Common Abdominal Conditions Flashcards
What populations are most likely to obtain a side strain?
Athletes requiring repetitive, unilateral and explosive trunk motion
What is the pathology of a side strain?
Usually a tear of internal oblique, esp. at rib or costal cartilage attachment
What are the clinical features of a side strain?
Acute pain and focal tenderness at costal margin
What movements reproduce familiar pain of side strains?
Trunk lateral flexion consistent with mechanism of injury
Agg. with deep breathing, coughing, rolling over in bed
What is an inguinal hernia?
Protrusion of abdominal contents (intestines, omentum) into the inguinal canal
What are the two classifications of hernia?
Indirect (lateral) hernia
DIrect (medial) hernia
What is an indirect hernia?
Hernia sac passes through the deep inguinal ring and runs in the inguinal canal
What is a direct hernia?
Bulges directly through the posterior wall of the inguinal canal
Who is more at risk of hernia, males or females?
Males - 27%
Females - 3%
What are the other types of hernias?
Umbilical, femoral, incisional
What is the aetiology of an indirect hernia?
Strong association with having a patent vaginal process
- An anatomical pathway that never closed over during embryological development
What is the aetiology of a direct hernia?
Usually due to weakness in the transversalis fascia
What are the main risk factors of hernias?
Male sex
Advanced age
Occupations involving increased lifting and standing/walking
Connective tissue disorders
Inguinal cryptorchidism
Smoking and high BMI increase the risk for recurrence
What are the clinical features of a hernia?
Lump in groin
- Goes away with pressure or lying supine
Mild to moderate discomfort (worse with activity)
- 30% patients have no pain
What is the management of hernias?
Mesh vs suture repair
Open vs laparoscopic
What are the complications of hernia surgery?
Recurrence
Chronic pain
Infertility
What are aneurysms?
A localised dilation or outpouching of a vessel
What types of aneurysms are there?
Fusiform: around the entire circumference
Saccular: bulging only from one side
What is the incidence of aneurysms?
The abdominal aorta is particularly susceptible
-75% of aneurysms occur in abdominal aorta
Many AAAs are asymptomatic and remain undiagnosed
What is the aetiology of AAA?
Any factor that disrupts the collagen and elastin fibres within an arterial wall predisposes it to dilation
What conditions can lead to an aneurysm?
Atherosclerosis
- Most common cause; plaque formation erodes wall and contributes to inflammation that further weakens the vessel
Hypertension
- Also increases wall stress
Other causes
- Connective tissue disorders, infection
What are complications caused by AAA?
Dilation and rupture
Stagnant blood flow can undergo thrombosis
Thromboembolism can obstruct peripheral flow
What is the classic presentation of AAA?
Male, hypertensive, smoker aged > 50years
Are AAA asymptomatic?
Yes, until they leak and possibly rupture
What could it mean if the AAA is more than 5cm?
Could be a pulsatile mass in the lower abdomen +/- bruit
What symptoms of AAA are caused by pressure on surrounding organs?
Dysphagia
Dyspnoea
What are the features of a rupture?
Acute abdominal pain, features of hypovolaemic shock
What should be done about an AAA?
Emergency referral for diagnosis and management
- Mortality after rupture: 50%
What is suggested for a large or ruptured AAA?
Surgery
- Insertion of prosthetic graft
What is suggested for early AAA?
Medical management
- Anti-hypertensive drugs, smoking cessation
