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Semester 3 > GI Session 3 > Flashcards

GI Session 3 Flashcards

1
Q

What is the purpose of the tendinous intersections which divide the rectus abdominis?

A

Damage less devastating

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2
Q

What is the linea alba?

A

Aponeurotic fibres from the three abdominal muscles where they meet near the midline

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3
Q

What are the layers of the abdominal muscle wall from superficial to deep?

A

External oblique
Internal oblique
Transversalis abdominis

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4
Q

What forms the anterior and posterior walls of the rectus sheath?

A

Anterior: external abdominal oblique +1/2 internal
Posterior: 1/2 internal and transversalis abdominis

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5
Q

What is the purpose of the rectus abdominis?

A

Contain it to prevent it from bowing

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6
Q

What are the layers of the abdominal wall fascia from superficial to deep?

A

Rectus sheath
Transversalis fascia
Peritoneum
Greater omentum

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7
Q

What is the function of the greater omentum?

A

Mobile fat which is can be used to isolate an area of infection e.g. in appendicitis

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8
Q

What is the arcuate line?

A

Line at umbilicus above which the posterior rectus sheath is present and below which only the anterior rectus sheath is present

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9
Q

Where is the arcuate line found in relation to the umbilicus?

A

1/3 of the distance between the umbilicus and pubic symphysis

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10
Q

What is a Pfannstiel incision?

A

1/3 of the distance between umbilicus and pubic symphysis above pubic symphysis where an incision for caesarean is made which will be hidden by pubic hair

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11
Q

What is divarication of recti?

A

Apparent hernia seen in midline actually due to laxity of linea alba after it has been stretched and become thin

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12
Q

What can cause divarication recti?

A

Obesity
Ageing
Post-surgery
Post-partum

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13
Q

What is rectus sheath heamatoma?

A

Blood accumulates in anterior rectus sheath which travels down to arcuate line and up anterior surface –> large visible bruise on abdominal surface darkest at arcuate line

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14
Q

How is rectus sheath heamatoma identified?

A

Pt lies flat and if legs/head raised this is very painful

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15
Q

Why do incisions for surgery have to be in aponeurosis fibres?

A

Sutures ‘cut out’ so don’t hold

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16
Q

Where are the surgical bites in midline and transverse incisions?

A

Midline: linea alba
Transverse: external oblique aponeurosis

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17
Q

Where is appendicectomy carried out?

A

McBurney’s point located 2/3 from the umbilicus to the R ASIS

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18
Q

What muscle-splitting incision must be used to cut through the abdominal muscles in appendicectomy?

A

Grid iron

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19
Q

What is ectopia cordis?

A

Uncommon congenital condition where the heart develops on the abdominal wall and is at high risk of fibrillation due to knocks

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20
Q

What happens in patent urachus?

A

Allantois duct fails to close and recede –> urine exiting via umbilicus

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21
Q

How does patent urachus present in an older male pt?

A

BPH –> bladder outflow obstruction –> increased pressure in bladder –> urachus opens

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22
Q

How is patent urachus differentiated from patent vitellointestinal duct which presents similarly?

A

Use small catheter to inject radio-visible dye and see what path it takes

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23
Q

What is a urachal cyst?

A

Urine filled cyst located at the umbilicus

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24
Q

What is exomphalos?

A

Umbilical defect where viscera are covered by peritoneum and amnion but are located outside of the body

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25
Q

What is gastoschisis?

A

Vertical herniation to the R of the umbilicus where viscera are not covered by peritoneum and amnion and are outside of the body

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26
Q

What type of pain can the pancreas and aorta cause and why?

A

Central back pain as they are retroperitoneal

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27
Q

What is referred pain?

A

Pain perceived at a site distant from the site of cause

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28
Q

Why is referred pain seen more commonly in children?

A

Brain is less developed

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29
Q

What causes somatic nerve pain?

A

Pain from noxious stimulus to proximal part of a somatic nerve –> perceived pain in distal dermatome of the nerve

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30
Q

Give an example of somatic referred pain.

