Twist and Shout

Twist and Shout

1. anatomy

   • anterior abdominal wall
     • boundaries
     • wall layers
     • muscles
       • 3 lateral
         • External oblique
         • internal oblique
         • Transversus abdominis
       • 2 anterior
         • rectus abdominis
         • pyramidalis
     • Rectus Sheath
       • formation
       • contents
         • 2 muscles
         • 4 bld. Vessels
           • Sup. & Inf. epigastric arteries
           • Sup. & Inf. epigastric veins
         • 6 nerves
           • T7 –T11 intercostals
           • Subcostal n. (T12)
     • blood supply& innervation
   • Inguinal region
     • Inguinal ligamentet
     • Inguinal canal
       • Contents
         • Male
           • Spermatic cord
         • female
           • round lig. of uterus
           • ilioinguinal n.

2. hernias

   • diagnosis
     • blood test
       • CBC
         • inflammation
         • blood loss& dehydration
       • biochemistry report
         • electrolytes balance
         • blood pH
     • abdominal examination
       • presence of masses
     • rectal examination
     • patient's history
       • most diagnosis
     • X-ray
       • obstruction
       • extraperitoneal involvement
   • causes
     • congenital
       • Develops in children with abdominal wall weakness
     • acquired
       • problems that increases pressure on the abdominal wall
   • risk factors
     • smoking
     • age
     • chronic cough or conctipation
     • obesity
   • signs & symptoms
     • asymptomatic
     • swelling
     • pain
     • bowel obstruction
   • types
     • incisional
       • common in elderly
       • site of previous abdominal surgery
     • femoral
       • common in pregnant woman
       • wider pelvis
       • intestine enters the femoral canal
     • umbilical
       • common in children& infants& multiple pregnancies
       • intestine bulge in the middle of the umbilicus
     • hiatal
       • happen due to
         • failure of esophagus elongation
       • could lead to
         • GERD
       • types
         • sliding
         • paraesophageal
     • epigastric
       • common in adult & children
       • due to
         • weakness of abdominal muscle
     • Spigelian
       • no obvious swelling
         • difficult to detect
     • inguinal
       • Signs& symptoms
         • Visible lump in the groin
         • Pain on exertion
         • Constipation
         • Lump enlarges upon coughing
       • types
         • direct
           • Doesn't enter the scrotum
           • Medial to Superior epigastric vessels
           • Protrudes through
             • Hesselbach's triangle and superficial inguinal ring
         • indirect
           • Enters the Scrotum
           • Lateral to inferior epigastric vessels
           • Protrudes through
             • Deep and superficial inguinal rings
       • complication
         • Bleeding& infection
         • Bowel obstruction & ischemia
         • Damage to Nerves/ Blood Vessels
       • managment
         • Pre operative
           • IV Fluids
           • Prophylactic Antibiotics (Cefotaxime and Metronidazole)
             • cefotaxime
               • MOA
                 • bacterial cell wall inhibitor
               • adverse effects
                 • rash
                 • nausea $ vomiting
             • Metronidazole
               • MOA
                 • bacterial nucleic acid inhibitor
               • adverse effects
                 • abdominal pain
                 • metalic taste
         • post operative
           • Same Antibiotics
           • NG Tube

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