L6 surgical anat of abdo

Question 1

Abdo incis

Answer 1

• sew musc not hold. Midline incis linea Alba= ew aponeurosis. Transv incis sew sheath togeth.
• appendectomy- 2/3 btw umbilicus and ant sup iliac spine (Ext oblique). Mcburneys pt. grid iron musc split incis. Int oblique- transversalis. Spread fibres apart.

Question 2

Embryology

Answer 2

-6 wk vitelline duct join midgut to YS. Allantois early excret and Gas exch- join to fut bladder.
Allantois aka urachus can persist. In prostatic HTN= urine to umbilicus.
Vitello-int duct can rem patent- early bit duct remains= meckels diverticulum.
Exomphalos- gut out wall twist- fail back in= visc outside wall, cov in perit.
Gastroschisis- R umb. Visc no perit.

Question 3

Pain

Answer 3

-referred pain- perceived at site distant from cause.
-Somat ref- stim proxim somat nerve, perc distal dermatome. T10 to lev umbilicus dermatome. T12 to supra pubic area.
Shingles init RIF pain, site init back, perceived by distal nerve.
R lower lob precun = RIF pain init somat nerve supp pleura, perceived distal.
-visc ref- thorax and abdo visc aff foll sympath to S segm that= pre gang sympath.
CNS perc visc pain from somat part of bod supp by relev SC segms.
Visc sensory from appendix join sympath path at same lev somat sensory T10. Append inflamm= brain think from somat= umbilicus.
-cause visc pain- isch, abn strong contrac, inflamm, stretch. NOT touch/burn/cut/crush.
Foregut pain epigastric reg. Midgut peri umbilical. Hind gut suprapubic.
-cardiac pain- heavy, tight. Central, epigastric, neck, jaw, L arm, ear.
oesoph pain- burn, retrosternal and either side notch.
Gastric and duod epigastric.
Gallbl- epigastric, gallbl site, just under R scapula.
-retro perit can= cent back pain. Panc mid lumbar spine and and umb. AAa.
-acute append somat pain over append.
Small bowel colic- umb, waves.
Large bowel colic- suprapubic and less freq.
renal/ uterus- ref to scrotum somet.
Ureter colic floor roll.
Uterine/ovarian pain- suprapubic- lower L/sacral back.
Bladder suprapubic.
Ref diaphragm irrit- rupt spleen, ectopic preg, perf ulcer. Diaph takes C3,4,5 nerve supp down. Somat skin supp L shoulder. Liver blocks on R if lie down.

Question 4

Abdo muscles

Answer 4

-musc lays and diff fibre directs.
Rectus abdominis behind aponeurosis- dig to intertend intersec= effic. Pelvis gut weight eg rectal prolapse.
-musc ori- in ant wall- ribs ext, pelvis, tranv procs of verteb. Outer abdo musc ribs to Rectus sheath.
Ext oblique down and infer. Bef sheath forms own aponeurosis- meets lat border of Rectus sheath.
Int oblique ori from pelvis. Upw and medial to sheath. Can aponeurosis.
Tranversalis abdominis ori transv proc to post Rectus sheath. Aponeurosis. Beneath is transv fascia.
Peritoneum to perit cav proper. Greater oment.
-Rectus sheath come togeth= lines Alba. Lat border Rectus abdom= linea semilunares. Tend intersecs.
Ant and post sheath- below arcuate line post dissap so all aponeurosis ant- 1/3 btw umbilicus and pubic symph.
Pfannestial in is C sec no post sheath to go through.
Linea Alba weak and stretchy= divaricat of recti, wider than should be.
-warfarin- may bleed to Rectus abdominis, v tight and pain. Test by lift head/legs- incr pain. Bruise as blood out.