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ESA 3 > GI Session 3- Abdomen And Hernias > Flashcards

GI Session 3- Abdomen And Hernias Flashcards

1
Q

What are the main functions of the abdominal wall?

A

Forms a firm, flexible wall which keeps the abdominal viscera in the abdominal cavity
Protects abdominal viscera from injury
Maintains anatomical position of abdominal viscera against gravity
Assists in forceful expiration by pushing the abdominal viscera upwards
Involved an action that increases intra abdominal pressure

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2
Q

What are the layers of the abdominal wall? (Ex to in)

A

Skin
Superficial fascia
Muscles and associated fascia
Parietal peritoneum

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3
Q

How does the composition of the superficial fascia differ depending on its location?

A

Above umbilicus- single sheet of connective tissue
Below umbilicus- divided into 2 layers, fatty superficial layer (camper’s fascia) and membranous deep layer (scarpa’s fascia). Superficial vessels and nerves run between the 2 layers of fascia.

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4
Q

How many muscles are there in the abdominal wall and what groups can they be divided into?

A

2 vertical muscles

3 flat muscles

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5
Q

Name the 3 flat muscles and where they are located

A

External oblique, internal oblique and transversus abdominis

Located laterally in the abdominal wall stacked upon one another

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6
Q

What movement are the flat muscles responsible for?

A

Flex, laterally flex and rotate the trunk

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7
Q

Describe the external oblique muscle

A

Larges and most superficial

Fibres run inferomedially, as fibres approach the midline they for a an aponeurosis

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8
Q

What is the linea alba?

A

Fibrous structures that extends from the xiphoid process of the sternum to the pubic symphysis
Where all the aponeuroses of the flat muscles become entwined

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9
Q

Describe the internal oblique muscle

A

Lies deep to the external oblique
Smaller and thinner in structure
Fibres run superomedially

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10
Q

Describe the transversus abdominis muscle

A

Deepest of the flat muscles
Transversely running fibres
Deep to this muscle is the transversalis fascia

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11
Q

Name the 2 vertical muscles

A

Rectus abdominis

Pyramidalis

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12
Q

Describe the rectus abdominis muscle

A

Long paired muscle found either side of the midline in the abdominal wall
It is split in 2 by the linea alba
Lateral border creates the linea semilunaris
Tendinous intersections connect to linea alba and create 6 pack

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13
Q

What is the function of the rectus abdominis?

A

Compressing abdominal viscera
Stabilises pelvis during walking
Depresses the ribs

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14
Q

Describe the pyramidalis and its function

A

Small triangle shaped muscle
Superficial to the rectus abdominus
Located inferiority- base on pubis bone and apex of the triangle attached to the linea alba
Acts to tense linea alba

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15
Q

What is the rectus sheath?

A

Formed by the aponeuroses of 3 flat muscles and encloses rectus abdominis and pyramidalis muscles

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16
Q

What forms the anterior and posterior walls of the rectus sheath?

A

Anterior wall- aponeuroses of external oblique and half internal oblique
Posterior- aponeuroses of half internal oblique and transversus abdominis
Halfway between umbilicus and pubic symphysis all aponeuroses move to anterior wall so no posterior wall

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17
Q

What is the area of transition between posterior wall and no posterior wall called?

A

Arcuate line

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18
Q

What must be considered by a surgeon when deciding on an incision?

A

Direction of muscle fibres
Location of nerves
Ease of access to desired viscera

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19
Q

Describe the 2 vertical incision that can be made

A

Median- through linea alba, can be extended the whole length of the abdomen curving round umbilicus
Paramedian- lateral to linea alba

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20
Q

What are the advantages of a median incision?

A

Minimal blood loss
Major nerves avoided
Used for any procedure requiring access to the abdominal cavity

21
Q

What are the advantages/disadvantages of paramedian incision?

A

Provides access to more lateral structures

Ligates blood and nerve supply to muscles medial to the incision, resulting in their atrophy

22
Q

Describe the different transverse incisions that can be used

A

Transverse- inferior and lateral to umbilicus
Suprapubic- 5cm superior to pubic symphysis
Subcostal- inferior to xiphoid process, and extents inferior parallel to costal margin
McBurney- grid iron incision, 2 perpendicular lines at McBurneys point

23
Q

Where is McBurneys point?

A

1/3 of the distance between ASIS and umbilicus

24
Q

What are the different transverse incisions used for?

A

Transverse- colon, duodenum and pancreas
Suprapubic- pelvic organs
Subcostal- gall bladder (R), spleen (L)
McBurney- appendicectomies

25
Q

What advantages/disadvantages do the different transverse incisions have?

