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Gastrointestinal System > Week 3 - Abdominal Wall and Hernias > Flashcards

Week 3 - Abdominal Wall and Hernias Flashcards

1
Q

State the proximal and distal attachments of rectus abdominis.

A

Proximal: Xiphisternum
Distal: Pubis

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2
Q

State the three main bony attachments for abdominal muscles.

A

From outermost to innermost:

  1. Ribs
  2. Iliac crest
  3. Transverse processes of vertebrae
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3
Q

State the direction in which fibres of the internal oblique muscle run.

A

Medially and superiorly

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4
Q

Define hernia.

A

Protrusion of part of the abdominal contents beyond the confines of the abdominal wall or its containing cavity

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5
Q

What is the usual sac for abdominal hernias?

A

Pouch of peritoneum

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6
Q

What are common abdominal contents found in a hernia sac?

A
  1. Loops of bowel
  2. Omentum

(Can be any structure found in the abdominal cavity)

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7
Q

What is the covering of a hernia sac?

A

Layers of abdominal wall through which the hernia has passed

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8
Q

State sites of potential weakness in the abdominal wall.

A
  1. Femoral canal
  2. Inguinal canal
  3. Umbilicus
  4. Previous incisions
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9
Q

What is the inguinal canal?

A

Oblique passage through lower part of abdominal wall

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10
Q

State the passage of structures in the inguinal canal for males.

A

Abdomen - Testis

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11
Q

State the passage of structures in the inguinal canal for females.

A

Round ligament: uterus - labium majus

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12
Q

What months does descent of the testis take place during?

A

7th - 8th months

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13
Q

What is the processus vaginalis?

A

A pouch of peritoneum

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14
Q

What is the gubernaculum?

A

Condensed band of mesenchyme that links the inferior portion of testis (gonad) to the labioscrotal swelling

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15
Q

When the processus vaginalis obliterates, what structure does it become?

A

Tunica vaginalis

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16
Q

What structure in the males runs from the peritoneal cavity to the scrotum (through the inguinal canal)?

A

Spermatic cord

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17
Q

What type of hernias can occur if the processus vaginalis fails to obliterate?

A
  1. Inguinal hernia

2. Scrotal hernia

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18
Q

State the layers of the abdominal wall (inguinal canal cross-section) from outermost to innermost.

A
  1. Skin
  2. Superficial fascia
  3. Deep fascia
  4. External oblique
  5. Internal oblique
  6. Transversus abdominus (conjoint tendon formed by IO and TA)
  7. Trasversali fascia
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19
Q

Which ligament is formed by the rolled free edge of external oblique?

A

Inguinal ligament

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20
Q

What forms the floor of the inguinal canal? What reinforces it medially?

A

Inguinal ligament, lacunar ligament

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21
Q

What forms the anterior boundary of the inguinal canal?

A

Aponeurosis of external oblique

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22
Q

What forms the roof of the inguinal canal?

A

Internal oblique and transverse abdominis

muscular arches + aponeurosis

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23
Q

What forms the posterior wall of the inguinal canal? What reinforces it medially?

A

Transversalis fascia

The conjoint tendon reinforces it medially

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24
Q

Where does the deep ring lie?

A

Trasversalis fascia

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25
Q

Where is the entrance to the inguinal canal present?

A

Transversalis fascia

26
Q

Where does the superficial ring lie?

A

Aponeurosis of external oblique - anterior boundary of the inguinal canal

27
Q

Which type of hernia constitutes the most common abdominal hernia?

A

Inguinal hernias: 75% of all abdominal hernias

28
Q

Which type of inguinal hernia is more common - direct or indirect?

A

Indirect - 50% vs. direct - 25%

Mainly right sided, males > females (7:1)

29
Q

State the percentage prevalences for abdominal hernias other than inguinal hernias.

A

Femoral hernia = 3-5%
Incisional hernia = 10%
Umbilical hernia = 10%

30
Q

What important structure is present below the mid-inguinal point?

A

Femoral artery

31
Q

Describe the relation of the mid point of the inguinal ligament to the mid-inguinal point.

A

Lateral (two finger breadths lateral) to the mid-inguinal point

32
Q

What important structure is present at the mid-point of the inguinal ligament?

