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Question 1

What are the layers of the abdominal wall?

Answer 1

SkinSuperficial fasciaMuscle and aponeurosesParietal peritoneum

Question 2

At what spinal level is the umbilicus?

Answer 2

L3

Question 3

What is the epigastric fossa?

Answer 3

Slight depression in the epigastric region, just inferior to the xiphoid process. Heartburn is commonly felt here.

Question 4

What is the linea alba?

Answer 4

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

Question 5

What is the arcuate line?

Answer 5

Point where the fibrous sheath stops 1/3 of the way from the umbilicus to the pubic crest – it disappears behind the umbilicus

Question 6

What are the flat muscles that make up the abdominal wall?

Answer 6

External obliqueInternal obliqueTransversus abdominis

Question 7

What are the vertical muscles that make up the abdominal wall?Give a particular characteristic for these muscles.

Answer 7

Rectus abdominisPyramidalisAre contained within the rectus sheath

Question 8

What direction do the fibres of the flat muscles run in?

Answer 8

External – obliquely and downwardsInternal – obliquely and upwards TA – transversely

Question 9

Where do the flat muscles attach?

Answer 9

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.

Question 10

Where does the linea alba extend from and to?

Answer 10

From the xiphoid process to the pubic symphysis

Question 11

Why do surgeons use particular incisions?

Answer 11

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.

Question 12

What is used for a midline incision?

Answer 12

Suture the linea alba for a strong closure

Question 13

What is used for a transverse incision?

Answer 13

Suture the external oblique aponeuroses

Question 14

Give the features used for an appendicectomy

Answer 14

Incision at MrBurney’s pointUse a gridiron splitting incision

Question 15

Where is McBurney’s point?

Answer 15

2/3rds of distance between ASIS and umbilicus

Question 16

What is a gridiron incision?

Answer 16

Separating out the muscle fibres with scissors – do not cut them. Have to separate out through different angles for each muscle layer.

Question 17

What lies under the three flat muscles?

Answer 17

Transversalis fascia

Question 18

Describe the peritoneum

Answer 18

Lines abdominal cavity and lies underneath the tranversalis fascia. Produces fluid to allow for smooth movement of organs over and next to each other.

Question 19

What overlies the organs?

Answer 19

The greater omentum – a fatty sheath. In appendicitis or infections it moves to cover and protect the healthy tissue from the infected area.

Question 20

What is the name of bleeding into the rectus abdominis?

Answer 20

Rectus sheath haematoma– will be very painful, even more so when they use this muscle. Can diagnose with ultrasound

Question 21

What is a patent urachus?

Answer 21

The urachus, which is the remnant of the allantois remains open, allowing urine to leave via the umbilicus.

Question 22

When does a patent urachus present?

Answer 22

At birthIn later life when older men being to develop benign prostatic hypertrophy, leading to ladder outflow obstruction.

Question 23

What is Meckels Diverticulum?

Answer 23

Only a portion of the vitelline duct closes, forming an out pocketing of the ileum.

Question 24

Give the characteristics of Meckel’s Diverticulum

Answer 24

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

Question 25

When does Meckel’s Diverticulum cause a problem?

Answer 25

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

Question 26

What is volvulus?

Answer 26

Twisting of the intestine around its site of mesenteric attachment which compromises the blood supply to that area. Causes strangulation and ischaemia.

Question 27

What is a vitelline fistula?

Answer 27

There is direct communication between the umbilicus and the intestinal tract. This results in faecal matter coming out of the umbilicus.

Question 28

What is omphalocoele?

Answer 28

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.

Question 29

What is gastroschisis?

Answer 29

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.

Question 30

Define somatic referred pain

Answer 30

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

Question 31

What is the dermatomal level of the umbilicus?

Answer 31

T10

Question 32

What is the dermatomal level of the pubis?

Answer 32

T12

Question 33

What is visceral referred pain?

Answer 33

The CNS perceives visceral pain as coming from the somatic area supplied by the same nerve.

Question 34

Where is visceral foregut pain felt?

Answer 34

Epigastric region

Question 35

Where is visceral midgut pain felt?

Answer 35

Periumbilical region

Question 36

Where is visceral hindgut pain felt?

Answer 36

Suprapubic region

Question 37

What causes visceral pain?

Answer 37

IschaemiaAbnormally strong muscle contraction,InflammationStretch