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Gastro-intestinal System > Surgical Anatomy And Hernias > Flashcards

Surgical Anatomy And Hernias Flashcards

1
Q

What is the most superficial muscle of the abdomen?

A

Rectus abdominus

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2
Q

What is the origin of the external obliques?

A

Ribs

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3
Q

What is the origin of the internal obliques?

A

Iliac crests

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4
Q

What is the origin on transveralis abdominus?

A

Transverse processes of spine

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5
Q

How can the greater omentum help during infections?

A

Fat can move across to wall off the infection

Limits it to an abscess rather than all over

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6
Q

How is the rectus abdominus muscle divided?

A

Down the midline by the linea alba
At the edges by linea semilunaris
Transversely by tendinous intersections

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7
Q

What is the arcuate line?

A

The point where (below it) the rectus abdominus has no posterior fascial sheath
1/3 of way from umbilicus to pubic symphysis
Below this, surgery is less traumatic

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8
Q

What do we call the incision used for a C section?

A

Pfannenstiel

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9
Q

What is a divarication of recti?

A

Fat bulge
Due to laxity of linea alba
Very common in ladies who have had lots of children

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10
Q

Why do we try not to sew through muscles?

A

Because tightening the knot shreds the muscles

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11
Q

Which incision would be used for an appendicectomy?

A

McBurney’s point

Gridiron muscle splitting incision

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12
Q

Describe a patent urachus

A

Failure of allantois to fuse/close
Tube between the apex of the bladder and the umbilicus
Can present at birth or later in life (esp in men with BPH)

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13
Q

What is exampholos? (Omphalocoele)

A

Gut sitting on the abdomen
Viscera covered by peritoneum and amnion
Quite common
Easy to deal with surgically

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14
Q

What is gastroschisis?

A

Split in the abdomen
Contents spill out
Usually a vertical defect (usually to the right hand side)
Viscera not covered by peritoneum and amnion
Serious - some of the gut dies
Higher mortality

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15
Q

Describe somatic referred pain

A

Pain caused by a stimulus to the proximal part of a somatic nerve
Perceived in the distal dermatome of that nerve
Often the brain thinks the source of the pain is the end of the nerve

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16
Q

Describe visceral referred pain

A

Visceral afferent pain fibres follow sympathetic fibres back to the same spinal cord segments they came from
CNS perceives pain as coming from the somatic portion

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17
Q

Give some causes of visceral pain

A

Ischaemia
Abnormally strong muscle contraction
Inflammation
Stretch

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18
Q

Where does the pain of the gut derivatives refer to?

A

Foregut - epigastric
Midgut - periumbilical
Hindgut - suprapubic

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19
Q

What are the causes of shoulder pain due to referred diaphragmatic irritation?

A

Ectopic pregnancy
Ruptured spleen
Perforated ulcer

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20
Q

Define a hernia

A

A protrusion of viscera beyond the normal confines of its containing cavity

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21
Q

What are the 3 general parts of any hernia?

A

Sac
Contents of sac
Covering of sac

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22
Q

Give some examples of weaknesses in the abdominal wall

A

Inguinal canal
Femoral canal
Umbilicus
Previous incisions

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23
Q

What is the most common type of abdominal hernia?

A

Inguinal hernia

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24
Q

What is the inguinal canal?

A

An oblique passage through the lower abdominal wall from the peritoneal cavity to the scrotum or labia

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25
Q

Are men or women more likely to get inguinal hernias and why?

A

Men

The testes descend through the inguinal leaving a wider canal than in females

26
Q

Are testes intra- or retroperitoneal?

A

Retroperitoneal

27
Q

What is the processus vaginalis?

A

Precedes the descending teste into the scrotal pouch
Should normally obliterate/recede leaving a pouch of peritoneum (tunica vaginalis) which attaches to a portion of the testes

28
Q

What is more likely to occur if the processus vaginalis doesn’t close?

A

Inguinal hernias

Scrotal hernias

29
Q

In men, what lies in the inguinal canal?

A

Spermatic cord

30
Q

What forms the inguinal ligament and where does the ligament run?

