Hernia

Question 1

Types of hernias

Answer 1

Epigastric
Incisional
Umbilical
Direct Inguinal
Indirect Inguinal
Femoral-through femoral canal

Question 2

Direct versus indirect hernia

Answer 2

Indirect passes through deep inguinal ring, inguinal canal and superficial ring and down spermatic cord to testes
Direct enters inguinal canal at a weakness in the abdominal wall (hesslebach’s triangle) and passes out via the superficial ring.

Question 3

Layers between skin and abdominal muscle

Answer 3

Skin
Camper’s Fascia (fat and adipose tissues)
Scarpa’s Fascia (membranous, thinner)
Abdominal muscles

Question 4

Muscles of the abdominal wall

Answer 4

External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
Pyramidalis

Question 5

External Oblique

Answer 5

Attachments: Originates from ribs 5-12, and inserts into the iliac crest and pubic tubercle.

Functions: Contralateral rotation of the torso.

Innervation: Thoracoabdominal nerves (T7-T11) and subcostal nerve (T12).

Question 6

Internal Oblique

Answer 6

Attachments: Originates from the inguinal ligament, iliac crest and lumbodorsal fascia, and inserts into ribs 10-12.

Functions: Bilateral contraction compresses the abdomen, while unilateral contraction ipsilaterally rotates the torso.

Innervation: Thoracoabdominal nerves (T6-T11), subcostal nerve (T12) and branches of the lumbar plexus.

Question 7

Transversus Abdominis

Answer 7

Attachments: Originates from the inguinal ligament, costal cartilages 7-12, the iliac crest and thoracolumbar fascia. Inserts into the conjoint tendon, xiphoid process, linea alba and the pubic crest.

Functions: Compression of abdominal contents.

Innervation: Thoracoabdominal nerves (T6-T11), subcostal nerve (T12) and branches of the lumbar plexus.

Question 8

Rectus Abdominis

Answer 8

Attachments: Originates from the crest of the pubis, before inserting into the xiphoid process of the sternum and the costal cartilage of ribs 5-7.

Functions: As well as assisting the flat muscles in compressing the abdominal viscera, the rectus abdominis also stabilises the pelvis during walking, and depresses the ribs.

Innervation: Thoracoabdominal nerves (T7-T11).

Question 9

Pyramidalis

Answer 9

Attachments: Originates from the pubic crest and pubic symphysis before inserting into the linea alba.

Functions: It acts to tense the linea alba.

Innervation: Subcostal nerve (T12).

Question 10

Surgical incisions

Answer 10

Median
Paramedian - Spleen, kidney, adrenal
Transverse - Colon, duodenum, pancreas
Suprapubic (pfannestiel) - Cesarean
Subcostal - Gall bladder (right), Spleen (left)
McBurney (iron grid)- Appendix

Question 11

Arterial blood supply Stomach

Answer 11

Coeliac trunk

• Left gastric artery
• Right gastric artery (common hepatic)
• Right gastro-omental (gastroduodenal, common hepatic)
• Left gastro-omental (splenic)

Question 12

Arterial blood supply Pancreas

Answer 12

Splenic artery
Gastroduodenal
Inferior pancreaticoduodenal (gastroduodenal)
Superior mesenteric artery

Question 13

Arterial blood supply Kidneys

Answer 13

Renal arteries

Question 14

Arterial supply gall bladder

Answer 14

Cystic artery (right hepatic artery-common hepatic artery)

Question 15

Arterial blood supply small intestines

Answer 15

Duodenum
Proximal to major duodenal papilla- gastroduodenal artery (coeliac)
Distal - inferior pancreatoduodenal artery (SMA)

Jejunum - SMA
Ileum - SMA

Question 16

Arterial blood supply large intestines

Answer 16

Cecum- Ant. Post. Cecal arteries (ileocolic - SMA)
Appendix - Appendicular artery (ileocolic)
Ascending colon - colic, anterior cecal and posterior cecal branches (ileocolic), right colic artery
Transverse colon - Right, middle colic (SMA), left (IMA)
Descending colon - Left colic
Sigmoid colon - Sigmoid artery (IMA)

Question 17

Arterial blood supply rectum

Answer 17

Superior rectal artery - IMA
Middle rectal artery - Internal Iliac artery
Inferior rectal artery - internal pudendal artery