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Surface anatomy of abdominal wall
jugular notch; costal margin; umbilicus; iliac crest; ASIS; transpyloric (L1)
Identify the contents of inguineal canal in Males and Females
Females-ilioinguineal nerve and the round ligament. Males- Ilioinguineal nerve and spermatic chord (its contents)
Portions of the inguinal canal
Deep (from transversalis facia) and superficial rings (from external oblique aponeurosis)
Contents of spermatic cord
ductus deferens and associate blood vessels; testicular artery; pampiniform venous plexus; autonomic nerves; lymphatics
Coverings of spermatic cord (and derivations from abdominal wall)
process vaginalis and tunica vaginalis testes (peritonium); internal spermatic fascia (transversalis fascia); transverse abdominis give nothing; cremaster muscle and fascia (internal oblique); external spermatic fascia (external oblique)
Structure and functional significance of rectus sheath
Above arcurate line--external oblique and interal oblique resides above the rectus abdominus. Below arcurate line--external; internal oblique; and transversalis abdominus. Point of attachment for abdominal mm and aid in containment of abd mm.
Describe how the structure of the abdominal wall is suited to its fxns
Compress; protect; support; breathing; flexion
Describe the aspects of direct inguinal hernia
usually seen in adults; acquired; medial to the epigastric blood vessles; do not pass through deep inguinal ring; may pass superficial ring
Describe the aspects of indirect inguinal hernia
seen in both adults and children; associated with patent processus vaginalis; congenial; lateral to the inferior epigastric blood; passes through the deep inguinal ring; has same covering as spermatic cord; pass though the superficial inguinal ring
double layered peritoneum; suspents organs to abdominal wall; conducts blood vessels and lymphatics to these organs.
difference between informed concent and the the clinical model of shared decision making
informed consent is a legal term; shared decision making is how it works in practice.
Two required preconditions for informed consent
voluntariness; decisional capacity- person has to be capable
What information ought to be disclosed in informed consent
nature of treatment; purpose of treatment; risks and consequences; benefits; alternatives; probability of success; prognosis if therapy is foregone.
Three standards of disclosure for dtermining the kind of amount of info given in order to obtain informed consent
Explain decisional cpacity vs legal competency
Decisional Capacity: specific medical decision; determined by physician with aid of specialists; can be short term of long term. Competency: conduct life afairs; decided by court; generally long term.
Health proxy vs health surrogate
Proxy is appointed by patient. Surrogate not appointed by patient to make medical decisions should the patient lose capacity.
Define two standards of surrogate decision making
Substituted judgment standard- what the patient would want. Best interest standard- what a typical person in similar circustance would want.
Exceptions to the informed consent (five)
Emergency; incapacity; patient waiver; national/state health programs; therapeutic priviledge.
appropriate way to treat a patient who waives the right to full informed consent
Generally better communication.
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