Clinical Questions-II

• McBurney’s point.
• This point indicates maximum tenderness in a patient
suffering from inflammation of the appendix.
• Caput medusae.
• Cause: Portal vein obstruction
• Paraumbilical veins and superficial veins around the
umbilicus
• Oesophageal varices
• Dilated submucosal veins at the lower end of esophagus
due to portal obstruction
• Inguinal hernia
• It is a protrusion of abdominal viscera into the inguinal canal.
It presents as a pear-shaped swelling above and medial to the
pubic tubercle, above the inguinal ligament.
Prevented by
• Flap-valve mechanism
• Guarding of the inguinal rings.
• Shutter mechanism
• Slit-valve mechanism
• Ball-valve mechanism
• Meckel’s diverticulum
• 2% of subject
• Remnant of the proximal part of the vitello-intestinal duct.

Clinical significance:
• When it get inflamed and it symptoms are similar to that of
acute appendicitis.
• A loop of small intestine may encircle the fibrous band of
the diverticulum and this produces intestinal obstruction.
• Internal Hemorrhoids or piles
• Cause: Variceal/Saccular dilatations of the tributaries of the
superior rectal vein in a fold of mucosa and submucosa of
anal canal above the pectinate line in portal hypertension.
• Factors responsible for causing internal piles:
– Poor supporting to veins
– Absence of valves in the superior rectal and portal
veins.
– Compression of the veins at the sites where they pierce
the muscular coat of the rectum
– Direct transmission of the increased portal pressure at
the portosystemic communications.
– Favoured by constipation, prolonged standing, excessive
straining at stool and portal hypertension.
• Lumbar puncture
• Interval b/w L3 and L4 vertebra to prevent injury to the
spinal cord.
Clinical significance:
• To obtain the sample of CSF for various diagnostic and
therapeutic purposes.
• For introducing air or radio-opaque dyes in to the
subarachnoid space for certain investigative procedures. E. g.
Myelography
• Drugs may be injected for treatment
• Spinal anesthesia.
• Prolapse of uterus
• Supports of uterus:
• Primary supports:
1. Muscular
1. Pelvic diaphragm
2. Perineal body
3. Urogenital diaphragm
2. Visceral
1. Urinary bladder
2. Vagina
3. Uterine axis
3. Fibromuscular
– Transverse cervical ligaments (of Mackenrodt)
– Pubocervical ligaments
– Uterosacral ligaments
– Round ligaments of the uterus
• Secondary supports
– Broad ligaments
– Uterovesical fold of peritoneum
– Rectovaginal fold of peritoneum
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