A

Formed by the free, rolled edge of external oblique

ASIS to pubic tubercle

31
Q

What is the anterior border of the inguinal canal?

A

Aponeurosis of external oblique

32
Q

What is the floor of the inguinal canal?

A

Inguinal ligament

Reinforced medially by the lacuna ligament

33
Q

What forms the lacuna ligament?

A

Aponeurosis of external oblique

34
Q

What is the roof of the inguinal canal?

A

Arching fibres of internal oblique and transversus abdominus

35
Q

What is the posterior border of the inguinal canal?

A

Medially = Conjoint tendon - merged fibres of internal oblique and transversus abdominus
Whole length = transversalis fascia

36
Q

In which structures do the deep and superficial inguinal rings sit?

A 
Deep = posterior wall of inguinal canal in transversalis fascia
Superficial = anterior wall of inguinal canal in aponeurosis of external oblique
37
Q

Name the 2 different types of inguinal hernia and state which is the more common

A

Indirect (commonest)

Direct

38
Q

Which side of the body are indirect inguinal hernias more likely to occur on?

A

Right hand side

39
Q

What structures do we use are the markers for the origin of inguinal hernias?

A

Inferior epigastric vessels
Indirect = lateral to
Direct = medial to

40
Q

Which artery continues under the inguinal ligament as the femoral artery?

A

External iliac

41
Q

Under which point is the deep inguinal ring?

A

Mid point of the inguinal ligament

42
Q

Under which point is the femoral artery?

A

Mid inguinal point

43
Q

What forms the borders of Hesselbach’s triangle?

A

Edge of rectus abdominus muscle
Inferior epigastric vessels
Inguinal ligament

44
Q

When are direct hernias more likely to occur?

A

If there is a weak or absent conjoin tendon

45
Q

Are femoral hernias more likely to occur in males or females and why?

A

Females

The angle of the pelvis is wider so the femoral ring is slightly broader

46
Q

Describe the common course of a femoral hernia

A

Bulges into the femoral canal

Bulges out of the saphenous opening in the thigh

47
Q

Describe an acquired infantile umbilical hernia

A

Very common
Often occur when infant is straining or crying
Usually self resolving by the age of 2 years
Contents herniate through weakness in scar of umbilicus

48
Q

Describe an acquired adult umbilical hernia

A

More common in females
Through the linea alba
Can be caused by anything that raises intraabdominal pressure

49
Q

Describe an epigastric hernia

A

Relatively common
Occurs through the linea alba
Between the xiphoid process and the umbilicus
Usually due to chronic straining forces

50
Q

Describe an incarcerated hernia

A

‘Stuck’

Irreducible ie. cannot push back inside

51
Q

What does strangulated mean?

A

Blood supply is cut off

52
Q

Somatic abdominal pain can arise from which structures of the abdomen?

A

Skin
Fascia
Muscles
Parietal peritoneum

53
Q

What is the innervation to the peripheral part of the diaphragm?

A

Intercostal nerves (T7-T11)

54
Q

What is the innervation of the anterior abdominal wall?

A 
Thoracic nerves (T7-T12) 
And L1
55
Q

What is the innervation to the pelvic wall?

A

Obturator nerve (L2, 3, 4)

56
Q

What structures does visceral abdominal pain arise from?

A

Abdominal organs
Visceral peritoneum
Mesenteries

57
Q

What is the difference between somatic and visceral pain?

A 
Somatic = severe, precisely localised
Visceral = dull, poorly localised
58
Q

Where is visceral abdominal pain usually referred to?

A

The midline

59
Q

Why might sweating, salivation, nausea etc. accompany visceral pain?

A

Many visceral afferent fibres that enter the spinal cord also participate in reflex activity

60
Q

Describe referred somatic pain

A

Nerve fibres from the diseased structure and the area where the pain is felt ascend in the CNS along a common pathway so the pain is unable to distinguish

61
Q

Describe referred visceral pain

A

Afferent pain fibres ascend in company with the sympathetic nerves
They enter the spinal cord at a particular level and will cause referred pain in that dermatome

Gastro-intestinal System (10 decks)

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