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57 Cards in this Set
- Front
- Back
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If you were stabbed in abdomen named the layers from skin to peritoneum...
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skin, subcutaneous tissue (superficial campers, and deeper scarpas), external oblique, internal oblique, transversus muscle, transversalis fascia, and peritoneum
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Thick area between skin and actual fascia (more fatty)
This layer is more fibrous and denser between skin and perineal fascia |
Camper's fascia (superficial)
- scarpa's fascia (deeper layer) |
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Subcutaneous tissue of abdomen is contiguous into the perineum as what?
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superficial perineal fascia of colle's
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This forms the inguinal ligament in groin and medially fuses with Cooper's ligament
What does it fuse with and form? |
external oblique
- fuses with internal oblique aponeurosis to form anterior rectus sheath |
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Name what the following two things describe
• Elastin creating skin tension transversely • Lower abdomen lines are slightly more oblique |
definition of langer's line of cleavage
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Where does internal oblique muscle arise from?
What does it become in the spermatic cord? |
Iliac crest, lumbodorsal fascia, and psoas fascia
= cremaster muscle |
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What rolls to forms inguinal ligament?
Where does the internal abdominal oblique arise from? |
external oblique muscle
iliac crest, lumbodordal fascia, and psoas fascia |
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What is the most important thing for the surgeon for hernia repair?
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posterior inguinal wall
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What does the external oblique muscle and transversus medially fuse with?
This is the deepest muscle layer of the abdomen? |
cooper's ligament
- transversus muscle |
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serous membrane that lines the entire abdominal cavity
What is the origin of the tunica vaginalis? What happens if this does not shed off? |
peritoneum
peritoneum - most likely indirect hernia or hydrocele |
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What does the transversus muscle form?
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posterior inguinal wall
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Tubular diverticulum of embryonic hindgut
- results in what? |
allantois
= urachal cyst or urachal fistula (poop in pee) |
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What can left umbilical vein stays patent be used for?
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vascular access
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This is is a vitelline duct cyst, duct patentcy with stool at umbilicus and meckel's are seen with this
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ophallomesenteric duct
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What is the size for most likely to spontaneously close umbilical hernia?
What age should operate after? |
if less than 2 cm otherwise bowel and other things may get in
= after 2 yrs old |
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This type of hernia occurs often from patent processus vaginalis
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indirect inguinal hernia
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Why does a hernia cause pain often?
When doing the physical exam for hernia what do you feel and feel for? |
due to fascia tearing, which is highly vascularized
- feeling for normal impulse and vessels in inguinal canal, if you feel extreme bulge then it is hernia |
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For inguinal hernia variations... this one
a. is when something is stuck b. something is dying due to constricted blood supply How do you know if hernia is hydrocele or not? |
a. incarerated
b. strangulated - put light behind balls, if it lights up like a pumpking then you know that it is all fluid inside (i.e. hydrocele) |
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This is an acquired hernia that erodes through floor of this muscle_____. Compared to this type, the femoral presents where?
It is _____ in relation to groin vessels How does it look and feel compared to indirect inguinal hernal? |
transversus, (Direct hernia), presents lower below to inguinal ligament
- medial - same |
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Women are most likely to get what type of hernias
- What is caviate? HHHHHHHHHHHHHHHHHHHH |
inguinal, but more likely to get femoral than men
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Incidence of hernias in...
a. men b. kids c. women |
a. 50% indirect, 40% direct
b. all indirect c. 70% indirect, 30% femoral |
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What are the three main concepts of hernia repair
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1. Reduce any abdominal viscus into
abdominal cavity • 2. Create a new, tension free inguinal floor • 3. Recreate a snug internal ring • ALSO – Obliterate the processus vaginalis – Obliterate the femoral space or cover with mesh |
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sliding hernia most common...
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cecum
Intra‐abdominal organ part of wall |
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With adults male what is the most important step of hernia repair?
What is the overall goal of hernia surgery? |
creating a new tension free inguinal floor
- tension free |
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Type of hernia:
Richter's |
– Side wall of bowel
– often without obstruction – Can have gangrene of bowel |
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Grynfelt’s hernia
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Grynfelt’s hernia
– Superior lumbar triangle – Sacrospinalis, internal oblique, 12th rib |
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Whats a Spigelian hernia
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Semilunar and semi‐circular line of Douglass
intersection – Above inferior epigastric vessels – Prone to incarceration |
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type of hernia
Inferior lumbar triangle – Lat dorsi, medial ext oblique, ilac crest |
Petit’s Hernia
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type of hernia
– Side wall of bowel – often without obstruction – Can have gangrene of bowel |
richter
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littre’s Hernia
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Any groin hernia with a Meckel’s diverticulum
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armands hernia
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– Any groin hernia with appendix in sac
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Diastasis Recti
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– Not a real hernia
– Lay flat lift head off table/bed – Midline bulge, above umbilicus – Wide linea alba |
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Umibilical hernia
Cause? Occurence? Mesh repair when? Recurrence higher in? What do they show up at birth looking similar to? |
Congenital
- only in infants - mesh if >1.5 cm - recurrence high in cirhossis - omphalocele |
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With early diagnosis what are two key points of acute abdomen?
