Common Abdominal Conditions

Question 1

What populations are most likely to obtain a side strain?

Answer 1

Athletes requiring repetitive, unilateral and explosive trunk motion

Question 2

What is the pathology of a side strain?

Answer 2

Usually a tear of internal oblique, esp. at rib or costal cartilage attachment

Question 3

What are the clinical features of a side strain?

Answer 3

Acute pain and focal tenderness at costal margin

Question 4

What movements reproduce familiar pain of side strains?

Answer 4

Trunk lateral flexion consistent with mechanism of injury
Agg. with deep breathing, coughing, rolling over in bed

Question 5

What is an inguinal hernia?

Answer 5

Protrusion of abdominal contents (intestines, omentum) into the inguinal canal

Question 6

What are the two classifications of hernia?

Answer 6

Indirect (lateral) hernia
DIrect (medial) hernia

Question 7

What is an indirect hernia?

Answer 7

Hernia sac passes through the deep inguinal ring and runs in the inguinal canal

Question 8

What is a direct hernia?

Answer 8

Bulges directly through the posterior wall of the inguinal canal

Question 9

Who is more at risk of hernia, males or females?

Answer 9

Males - 27%
Females - 3%

Question 10

What are the other types of hernias?

Answer 10

Umbilical, femoral, incisional

Question 11

What is the aetiology of an indirect hernia?

Answer 11

Strong association with having a patent vaginal process
- An anatomical pathway that never closed over during embryological development

Question 12

What is the aetiology of a direct hernia?

Answer 12

Usually due to weakness in the transversalis fascia

Question 13

What are the main risk factors of hernias?

Answer 13

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

Question 14

What are the clinical features of a hernia?

Answer 14

Lump in groin
- Goes away with pressure or lying supine
Mild to moderate discomfort (worse with activity)
- 30% patients have no pain

Question 15

What is the management of hernias?

Answer 15

Mesh vs suture repair
Open vs laparoscopic

Question 16

What are the complications of hernia surgery?

Answer 16

Recurrence
Chronic pain
Infertility

Question 17

What are aneurysms?

Answer 17

A localised dilation or outpouching of a vessel

Question 18

What types of aneurysms are there?

Answer 18

Fusiform: around the entire circumference
Saccular: bulging only from one side

Question 19

What is the incidence of aneurysms?

Answer 19

The abdominal aorta is particularly susceptible
-75% of aneurysms occur in abdominal aorta
Many AAAs are asymptomatic and remain undiagnosed

Question 20

What is the aetiology of AAA?

Answer 20

Any factor that disrupts the collagen and elastin fibres within an arterial wall predisposes it to dilation

Question 21

What conditions can lead to an aneurysm?

Answer 21

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

Question 22

What are complications caused by AAA?

Answer 22

Dilation and rupture
Stagnant blood flow can undergo thrombosis
Thromboembolism can obstruct peripheral flow

Question 23

What is the classic presentation of AAA?

Answer 23

Male, hypertensive, smoker aged > 50years

Question 24

Are AAA asymptomatic?

Answer 24

Yes, until they leak and possibly rupture

Question 25

What could it mean if the AAA is more than 5cm?

Answer 25

Could be a pulsatile mass in the lower abdomen +/- bruit

Question 26

What symptoms of AAA are caused by pressure on surrounding organs?

Answer 26

Dysphagia
Dyspnoea

Question 27

What are the features of a rupture?

Answer 27

Acute abdominal pain, features of hypovolaemic shock

Question 28

What should be done about an AAA?

Answer 28

Emergency referral for diagnosis and management
- Mortality after rupture: 50%

Question 29

What is suggested for a large or ruptured AAA?

Answer 29

Surgery
- Insertion of prosthetic graft

Question 30

What is suggested for early AAA?

Answer 30

Medical management
- Anti-hypertensive drugs, smoking cessation