A

Causeof pain in flank at T10 level –> felt at umbilicus

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31
Q

Give two causes of right iliac fossa pain due to somatic referred pain.

A

Shingles

R lower lobe pneumonia

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32
Q

What causes visceral referred pain?

A

In thorax and abdomen visceral afferent pain fibres follow sympathetic fibres back to same spinal cord segment that gave rise to preganglionic sympathetic fibres –> CNS perceives it as coming from somatic portion supplied by same spinal cord segment

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33
Q

How does appendicitis explain visceral referred pain?

A

Appendicitis pain –> visceral sensory nerve –> T10 spinal segment –> brain perceives pain as coming from T10 somatic sensory nerves –> umbilical pain

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34
Q

What causes visceral pain?

A

Ischaemia
Abnormally strong muscle contraction
Inflammation
Stretch

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35
Q

What stimuli do not cause visceral pain?

A

Touch
Burning
Cutting
Crushing

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36
Q

Where can gallbladder pain be felt?

A

Epigastrium
RUQ
Back

37
Q

How do the embryonic divisions of the gut determine pain felt?

A

Foregut –> epigastric
Midgut –> periumbilical
Hindgut –> suprapubic

38
Q

Where does the aorta bifurcate?

A

At umbilical level

39
Q

How does the pain felt in acute appendicitis change as it progresses?

A

Early is referred visceral pain but as inflammation spreads to adjacent peritoneum which has somatic nerve supply –> localised somatic pain

40
Q

How is small bowel colic pain felt?

A

Periumbilical pain which causes pts to double over and hold stomach due to waves which come every 35-40s

41
Q

How is large bowel colic pain felt?

A

Waves of suprapubic pain every 2-3 mins which causes sufferers to hunch over

42
Q

Why may renal/ureteric colic pain be referred to testicle/labia?

A

Descent in embryonic development

43
Q

How is uterine and ovarian pain experienced?

A

Suprapubic pain which is localised to affected side if ovarian

44
Q

Where is bladder pain experienced?

A

Suprapubic

45
Q

Why can ruptured spleen/ectopic pregnancy/perforated ulcer cause shoulder pain?

A

If diaphragm is implicated the brain perceives pain as being in the shoulder due to dermatomes of C3,4,5

46
Q

What is rectus abdominis?

A

Paired muscle which runs from ribs –> pubic symphysis which holds abdominal organs in place and aids posture

47
Q

What is a hernia?

A

Protusion of part of the abdominal viscus through a defect in the abdominal wall

48
Q

What forms the borders of Hesselbalch’s triangle?

A

Medial: rectus abdominis
Inferior: inguinal ligament
Lateral: inferior epigastric blood vessels

49
Q

Describe the path of the inguinal canal.

A

Extends inferiorly and medially through inferior abdominal wall, superior and parallel to inguinal ligament from deep to superficial inguinal rings

50
Q

What forms the roof of the inguinal canal?

A

Transversalis fascia
Internal oblique
Transversus abdominis

51
Q

What forms the posterior wall of the inguinal canal?

A

Transversalis fascia

52
Q

What forms the flow of the inguinal canal?

A 
Inguinal ligament
Lacunar ligament (medially)
53
Q

What forms the anterior wall of the inguinal canal?

A

Aponeurosis of external oblique reinforced by internal oblique muscle laterally

54
Q

What forms the superficial inguinal ring?

A

Evagination of external oblique which contains intercrural fibres parallel to external oblique aponeurosis fibres

55
Q

Where is the mid-inguinal point?

A

1/2 way between public symphysis and ASIS

56
Q

What is found at the mid-inguinal point?

A

Femoral artery

57
Q

Where is the mid-point of the inguinal ligament and what is found here?

A

1/2 way between pubic tubercle and ASIS just below opening to inguinal canal

58
Q

What is the transverse fascial sling?

A

Antero-superior crus and postero-superior crus which form a U-shaped ring around the deep inguinal ring

59
Q

Where are common abdominal hernias located?

