deck_1406572 Flashcards
What are the layers of the abdominal wall?
SkinSuperficial fasciaMuscle and aponeurosesParietal peritoneum
At what spinal level is the umbilicus?
L3
What is the epigastric fossa?
Slight depression in the epigastric region, just inferior to the xiphoid process. Heartburn is commonly felt here.
What is the linea alba?
Aponeuroses of abdominal muscles, separating the left and right rectus abdominis. If the linea alba is lax, when the rectus abdominis contract the muscles spread apart
What is the arcuate line?
Point where the fibrous sheath stops 1/3 of the way from the umbilicus to the pubic crest – it disappears behind the umbilicus
What are the flat muscles that make up the abdominal wall?
External obliqueInternal obliqueTransversus abdominis
What are the vertical muscles that make up the abdominal wall?Give a particular characteristic for these muscles.
Rectus abdominisPyramidalisAre contained within the rectus sheath
What direction do the fibres of the flat muscles run in?
External – obliquely and downwardsInternal – obliquely and upwards TA – transversely
Where do the flat muscles attach?
They continue as aponeuroses and form the rectus sheath which encloses the rectus abdominis. In the midline, the opposing aponeuroses weave together from left and right and between superficial and deep layers, to form the linea alba.
Where does the linea alba extend from and to?
From the xiphoid process to the pubic symphysis
Why do surgeons use particular incisions?
Have to give incisions that will close and heal correctly to minimise incisional herniae. Muscle cannot be sew together as the sutures would just slice though the muscle.
What is used for a midline incision?
Suture the linea alba for a strong closure
What is used for a transverse incision?
Suture the external oblique aponeuroses
Give the features used for an appendicectomy
Incision at MrBurney’s pointUse a gridiron splitting incision
Where is McBurney’s point?
2/3rds of distance between ASIS and umbilicus
What is a gridiron incision?
Separating out the muscle fibres with scissors – do not cut them. Have to separate out through different angles for each muscle layer.
What lies under the three flat muscles?
Transversalis fascia
Describe the peritoneum
Lines abdominal cavity and lies underneath the tranversalis fascia. Produces fluid to allow for smooth movement of organs over and next to each other.
What overlies the organs?
The greater omentum – a fatty sheath. In appendicitis or infections it moves to cover and protect the healthy tissue from the infected area.
What is the name of bleeding into the rectus abdominis?
Rectus sheath haematoma– will be very painful, even more so when they use this muscle. Can diagnose with ultrasound
What is a patent urachus?
The urachus, which is the remnant of the allantois remains open, allowing urine to leave via the umbilicus.
When does a patent urachus present?
At birthIn later life when older men being to develop benign prostatic hypertrophy, leading to ladder outflow obstruction.
What is Meckels Diverticulum?
Only a portion of the vitelline duct closes, forming an out pocketing of the ileum.
Give the characteristics of Meckel’s Diverticulum
Occurs in 2% if the populationIs 2 feet proximal to the ileocecal valveIs 2 inches in length2 year is the most common clinical presentation2:1 male:female ratio (true of all congenital abnormalities)Can contain ectopic gastric issue or pancreatic tissue
When does Meckel’s Diverticulum cause a problem?
When is has a mixture of tissues which secrete gastric acids, causing ulceration as the surrounding tissue is not protected from these enzymes. – more often than not, it is asymptomatic– causes blood in the stool– starts as abdominal pain, vomiting and constipation
What is volvulus?
Twisting of the intestine around its site of mesenteric attachment which compromises the blood supply to that area. Causes strangulation and ischaemia.
What is a vitelline fistula?
There is direct communication between the umbilicus and the intestinal tract. This results in faecal matter coming out of the umbilicus.
What is omphalocoele?
The persistence of physiological herniation. A part of the gut tube fails to return to the abdominal cavity following its normal herniation into the umbilical cord. The gut tube is covered by a layer of amnion.
What is gastroschisis?
The failure of closure of the abdominal wall during folding of the embryo, leaving the gut tube and its derivatives outside the body cavity. There is no covering over the gut tube.
Define somatic referred pain
Pain caused by a noxious stimulus to the proximal part of a somatic nerve that is perceived in the distal dermatome of the nerve. – pain is felt distal to the cause of the pain
What is the dermatomal level of the umbilicus?
T10
What is the dermatomal level of the pubis?
T12
What is visceral referred pain?
The CNS perceives visceral pain as coming from the somatic area supplied by the same nerve.
Where is visceral foregut pain felt?
Epigastric region
Where is visceral midgut pain felt?
Periumbilical region
Where is visceral hindgut pain felt?
Suprapubic region
What causes visceral pain?
IschaemiaAbnormally strong muscle contraction,InflammationStretch
