Session 3 - Surgical Anatomy And Hernias Flashcards
Name the layers that a needle would pass through to get to the parietal peritoneum in the anterolateral abdominal wall.
Skin -> Subcutaneous tissue -> Muscles and their aponeuroses -> Deep Fascia -> Extraperitoneal fat -> Parietal Peritoneum
At what spinal level is the Umbilicus?
L3
Describe the position of the epigastric fossa?
And what pain is commonly felt here?
Slight depression in epigastric region, just inferior to the xiphoid process
Heartburn is commonly felt here
What is the Linea Alba?
A vertical line that can be seen on lean individuals which is the aponeurosis of the abdominal muscles, separating the L+R rectus abdominis
What is Divarication of the recti?
When the Linea Alba is lax even though the rectus abdominis are contract and spread apart
What are the five muscles which lie in the anterolateral abdominal wall?
- External Oblique
- Internal Oblique
- Transverse Abdominis
- Rectus Abdominis
- Pyramidalis
What is the Rectus Sheath?
All three flat muscles of the anterolateral abdominal wall continue anteriorly and medially as a strong, sheet like aponeurosis - the Rectus Sheath.
The Rectus Sheath completely encloses two muscles, which are they?
The Rectus Abdominis and the Pyramidalis
Why can surgical incisions not just be made anywhere?
If we try to sew muscles back together the sutures will pull straight out as soon as the muscles are stretched.
Describe a midline incision closure
The Line Alba is suture back together to provide a strong closure
Describe a Transverse Incision closure
Surgeons suture the external liquefactive aponeurois together to provide a strong closure
What is name of the incision used for an Appendicetomy, and where is this location?
McBurney’s Point - 2/3 of the distance between the umbilicus and the ASIS
What is a Gridiron Incision?
Scissors are put into muscle fibres while closed and then opened up to seperate the muscle fibres
What is the difference between an Omphalocoele and Gastroschisis?
In Omphalocoele there is a covering on the herniated gut however in Gastroschisis there is no epethelial covering of the gut
Describe Somatic Referral pain
Pain caused by a noxious stimulus to proximal part of a somatic nerve that is perceived in the distal dermatome of that nerve
Describe Visceral Referred Pain
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
Name some causes of visceral pain
- Ischaemia
- Abnormally strong muscle contractions
- Inflammation
Where may Gall Bladder pain be felt?
In the region of the gall bladder + epigastric fossa
Also on the back in the area of the base of right lung
Where may Gastric + duodenal pain be felt?
Epigastric Fossa
Where may Hepatic pain be felt?
Felt in region of liver on the front and back
Where may Splenic Pain be felt?
In the region of the spleen
Where may Oesophageal Pain be felt?
Felt down the length of the oesophagus on the front
Where may pancreatic pain be felt?
Central Back pain and in umbilical region
Describe the pain development in acute appendicitis
- Felt early on in umbilical region
- Then localises to lower right quadrant
