Lecture 19: Clinical abdomen Flashcards
Characteristics of inguinal hernia
Bulge appearing in groin
Pain in the area, increased by lifting heavy objects or strain during bowel movement
Bulge increases in volume when patient coughs
Bulge disappears when patient is supine
If you insert your finger into the superficial inguinal ring and ask patient to cough, you feel a mass pressing against your finger
What is an inguinal hernia?
Displacement of intra-abdominal structures such as small intestine or greater omentum through a weak area of the abdominal wall in the inguinal region.
What are the muscles of the anterolateral abdominal wall and inguinal canal?
External oblique
Internal oblique
Transverse abdominus
Transversalis fascia
Where does the spermatic cord travel in the abdomen?
Spermatic cord enters at the deep inguinal ring, travels down the inguinal canal, and enters the scrotum at the superficial inguinal ring
Borders of the inguinal triangle
aka Hesselbach’s triangle
Medial = lateral edge of rectus abdominis (1)
Lateral = inferior epigastric
artery and vein (2)
Inferior = Inguinal ligament (3)
See figure
What is the most common type of hernia?
Indirect inguinal hernia
Who gets indirect inguinal hernias most often?
Are often congenital (most hernias of this type close spontaneously by 1 year of age)
Who gets indirect inguinal hernias most frequently?
More common in males than females
Where does the indirect inguinal hernia occur?
LATERAL to the inferior epigastric artery
Who gets the direct inguinal hernia most frequently?
Mostly seen in adults and almost exclusively in males
What is the cause of a direct inguinal hernia?
weakness of the transversalis fascia at inguinal (Hesselbach’s) triangle
Where do direct inguinal hernias occur?
MEDIAL to the inferior epigastric artery
Typical presentation of appendicitis
Abdominal pain in the region of the umbilicus.
Pain gradually became more severe and moved to the lower right quadrant of the abdomen.
Accompanied by fever, vomiting, and nausea.
Upon palpating the abdomen, they noted tenderness over McBurney’s point.
What is appendicitis?
Inflammation of the vermiform appendix (narrow, blind-ending tube)
Appendix contains bacteria
Blockage of the appendix
(usually by fecal matter) causes the bacteria to grow and build up, leading to infection and inflammation
If not treated, the appendix can rupture, leading to peritonitis
Where is McBurney’s point?
Found 1/3 of the distance along a straight line from the pelvis (anterior superior iliac spine) to the umbilicus
Tenderness over this point is a classic sign of appendicitis, but remember that the appendix can move around!
See figure