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1. Make diagnosis or differential after H/P
2. hold or limit pain medications |
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If you take a deep breath and it hurts RUQ what might they have?
What might mimic Appendicitis? |
hepatitis among normal
- herpes zoster |
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When listening what is borborygmi?
What noise are you listening for? |
bowel sounds
- high pitches, absent, normal... bruit? |
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Where do you start palpation?
For appendix what do you palpate for? |
away from the pain
- rebound tenderness, rigidity, hyperesthesia, iliopsoas test |
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For appendicitis what is positive in rectal exam?
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Lateral tenderness can mean appendicitis
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Foregut problems presents like?
What most likely causes? |
Epigastric pain
• Ulcer, gastritis, cholecystitis, pancreatitis |
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Midgut problems presents like?
Most likely causes |
Periumbilical
• Duodenum to transverse colon |
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Hindgut problems presents like?
causes? |
Seatbelt like
• Transverse colon to anus |
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Why is vomiting often the first sign to appendicitis?
When the pain moves to RLQ why? |
distention of appendiceal lumen
- as infection progresses peritoneum is irritated |
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Physical findings for appendicitis
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• McBurney tenderness
• Rovsing sign (referred rebound) • RLQ hyperesthesia • Heel tenderness • Right rectal pain • Not distractable |
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Diff/Diagnosis of appendicitis
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• Ruptured ovarian cyst
• Tubal pregnancy • Mesenteric adenitis • Meckel’s diverticulitis • Right Spigelian hernia • Cecal or sigmoid diverticulitis • Crohn’s disease |
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Diagnostic findings with appendicitis?
a. WBC b. Ultrasound c. CT d. accepted fals neg rate |
WBC usually 12‐16,000
• Ultrasound helpful in females • CT misses fewer cases than exam – Consider radiation risk, costs etc • Accepted 15% false negative operative rate • About 48‐72 hours ill rupture • Antibiotics do not make it go away |
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– Fever, nausea, anorexia,
WBC, peritonitis – Localizes to RLQ – Normal appendix removed |
valentino's syndrome
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Acute Cholecystitis
5 F's Preceded 60% by ____? |
female, fate, fertile, forties, flatulent
- Cholesterol stones most frequent - biliary colic |
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This type of colic is the type that shows with person moving to stop pain
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renal colic
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Most common cause of acute intestinal obstruction?
Two big huge things that mask acute abdomen? |
intraabdominal adhesions from previous surgeries
- Steroids and opiates |
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Acute abdomen with women differential diagnosis
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• Tubal pregnancy
• Ruptured cyst • Torsion of the ovary • PID • Tubo‐ovarian abscess |
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Fecal loading or constipation can cause crampy abdomnial pain and possibly mimic surgical abdomen?
Appendicitis in the third trimester of pregnancy could mimic what? |
true
gallbladder disease |
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What causes the RLQ in appendicitis?
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peritoneal distension
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Surgical options of Appendicitis?
What is carcinoids are found? What is used for a delayed operation? |
1. Open Appendectomy- (McBurney incision)
2. Laparascopic appendectomy 3. Right hemicolectomy (for carcinoids) 4. CT guided drainage in perforation- delayed operation |
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1. Surgical management for perforated ulcer?
2. What type of patch may be used? What type of infection prevention care is done? |
1. Laparotomy
2. Wash out peritoneal cavity 3. Graham patch with omentum (NG decompression) 4. Treat H. Pylori- to prevent bacterial caused ulcer 5. H2 blockers or protonics - |
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a. If ulcer was posterior it would ____?
b. It ulcer perforated anterior it would ___? Where else could perforations present |
a. bleed
b. perforate - if perforate into cavity it could present like appendicitis |
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With Acute Cholecystitis and the following results... what are the surgical treatments?
a. cholangitis b. Gall stone pancreatitis c. most common |
a. emergency needs drainage
b. duct exploration or ERCP c.laparascopic cholecystectomy |
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• Patient lays quietly
– Hurts to move • No crampy component • Ischemic intestine or perforation • Rigid abdominal muscles • Erythema in infants – Thinner abdominal wall |
acute peritonitis
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