Surgical anatomy

Question 1

Draw the anatomy of the abdomen

Answer 1

Question 2

What is found in the 9 quadrants of the abdomen?

Answer 2

Question 3

What are the layers of the abdominal wall?

Answer 3

Question 4

Explain the surgical incisions in the abdomen

Answer 4

Question 5

Draw the biliary system

Answer 5

Question 6

Draw the midgut

Answer 6

Question 7

Draw liver anterior

Answer 7

Question 8

Label the stomach

Answer 8

Question 9

Labeled arteries of stomach

Answer 9

Question 10

Draw intestines

Answer 10

Question 11

Vasculature label of small intestines

Answer 11

Question 12

Label large intestine

Answer 12

Question 13

Label arteries of large intestine

Answer 13

Question 14

Branches of abdominal aorta

Answer 14

Question 15

Explain hernias and types

Answer 15

• Hernia = protusion of part or whole of an organ or tissue through the wall of the cavity that usually contains it.
• Inguinal hernias are the most common type (75% of anterior abdominal wall hernias)

Question 16

Explain the inguinal canal

Answer 16

• The inguinal canal is a passageway through the inguinal ligament for abdominal contents to leave the abdominal cavity.
  
  • ilioinguinal nerve
  • Spermatic cord (males)
  • Round ligament (females)
• The deep ring is found halfway between the ASIS and pubic tubercle

Question 17

Explain inguinal hernias

Answer 17

Indirect inguinal hernias (80%)

•Bowel enters inguinal canal via deep inguinal ring•

Direct inguinal hernias (20%)

•Bowel enters inguinal canal via weakness in posterior wall of canal (Hesselbach’s triangle)

Direct inguinal hernias are more likely to occur in older patients due to:

• Increased intra-abdominal pressure
• Abdominal wall laxity

Question 18

Clinical feature of inguinal hernias

Answer 18

• Lump in the groin usually disappears with minimal pressure or laying down (Reducible)
• May be discomfort with activity or standing
• Incarcerated – painful,tender erythematous
• Strangulated – irreducible, tender, tense
• Features of bowel obstruction

When examining a groin lump:

• Location
  
  • Inguinal hernias are superomedial to pubic tubercle
• Is it reducible?
• Cough impulse
• Direct or indirect?
• Place pressure over deep inguinal ring and ask patient to cough

Question 19

Risk factors of inguinal hernias

Answer 19

• Male
• Increasing age
• Obesity
• Raised intra-abdominal pressure (chronic cough, constipation, heavy lifting)

Question 20

What is the investigation and management of inguinal hernias?

Answer 20

INVESTIGATION

• Usually a clinical diagnosis
• First line imaging - USS
• If features of strangulation - CT

MANAGEMENT

• Asymptomatic – conservative management
• Symptomatic – offer surgical repair

RED FLAGS

A Strangulated hernia is a surgical emergency and requires urgent surgical exploration