A

Epigastric
Umbilical
Inguinal
Femoral

60
Q

What is an incisional hernia?

A

Improper healing of a surgical incision or scar –> site of herniation

61
Q

What is an incarcerated hernia?

A

Hernia that cannot be massaged back into the abdomen due to swelling

62
Q

What is a strangulated hernia?

A

Hernia with neck clamped –> necrosis of hernial sac and contents –> medical emergency

63
Q

Are indirect or direct hernias more common?

A

Indirect

64
Q

What is an indirect hernia?

A

Occurs at the deep inguinal ring –> through transversalis fascial sling –> extends along inguinal canal –> appears in scrotum or labium majora

65
Q

What is a direct hernia?

A

Occurs in weak area of Hesselbalch’s triangle medial to vessels –> outpouching of strong conjoint tendon –> bulge in inguinal region

66
Q

What causes indirect inguinal hernias?

A

Congenital due to failure of the processus vaginalis to regress with amount remaining determining degree of herniation

67
Q

What are the S/S of indirect inguinal hernias?

A

Swelling
Pain in scrotum
Dragging sensation

68
Q

What coverings does the peritoneal sac acquire in indirect inguinal hernia?

A

Same as the contents of the canal

69
Q

What causes direct inguinal hernias?

A

Generally acquired seen in elderly with chronic conditions which increase intra-abdominal pressure long term e.g. COPD, bladder outflow obstruction, chronic constipation

70
Q

What is the diagnostic sign of a direct inguinal hernia on CT scan?

A

Lateral crescent of fat

71
Q

What can femoral hernias contain?

A

Preperitoneal fat
Omentum
Small bowel

72
Q

Where are femoral hernias more common?

A

R sided predilection

More common in females

73
Q

Where do femoral hernias arise?

A

Protrude inferior to epigastric vessels and medial to common femoral vein

74
Q

What can lead to engorgement of distal collaterals veins seen in femoral but not inguinal hernias?

A

Neck of hernia below inguinal ligament with narrow funnel shape that can compress femoral vein

75
Q

How does the relation to the pubic tubercle compare between inguinal and femoral hernias?

A

Femoral remain lateral, inguinal don’t

76
Q

What can cause diaphragmatic hernias?

A

Developmental defects which allow any viscus to push through improperly developed diaphragm
Traumatic diaphragmatic rupture
Hiatus hernia

77
Q

Are sliding or rolling hiatus hernias more common?

A

Sliding ~90%

Rolling ~10%

78
Q

What is a sliding hiatus hernia?

A

Gastro-oesophageal junction slides into chest

79
Q

What is a rolling hiatus hernia?

A

Gastro-oesophageal junction is in the normal position but the fundus of stomach moves into chest alongside oesophagus

80
Q

What are the S/S of hiatus hernia?

A

Usually asymptomatic
Epigastric/chest pain
Post prandial fullness
N+V

81
Q

What causes a congenital umbilical hernia?

A

Incomplete closure of the anterior abdominal wall after gut returns to the abdominal cavity in the 10th week of gestation

82
Q

What are risk-factors for developing an umbilical hernia in adulthood?

A

Obesity
Multiparity
Ascites
Large intra-abdominal mass

83
Q

What do umbilical hernias commonly contain?

A

Fat
Mesentery
Small +/- large bowel

84
Q

What is Richter’s hernia?

A

Terminal ileum through a small defect in abdominal wall –> partial obstruction of bowel –> vomiting

85
Q

What is visible on CT in Richter’s hernia?

A

Bowel loop on middle of the abdominal wall

86
Q

What is Spigelian hernia?

A

Rare herniation along semilunar line through transversus abdominis aponeurosis close to arcuate line level

87
Q

Why do S/S of Spigelian hernia vary?

A

Due to contents of hernial sac, degree and type of herniation and there is not typical pain associated

88
Q

What does groin pain without a hernia suggest?

A

Repetitive strain of inguinal ligament

Semester 3 (50 decks)

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