?
Lateral to the inferior epigastric artery
Where is the Direct inguinal hernia with reference to the inferior epigastric artery?
Medial to the inferior epigastric artery
What are the medial, lateral and superior borders of the Femoral Triangle?
Superiorly: Inguinal Ligament
Medially: Adductus Longus
Laterally: Sartorius
Are Indirect and Direct Inguinal Hernias acquired or congenital? Which are more common?
Indirect - Congenital (are more common)
Direct - Acquired (are least common)
What is an Epigastric Hernia?
Herniation of bowel through the Linea Alba, above the umbilicus
What are the references for the Femoral Nerve and Femoral Artery?
Femoral Nerve: Midpoint of Inguinal ligament
Femoral Artery: Mid-Inguinal point
What are complications of a Hernia?
Incarceration (trapping of hernia in wall)
Strangulation (ischaemia of bowel tissue)
The appendix is embryologically derived from what? What is the arterial supply and drainage?
The midgut. Is supplied by the appendicular artery, a branch of the superior mesenteric artery. Drained by the appendicular vein
What is the lymphatic drainage of the Appendix?
Ileocolic lymph nodes
The sympathetic fibres to the Appendix run from which region of the spinal cord?
T10
What is the most common position of the Appendix?
Retrocaecal position (11 o’clock)
What is McBurney’s Point defined as?
1/3 lateral from the ASIS to the umbillicus
Where is the approximate base of the appendix?
2cm from the Ileocaecal valve
Rupture of the appendix causing peritonitis leads to what specific set of pain symptoms?
Rebound tenderness (pain on removing pressure) and abdominal guarding
What are 4 causes of Appendicitis?
- Obstructed Faecolith
- Undigested material
- Parasitic infection
- Lymphoid hyperplasia
What are 3 complications of Appendicitis?
- Rupture of appendix
- Periappendiceal abscess
- Subphrenic abscess
What are the two bacterial strains associated with a case of perforated Appendicitis?
Bacteroides fragilis
Echerischia coli
What is the Rovsing’s sign? What does it suggest?
Palpation of the LLQ increases pain in RLQ. Sign of appendicitis
What is the Psoas sign? What does it suggest?
Extension of right hip causes pain in RLQ. Sign of appendicitis in the retrocaecal position
What are the three main types of Volvulus? Which is most common
Sigmoid volvulus (most common)
Caecal volvulus
Mindgut volvulus
What is Hirschprung’s disease?
Where nerves to the intestine are missing in parts, causing constipation as the main symptom
Sigmoid volvulus is commonly seen in what sorts of patients?
- Can affect pregnant women
- Can affect middle-aged / elderly with constipation
- Can affect patients with Hirschprung’s disease
Caecal volvulus is caused by what? What patients present with it?
Presents in young adults, and occurs due to poor mesentery development where there are fever attachment points
Midgut volvulus is caused by what? What patients present with it?
Presents in babies and young children, where they have a poorly developed intestine causing malrotation at 12 weeks in utero
How might a Volvulus present on a Barium Enema?
“Bird’s beak appearance”
How are Sigmoid and Caecal volvulus treated?
Sigmoid volvulus - Sigmoidoscopy
Caecal volvulus - Colonscopy
