Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Digestive > Session 2 - Hernias > Flashcards

Session 2 - Hernias Flashcards

1
Q

How is the lesser sac formed

A

Stomach rotates and carves off a bit of the cavity leaving it behind the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the peritoneal cavity and what is it segmented into

A

A POTENTIAL space divided into the lesser and greater sacs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is the greater and lesser sac

A

Greater is in front and inferior to stomach but lesser is behind lesser omentum , left lobe of liver and stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is the peritoneal cavity a potential space and not a space including viscera

What then holds the viscera in place

A

It is only enveloping the viscera not actually engulfing them hence why it is only a potential space

Double layers of peritoneum (mesenteries, ligaments, omentum) holding viscera in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the purpose of the lesser omentum

A

Connects the stomach and the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the gastracolic ligament connect (which is also another double fold of peritoneum)

A

The transverse colon and the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the greater omentum connect

A

Greater curve of stomach and transverse colon

Stomach also able to be picked up on greater omentum dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mesenteries go to small bowel

A

As double fold of peritoneum with BV going toward it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What kind of image Orientation would a CT give you

A

Transverse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the lesser omentum boundaries and what is the connection called that connects the greater and lesser sac

A

Connection: foramen of Winslow

Behind lesser omentum and stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why does visceral peritoneum not hurt

What 3 things does it respond to

A

Does not have somatic nervous system

Only responds to stretching, inflammation, ichaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How would visceral pain resent clinically

A 
Poor localised 
Often midline ( central even if actual viscera off to one side )

Nausea
Sweating
Vomiting

Vague - need comprehensive history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the “on” and “off” buttons of the gut

A

Sympathetic - off ( constrict blood supply to GI tract if needed elsewhere )
Parasympathetic - on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the sympathetic flow of the gut ( origin, path, innervation)

A

Arise from T5-L2

Pass through sympathetic trunk without synapsing (preganglionic) and form presynaptic splachnic nerves by joining together (pre ganglionic)

Greater ( T5-9 )
Lesser (T10 - 11)
Least (T12)

These synapse with prevertebral ganglia in front of spinal cord (loop back) like superior and inferior mesenteric, celiac etc

Go from prevert ganglia to viscera (now postganglionic)

Mainly innervate BV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the path of sensory viscera afferents

A

Follow path of sympathetic ( in reverse cuz sensation comes back in reverse ) to the organ

Pain in organ will follow whatever gut portion nerves supply it and go back to spinal level (stomach- midgut- T5-T9) brain registers that to be DERMATOMAL level so pain in epigastric region of abdomen ( gut split into regions )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do each splachnic nerve supply

A

Greater - foregut
Lesser - midgut
Least - hindgut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is visceral pain always midline

A

Since this occur bilaterally brain cannot distinguish which stimulus is stronger ( splenic pain still in mid line )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a hernia

A

Protrusion of the abdominal contents beyond normal confines of abdominal wall or containing cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs and symptoms of hernias (stuck vs non stuck)

A

Not Stuck

  • swelling
  • gets larger when intra abdominal pressure incr
  • aches

Stuck (incarcerated) can compromise blood supply

  • pain
  • cannot be moved
  • nausea and vomiting (plus other bowel obstruction signs)
  • systemic issues if obstruction of bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Explain how ichaemia to a hernia may arise

A

If stuck hernia, venous pressure lower than arterial so may collapse first, then swelling occur due o arterial supply (pressure high) but eventually swelling pressure overcome arterial causing collapse of arteries and leading to ichaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some causes of hernias

A

Weakness in containing cavity (post surgery, congenital, or just in normal spots of weakness)

Anything increases intra abdominal pressure ( obesity , chronic coughing )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 3 parts of a hernia

A

Sac - peritoneum

Contents - anything found in abdominal cavity (omentum etc)

Coverings - layers of abdominal wall that hernia has passed through

23
Q

List some weak spots in the abdomen where hernias usually occur

A

Inguinal canal
Femoral canal
Umblicus
Previous incisions

24
Q

What is the inguinal canal and where does it pass in males and females

A

Oblique passed though lower abdominal wall (hand in pocket direction)

Males : abdomen-testis

Females : round ligament goes through and passes from uterus to labia majus

25
Q

Where are inguinal canal hernias usually found ( right or left )

A

Much more common on right

26
Q

Describe the embryological origin of testes and how it relates to inguinal hernias

A

Testes descend from abdominal wall (7-8 month)

Process vaginalis ( goes into scrotum before testes when testes come previous connection between peritoneum disintegrates and it becomes tunica Vaginalis wrappping around testes)

Gubernaculum (attaches and guides testes to future scrotum)

27
Q

What happens if process vaginalis doesn’t disintegrate

A

Connection between peritoneal cavity and scrotum remains allowing fluid to gather and cause issues

