Session 3

Question 1

Why do anal prolapses occur?

Answer 1

Because the muscles of the pelvic floor are not strong enough to support the bowel

Question 2

What are the abdominal muscle points of attachment?

Answer 2

Ribs - Most external
Pelvic (Pelvic Rim)
Spine (Transverse processes)

Question 3

What are the 4 layers of muscle in the abdomen?

Answer 3

External oblique (Superficial)
Internal oblique
Transversalis abdominis
Transversalis fascia (Deep)

Question 4

Why are 2 antagonistic muscles never attached to one other?

Answer 4

Because the contraction of the fibres would tear the muscle apart

Question 5

What is a rectus sheath heamatoma?

Answer 5

There is a bleed into the rectus abdominis muscle in the midline. Warfarin increases the chances of this

Question 6

How can you check for pain from the rectus abdominis muscle?

Answer 6

Ask the patient to lie on their back and then either lift their head or lift their feet

Question 7

Why can’t you suture through just muscle?

Answer 7

Because the sutures will come out

Question 8

What is Divarication of the recti?

Answer 8

Laxity of the linea alba causes it to separate slightly. It is NOT a hernia

Question 9

Where can you have some strong closures in the abdomen?

Answer 9

The linea alba (midline)

The external oblique aponeurosis (transverse)

Question 10

Where is the incision point for an appendicectomy?

Answer 10

McBurney’s point (2/3rds of the distance between the ASIS and umbilicus)

Question 11

What is a patent urachus?

Answer 11

The urachus fails to close before birth, therefore there is an opening between the bladder and umbilicus.

Question 12

What is the symptom of a patent urachus?

& why?

Answer 12

Older males notice that urine leaks from their umbilicus when they urinate
This is because benign prostatic hypertrophy causes pressure to increase in the bladder. Therefore urine rises upwards and out of the umbilicus

Question 13

Define referred pain

Answer 13

Pain perceived at the site distant from the site causing the pain

Question 14

What is the dermatome for umbilical level?

Answer 14

T10

Question 15

What is the dermatome for the level of the pubis?

Answer 15

T12

Question 16

What is somatic referred pain?

Answer 16

Pain caused by a harmful stimulus tot he proximal section of the somatic nerve that is perceived in the distal dermatome of the nerve

Question 17

What is a Ectopia Cordis?

Answer 17

The liver is where the heart should be and the heart is where the liver should be

Question 18

What is visceral referred pain?

Answer 18

In the thorax/abdomen
Visceral afferent pain fibres follow sympathetic fibres back to the same spinal chord segments that gave rise to the preganglionic sympathetic fibres.

Question 19

What are some of the causes of visceral referred pain?

Answer 19

Isachaemia
Strong muscle contraction
Inflammation
Stretch
NOT Burn, Cut, Crush

Question 20

Where can you have pain from the pancreas or aorta?

Answer 20

In the centre of the back

They are retroperitoneal structures!

Question 21

What is under the peritoneum?

Answer 21

The Greater Omentum

Question 22

What is the Greater Omentum made of?

Answer 22

Fat

Question 23

What is the purpose of the Greater Omentum?

Answer 23

It cushions the organs

It migrates to an area that is inflammed to help seal off the infection

Question 24

What is the purpose of the Vitelline duct in the embryo?

Answer 24

It connects the small bowel of the embryo to the yolk sac

Question 25

What is the purpose of the Allautois in the embryo?

Answer 25

It connects the cloaca to the placenta for gas exchange and excretion

Question 26

Where can pain present in someone with shingles on their back?

Answer 26

Over the illiac fossa

Question 27

In a neonate, what can pain over the right illiac fossa be?

Answer 27

A right lower lobe pneumonia

Is commonly mistaken for appendicitis