A

Transverse- least damage to nerve supply, heals well
Suprapubic- can perforate bladder as fascia thins around bladder area
McBurney- excellent healing as muscle fibres not cut

26
Q

Name the 9 regions the abdomen can be split into

A 
R and L hyperchondrium
Epigastric
R and L flank
Umbilical
R and L groin
Pubic
27
Q

How is the abdomen split into 9?

A

2 horizontal and 2 vertical planes

28
Q

What are the 2 horizontal planes?

A

Transpyloric plane- horizontal line halfway between xiphoid process and umbilicus, passing through pyloris of the stomach
Intertubecular plane- horizontal line joining iliac crests

29
Q

Where do the 2 vertical planes lie?

A

Run vertically from the mid clavicle to mid inguinal point

Called mid clavicular lines

30
Q

Name some developmental defects of the abdominal wall

A

Ectopic cordis- heart develops outside chest
Patent urachus
Urachal cyst
Patent vitellointestinal duct
Exampholos- viscera covered by peritoneum and amnion
Gastroschisis- vertical defect to right of umbilicus, viscera not covered by peritoneum and amnion

31
Q

What is somatic referred pain?

A

Pain caused by a noxious stimulus to the proximal part of a somatic nerve that is perceived in the distal dermatome of the nerve

32
Q

What is visceral referred pain?

A

In the thorax and abdomen, visceral afferent pain fibres follow sympathetic fibres back to the same spinal cord segments that gave rise to the preganglionic sympathetic fibres. CNS perceives visceral pain as coming from the somatic portion of the body supplied by the relevant spinal cord segments

33
Q

What can cause visceral pain?

A

Ischaemia
Abnormally strong muscle contraction
Inflammation
Stretch

34
Q

What are the 2 potential sites of weakness in the abdominal wall?

A

Inguinal canal
Femoral canal
Umbilicus
Previous incisions

35
Q

Describe the inguinal canal

A

Oblique passage that extends in a downward and medial direction
Begins at deep inguinal ring a and continues for 4cm ending at superficial inguinal ring

36
Q

What are the boundaries of the inguinal canal?

A

Anterior wall- aponeurosis of external oblique, and reinforced by internal oblique muscle laterally
Posterior wall- transversalis fascia
Roof- transversalis fascia, internal oblique and transversus abdominis
Floor- inguinal ligament, and thickened medially by lacunar ligament

37
Q

What are the contents of the inguinal canal?

A

In men- spermatic cord passes through

In women- round ligament of uterus traverses through the canal

38
Q

Define hernia

A

The protrusion of an organ or fascia through the wall of cavity that normally contain it

39
Q

What is a direct/indirect hernia?

A

Indirect- where the peritoneal sac enters the inguinal canal through the deep inguinal ring
Direct- where the peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal. Bulges through Hesselbach’s triangle

40
Q

How is an indirect inguinal hernia formed?

A

Congenital origin- failure of processes vaginalis to regress
Degree of herniation depends on the amount of processes vaginalis still present. As sac moves through canal it acquires same 5 coverings as contents of canal

41
Q

How is a direct inguinal hernia formed?

A

Acquired in origin due to weakening in abdominal musculature
Peritoneal sac originates from an area medial to epigastric vessels and bulges into the inguinal canal via posterior wall

42
Q

What is the anatomical difference between direct and indirect inguinal hernias?

A

Indirect inguinal hernia- lateral to the inferior epigastric vessels
Direct inguinal hernia- medial to inferior epigastric vessels

43
Q

Describe a femoral hernia

A

More common in females as they have wider hips

Can easily become incarcerated or strangulated

44
Q

Describe an umbilical hernia

A
  1. Congenital omphalocele
    Contents herniated into umbilical cord
    Has peritoneal covering
    Different to gastrochisis
  2. Acquired infantile- contents herniated through weakness in scar of umbilicus
  3. Acquired adult- goes through linea alba in region of umbilicus, more likely in females
45
Q

Describe an epigastric hernia

A

Occurs through linea alba between xiphoid process and umbilicus
Usually starts with small hernia
Chronic straining forces more fat out which can eventually pull peritoneum through

46
Q

What are the symptoms of an epigastric hernia?

A

Based around what happens if loops of bowel get trapped

-pain, vomiting, sepsis

47
Q

Define incarcerated

A

‘Stuck’, irreducable

48
Q

Define strangulated

A

Blood supply is disrupted- can lead to tissue necrosis

ESA 3 (18 decks)

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