Abdominal cavity and scrotum have direct connection meaning contents can herniate down into scrotum

Known as scrotal hernia ( does not disintegrate at all )

28
Q

What happens if the process vaginalis doesn’t disintegrate partly

A

Known as inguinal hernia

Small connection into inguinal cavity (ab cavity to scrotum normally but doesn’t usually have the lined peritoneum along with it)

29
Q

Outline the structure of the inguinal canal

A

Skin, superficial fascia, deep fascia, pubis as point of attachment, external oblique —> aponeurosis (tendon) rolls inferiorly making the inguinal ligament, internal oblique, transversalis —-> IO and TA form conjoint tendon by fusing together (reinforce back wall) and transversalis fascia

30
Q

Border of the inguinal canal

A

Anterior - aponeurosis of external oblique

Floor - inguinal ligament and lacunae lig reinforcing medially

Roof - arching fibres of internal oblique (more) and transverse abdominus

Posterior - transversalis fascia (conjoint tendon reinforce medially)

31
Q

Where do the abdominus muscles fuse

A

Midline

32
Q

What are the entrance and exit to inguinal canal

A

Entrance : Deep ring which is a gap in transversalis fascia (posterior wall)

Exit : superficial ring which is a defect in aponeurosis of external oblique

33
Q

Describe how a hernia would reach the scrotum through the inguinal canal

A

Come in deep ring, go down canal however far vaginalis obliterated and down superficial ring into scrotum potentially if that peritoneum of the tunica vaginalis still existed

Come down through weakness in canal due to partially open pre mature peritoneum

34
Q

What are the 2 types of inguinal hernias including examples

A

Indirect and direct

Indirect - through inguinal canal
Direct - straight from abdominal wall not from inguinal canal

35
Q

Why is the point at which a hernia leaves its containing cavity important

A

This is how the anatomy of the hernia is described

“Where it left its containing cavity … “

36
Q

Where are other common sites of hernias

A

Umblical
Incisional
Femoral

37
Q

What are some important landmarks when describing hernias

A

Inferior epigastric vessels (position is what marks difference between indirect and direct)

Indirect - lateral to vessel (deep ring)
Direct - medial to vessel (superficial ring) —-> does not traverse inguinal canal cuz only entrance deep ring which is lateral not medial

38
Q

Where do inferior epigastric vessels come from and what do they supply

A

External iliac and supply anterior abdominal wall

39
Q

At what point does the iliac artery become the femoral

A

Once it has passed the inguinal canal

40
Q

What is hesselbachs triangle

A

A potential area of weakness between 3 points in abdominal wall

41
Q

Boundaries of hesselbach triangle

A

Lateral - lateral border rectus muscles

Floor - inguinal lig

Inferior epigastric vessels

42
Q

What structure is found within the triangle and why is it important

A

Superficial ring

Important cuz hernias follow path of least resistance plus already defect

Will push through this taking more layers than indirect (doesn’t pierce)

43
Q

Where would a direct hernia come through

A

Superficial ring

44
Q

Describe femoral hernias

A

Goes through femoral canal and most common in females cuz pelvic anatomy different and can easily get incarcerated (stuck)

45
Q

NAVEL - what letter stands for the femoral canal

A

Empty space

46
Q

Boundaries of femoral canal

A

Lateral - femoral vein Medial - lacuna ligament

Hernia try to get in femoral ring and down canal

47
Q

Why is pelvic anatomy in females important when it comes to femoral hernias

A

Femoral ring slightly wider so more likely to herniate

Can get stuck - cant push it back into normal cavity (irreduceable hernia)

Less common

48
Q

What is an irreduceable hernia

A

Hernia you cannot push back to original cavity due to it getting stuck ( like in the femoral canal )

49
Q

What is omphalocoele

A

Failure of midgut to return to abdomen during development so viscera persist outside abdominal cavity within umblical ring (not going back in)

Viscera covered in peritoneum so can develop normally

50
Q

What is gastroschisis and why is the survival rate higher than prior

A

Defect in ventral abdominal wall where viscera not covered in peritoneum exposing them to amniotic fluid

Problems with gut development and feeding

Survival rate better than prior due to less genetic complications and defect can be closed at birth

Usually on right

51
Q

What is an umblical hernia

A

Found in babies and is a bulge at site of umblicus

Usually not painful

Usually close by age 3

Natural weakness in this area - common

52
Q

What is a para umblical hernia

A

Persisting umblical hernia or returning

Through midline (linea alba - where aponeurosis all meet)

53
Q

Symptoms of hernias

A

Babies

If loops of bowel get trapped can have pain , vomiting , sepsis etc cuz viscera broken down in Hernia (if they get stuck)

Digestive (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions