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ESA 3 - GI > Session 3 - Surgical Anatomy And Hernias > Flashcards

Session 3 - Surgical Anatomy And Hernias Flashcards

1
Q

Name the layers that a needle would pass through to get to the parietal peritoneum in the anterolateral abdominal wall.

A

Skin -> Subcutaneous tissue -> Muscles and their aponeuroses -> Deep Fascia -> Extraperitoneal fat -> Parietal Peritoneum

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2
Q

At what spinal level is the Umbilicus?

A

L3

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3
Q

Describe the position of the epigastric fossa?

And what pain is commonly felt here?

A

Slight depression in epigastric region, just inferior to the xiphoid process

Heartburn is commonly felt here

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4
Q

What is the Linea Alba?

A

A vertical line that can be seen on lean individuals which is the aponeurosis of the abdominal muscles, separating the L+R rectus abdominis

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5
Q

What is Divarication of the recti?

A

When the Linea Alba is lax even though the rectus abdominis are contract and spread apart

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6
Q

What are the five muscles which lie in the anterolateral abdominal wall?

A
  • External Oblique
  • Internal Oblique
  • Transverse Abdominis
  • Rectus Abdominis
  • Pyramidalis
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7
Q

What is the Rectus Sheath?

A

All three flat muscles of the anterolateral abdominal wall continue anteriorly and medially as a strong, sheet like aponeurosis - the Rectus Sheath.

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8
Q

The Rectus Sheath completely encloses two muscles, which are they?

A

The Rectus Abdominis and the Pyramidalis

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9
Q

Why can surgical incisions not just be made anywhere?

A

If we try to sew muscles back together the sutures will pull straight out as soon as the muscles are stretched.

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10
Q

Describe a midline incision closure

A

The Line Alba is suture back together to provide a strong closure

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11
Q

Describe a Transverse Incision closure

A

Surgeons suture the external liquefactive aponeurois together to provide a strong closure

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12
Q

What is name of the incision used for an Appendicetomy, and where is this location?

A

McBurney’s Point - 2/3 of the distance between the umbilicus and the ASIS

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13
Q

What is a Gridiron Incision?

A

Scissors are put into muscle fibres while closed and then opened up to seperate the muscle fibres

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14
Q

What is the difference between an Omphalocoele and Gastroschisis?

A

In Omphalocoele there is a covering on the herniated gut however in Gastroschisis there is no epethelial covering of the gut

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15
Q

Describe Somatic Referral pain

A

Pain caused by a noxious stimulus to proximal part of a somatic nerve that is perceived in the distal dermatome of that nerve

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16
Q

Describe Visceral Referred Pain

A

Visceral Afferent pain fibres follow the sympathetic fibres back to the same spinal cord segments. The CNS perceives visceral pain as coming from the somatic portion of body supplied by relevant spinal cord segments

17
Q

Name some causes of visceral pain

A
  • Ischaemia
  • Abnormally strong muscle contractions
  • Inflammation
18
Q

Where may Gall Bladder pain be felt?

A

In the region of the gall bladder + epigastric fossa

Also on the back in the area of the base of right lung

19
Q

Where may Gastric + duodenal pain be felt?

A

Epigastric Fossa

20
Q

Where may Hepatic pain be felt?

A

Felt in region of liver on the front and back

21
Q

Where may Splenic Pain be felt?

A

In the region of the spleen

22
Q

Where may Oesophageal Pain be felt?

A

Felt down the length of the oesophagus on the front

23
Q

Where may pancreatic pain be felt?

A

Central Back pain and in umbilical region

24
Q

Describe the pain development in acute appendicitis

A
  • Felt early on in umbilical region

- Then localises to lower right quadrant

25
Q

Where is Small Bowel pain felt?

A

Periumbilical Pain

26
Q

Where is Large Bowel pain felt?

A

Suprapubic Region

27
Q

Where is Renal/ureteric pain felt?

A

Extreme pain in Inguinal line and mid right back pain

Roll around on floor in pain

28
Q

Where is uteric/ovarian pain felt?

A

Suprapubic region and very low on back

29
Q

Where is bladder pain felt?

A

Suprapubic region

30
Q

What may cause referred diaphragmatic irritation?

A
  • A ruptured Spleen
  • An ectopic pregnancy
  • A perforated ulcer
31
Q

Describe the concept of the peritoneal cavity as a potential space.

A
  • Potential space between parietal and visceral layers of peritoneum
  • contains no organs
  • just contains a thin film of parietal fluid
32
Q

What do each of the parietal and visceral layers of peritoneum line?

A

Parietal - Lines internal surface of ab wall

Visceral - Invests viscera such as the stomach and intestines

33
Q

What is a Mesentery?

A

A double layer of peritoneum that occurs as a result of the invagination of peritoneum by an organ, it connects an intraperitoneal organ to the body wall

34
Q

What does the lesser omentum connect?

A

Lesser curvature of stomach and proximal part of duodenum to the liver

35
Q

The abdominal wall can be split into 9 regions by four lines. Where do these 4 lines run?

A

Vertical lines: Midclavicular lines

Horizontal lines: Sub costal and transtubercular lines

36
Q

Give the borders of the inguinal canal.

A

Floor: Inguinal ligament (lacunar ligament medially)
Roof: Internal Oblique / transverse abdominis
Posterior wall: Transversalis fascia
Anterior wall: aponeurosis of external oblique

37
Q

Give the borders of Hasselbach’s triangle

A

Inferior: Medial 1/2 of inguinal ligament
Medially: Lower lateral border of rectus abdominis
Laterally: Inferior epigastric artery

38
Q

What are the primary risk factors for an epigastric hernia?

A

Pregnancy and Obesity

39
Q

Describe the two possible complications of hernias.

A

Strangulation: constriction of blood vessels, preventing flow

Incarceration: Hernia cannot be rescued or pushed back into place with minimal force

ESA 3 - GI (9 decks)

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