A

Deep inguinal ring

33
Q

Which type of hernia passes through the deep inguinal ring?

A

Indirect inguinal hernia

34
Q

Which type of hernia has the potential to become a scrotal hernia?

A

Indirect inguinal hernia

(If processus vaginalis does not obliterate - remember that direct inguinal hernias do not pass through the inguinal canal!)

35
Q

What region in the abdominal wall is a potential area of weakness that a direct inguinal hernia can escape through?

A

Hesselbach’s triangle

36
Q

State the relationship of direct and indirect inguinal hernias to the inferior epigastric vessels.

A

Direct: medial to the inferior epigastric vessels
Indirect: Lateral to the inferior epigastric vessels

37
Q

Outline the main features of a congenital umbilical hernia.

A
  1. Omphalocele
  2. Contents herniate into umbilical cord
  3. Has peritoneal covering
38
Q

What is an infantile umbilical hernia?

A

-Contents herniate through weakness in scar of umbilicus

39
Q

What is an adult umbilical hernia?

A

Contents herniate through linea alba in region of umbilicus

40
Q

Which gender is an umbilical hernia more common in?

41
Q

Outline the features of epigastric hernias.

A
  • Occurs through line alba
  • Between xiphoid process and umbilicus
  • Usually starts: small hernia - extraperitoneal fat poking out through linea alba
  • Chronic straining forces more fat out which can eventually pull the peritoneum through
42
Q

State some possible symptoms of hernias.

A
  1. Pain
  2. Vomiting
  3. Sepsis
  4. Abdominal distension
  5. Peritonitis
43
Q

Differentiate between the terms “incarcerated” and “strangulated”.

A

Incarcerated: stuck/irreducible
Strangulated: blood supply is disrupted - can lead to tissue necrosis

44
Q

Why is the arcuate line clinically significant?

A
  • Below this line, the rectus abdominus is surrrounded by sheath only anteriorly, and this does not come posteriorly
  • At this point, an incision can be made because there is no rectal sheath to go through
  • Useful landmark for Pfannenstiel incisions
45
Q

State the exact anatomical position of the Douglas (arcuate) line.

A

Umbilicus - 1/3rd - pubic symphysis

46
Q

What is referred pain?

A

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

47
Q

What is somatic referred pain?

A

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

48
Q

State three differentials for right iliac fossa pain.

A
  1. Shingles
  2. Appendicitis
  3. Right lower lobe pneumonia
49
Q

What is visceral referred pain?

A
  • In the thorax and abdomen, visceral afferent pain fibres follow sympathetic fibres back to the same spinal cord segments that gave rise to the pre-ganglionic sympathetic fibres
  • The CNS perceives visceral pain as coming from the somatic portion of the body supplied by the relevant spinal cord segments
50
Q

What causes visceral pain?

A
  1. Ischaemia
  2. Abnormally strong muscle contractions
  3. Inflammation
  4. Stretch
51
Q

Which retroperitoneal structures can cause central back pain?

A

Pancreas and aorta

52
Q

What levels is pain from acute/chronic pancreatitis referred to?

53
Q

State three causes of referred diaphragmatic irritation.

A
  1. Ruptured spleen
  2. Ectopic pregnancy
  3. Perforated ulcer
54
Q

What is Hesselbach’s triangle normally reinforced by?

A

Can be reinforced by the fused fibres of the internal oblique and transversus abdominus muscle (conjoint tendon)

55
Q

State the lateral border of the femoral ring.

A

Femoral vein

56
Q

Anterior border of the femoral ring?

A

Inguinal ligament

57
Q

Posterior border of the femoral ring?

A

Pectineal ligament

58
Q

Medial border of the femoral ring?

A

Lacunar ligament

59
Q

What is the initial defect a femoral hernia passes through?

A

Femoral ring

60
Q

What anatomical structure lies below the mid point of the inguinal ligament?

A

Deep inguinal ring

61
Q

State the relationship of the deep inguinal ring to the femoral artery.

A

The DIR lies lateral to the femoral artery

62
Q

What anatomical structure lies below the mid-inguinal point?

A

Femoral artery

Gastrointestinal System (8 decks)

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