GI 3 Flashcards
Describe the basic features of the abdominal wall
Continuous
Subdivided into:
Anterior
Lateral walls (left and right)
Posterior wall
Lateral and anterior wall boundary is indefinite therefore the term ‘anterolateral abdominal wall’ is used to describe them together
Describe the boundaries of the anterolateral abdominal wall
Superiorly:
Xiphoid process
Cartilages of the 7th - 10th ribs
Inferiorly:
Inguinal ligament
Superior margin of the pelvic girdle (iliac crests, pubic crests and pubic symphisis)
What are the layers of the abdominal gut wall?
Skin
Subcutaneous tissue (superficial fascia and fat)
Muscles and their apneurosis
Deep fascia
Extraperitoneal fat
Parietal peritoneum
Label the black boxes
Top to bottom, right column first:
Skin
Superficial fatty layer of subcutaneous tissue
Deep membranous layer of subcutaneous tissue
Investing (Deep) fascia - superficial, intermediate and deep
2nd Column:
External oblique
Internal oblique
Transversus abdominus
Extraperitoneal fat
Endoabdominal fascia
Parietal peritoneum
What is the umbilicus?
Center of anterolateral abdominal wall
L3
What is the Epigastric Fossa?
Slight depression in epigastrum
Just inferior to xiphoid process
Heartburn commonly felt at this site
What is the linea alba?
What is a common abnormality?
Apneuroses of abdominal muscles
Separates the left and right rectus abdominis
Visible in lean individual
Apneuroses of right and left, Intermediate and deep layers of the gut wall interweave here
If lax then rectus abdominis spread apart on contraction (Divercation of recti)
What is the inguinal groove?
Skin crease parallel and just inferior to inguinal ligament
Marks the division between abdominal wall and thigh
What are the Semilunar lines?
Slightly curved, tendinous lines on either side of the rectus abdominis
What are the tendinous intersections of the rectus abdominis?
Clearly visible (in lean individuals) horizontal lines through the rectus abdominis
What are the Arcuate lines?
Where the inferior limit of the posterior rectus sheath ends
1/3 of the way between the umbilicus and the pubic crest
Label the Boxes
Top to bottom:
1st column:
Xiphoid process
Right costal margin
Umbilicus
Iliac crest
ASIS
Inguinal ligament
Pubic tubercle
2nd Column:
Epigastric fossa
Linea alba
Semilunar lines
Pubic symphysis
3rd Column
Serratus anterior
Ext. Oblique
Rectus abdominis
Linea alba
Umbilicus
Inguinal ligament
There are two types of muscle in the abdominal wall, what are they and what are the muscles in each category?
Flat:
External oblique
Internal oblique
Transversus abdominis
Vertical:
Rectus abdominis
Pyrimidalis
What directions do the fibres of the flat muscles of the abdominal wall run?
What is the order of the flat muscles in the abdominal wall?
External oblique:
Posterior to anterior
Superficial
Internal oblique:
Anterior to posterior
Middle
Transversus abdominis:
Transverse
Deep
What is the rectus sheath?
3 flat muscles are continued antero-medially as the the rectus sheath (apneuroses) that enclose the rectus abdominis and Pyrimidalis
Label the boxes
1st Column:
Rectus sheath
Rectus abdominis
Linea alba
Rectus sheath
2nd Column:
Apneuroses of TA
Parietal peritoneum
Transversalis fascia
TA muscle
Int. Oblique
Ext. Oblique
Subcutaneous tissue
Apneuroses of Ext. Oblique
Lamina of apneuroses of Int. Oblique
Skin
Parietal peritoneum
Extraperitoneal fat
Transversalis fascia
Membranous and Fatty layers of Subcutaneous tissue
What are the major considerations when designing a surgical abdominal insicion
Capable of closing
Strong and long lasting
Minimise incidence of insicional herniae
Not directly through muscle (Sutures will ‘cut out’)
List the major abdominal incisions
Midline
Transverse
Appendicectomy
Gridiron
Breifly describe a midline surgical incision
Insicion through linea alba
Briefly describe a transverse surgical incision
Cut through the external oblique apneuroses
Describe an appendicectomy incison
Incision at McBurney’s point
2/3 the distance between umbilicus and ASIS
Through a Gidiron muscle splitting incision
What is a Gidiron incision?
Separation of the muscle fibres of the flat muscles with scissors to get through to the peritoneum
What is a ‘patent urachus’ and what is a common consequence?
What are the common causes?
Urachus connects the bladder and umbilicus, when patent allows urine to leak from the umbilicus
Causes:
Congenital
Benign prostatic hypertrophy in older men
What is the vitelline duct?
What are the abnormalities that can be caused by it’s persistence?
A duct that connects the midgut to the yolk sac in the embryo
Abnormalities:
Meckel’s Diverticulum
Vitelline Cyst
Vitelline Fistula
Omphalocoele
Gastoschisis
Describe a Meckel’s Diverticulum?
Most common GI abnormality
Cul-de-sac in the ileum
Rule of 2’s:
- 2% of pop. affected
- 2ft from ileocecal valve
- 2 inches long
- Usually detected in <2’s
- 2:1 Male:Female
Can be asymptomatic
OR
Can contain ectopic gastric/pancreatic tissue that secretes enzymes and acid causing ulceration
What is a vitelline cyst?
The vitelline duct forms a cyst connected to the lieum and abdominal wall via thin fibrous strands
What is a vitelline fistula?
Direct communication between umbilicus and intestinal tract
This can result in faecal matter coming out of the umbilicus
What is an Omphalocoele?
Persistence of physiological herniation
Part of the gut tube fails to return to the abdominal cavity following its normal herniation into the umbilical cord
Epithelial layer around the umbilical cord (Amnion) covers the defect
What is Gastroschisis?
Failure of closure of the abdominal wall during embryo folding
Leaves the gut tube and its derivatives outside the body
There is no covering of the gut tube as they herniate directly through the abdominal wall into the amniotic cavity
Label these 3 abnormal structures
Meckel’s Diverticulum
Vitelline cyst
Vitelline fistulla
How does somatic pain become referred?
Noxious stimlus to proximal part of a somatic nerve is percieved in the distal dermatome
E.g. Shingles affects nerves, but is felt distally along nerve course to the infection
How does visceral referred pain come about?
In the abdomen and thorax visceral afferent pain fibres follow sympathetic fibres
Course back to the same spinal cord segments that ive rise to the pre-ganglionic sympathetic fibres
CNS therefore percieves pain as coming from the somatic portion of the body supplied by the relevant spinal cord segments
What can cause visceral pain?
Ischaemia
Abnormally strong muscle contraction
Stretch
ONLY
Where in the abdomen might visceral referred pain be felt and what regions of the gut are actually producing pain in each case?
Epigastric region:
Foregut pain
Umbilicus region:
Midgut pain
Suprapubic region:
Hindgut pain
Identify the source of the pain shown in the diagram
Gallbladder
Identify the source of the pain shown in this diagram
Hepatic Pain (Liver)