100 Concepts Set 2

Question 1

What is the Rectouterine (Douglas) Pouch

Answer 1

Deeper point of peritoneal space in vertical position of the female body between the rectum and the cervix of the uterus

Space of the Pelvic Abcess Location

Question 2

What is Culdocentesis?

Answer 2

Aspiration of fluid from the cul-de-sac of Douglas (rectouterine pouch) by a needle puncture of the posterior vaginal fornix near the midline between the uterosacral ligaments

Question 3

Why can the Rectouterine pouch collect inflammatory fluid (pelvic abcess)?

Answer 3

Because it is the lowest portion of the female peritoneal cavity

Question 4

Erosion of which structure is common in posterior gastric ulcer?

Answer 4

Splenic Artery

Due to proximity of artery to this wall

Question 5

Describe a potential course for a Posterior Gastric Ulcer?

Answer 5

Erode through posterior gastric wall into the omental bursa (lesser peritoneal sac) and affect the PANCREAS

this will result in referred pain to the back

Question 6

What is Meckel’s Diverticulum?

Answer 6

Congenital anomaly- persistent vitellointestinal duct

vitellointestinal duct- connection from the midgut to the yolk sac incorporated into the umbilical cord, normally degenerates 2-3 mo after gestation

Question 7

Meckel’s Diverticulum is normally asymptomatic. When does it become inflamed?

Answer 7

If it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration

Question 8

What is the Rule of 2s for Meckel’s Diverticulum?

Answer 8

• located on ileum TWO feet before ileocecal junction
• occurs in 2 percent of patients
• 2 inches long

Question 9

What artery supplies Meckel’s Diverticulum?

Answer 9

The Superior Mesenteric Artery

Question 10

Why is Meckel’s Diverticulum clinically important?

Answer 10

B/c diverticulitis, liberation, bleeding, perforation, and obstruction are complications requiring surgical intervention

Frequently mimic the symptoms of acute apendicitis

Question 11

What are some features of the Large Intestine?

Answer 11

• Epiploic Appendices
• Sacculations (Haustrations)
• Taeniae Coli (meet together at base of appendix where they form a complete longitudinal coat for the appendix)

Question 12

Describe the Ascending Colon?

Answer 12

• lies retroperitoneally

- lacks a mesentery

Question 13

Where does the Ascending Colon become continuous with the the transverse colon?

Answer 13

the Right Hepatic Flexure

Question 14

Describe the Transverse Colon

Answer 14

Has its own mesentery called the Transverse Mesocolon (intraperitoneal position)

Question 15

Where does the Transverse Colon become continuous with the descending colon?

Answer 15

The Left Splenic Flexure

Question 16

Describe the Sigmoid Colon

Answer 16

Suspended by the sigmoid mesocolon (intraperitoneal position)

Question 17

Where is the First Pain referred to in appendicits?

Answer 17

Around the Umbilicus

Question 18

What produces visceral pain in appendicitis?

Answer 18

Distension of lumen or spasm of its (appendix’s) muscle

Question 19

Describe the course of the Afferent Pain Fibers involved in Appendicitis?

Answer 19

• Enter spinal cord at level of T10 segment

- A vague, referred pain is felt in the region of the umbilicus (T10 dermatome)

Question 20

What happens if the Parietal Peritoneum gets involved in Appendicitis?

Answer 20

The pain is shifted laterally to McBurney’s point. Here the somatic pain is precise, severe, and localized (second pain)

Question 21

What does McBurney’s Point indicate?

Answer 21

Surface Marking of the Base of the Appendix

Question 22

Where is McBurney’s Point?

Answer 22

At the junction between the lateral 1/3 and medial 2/3 of a line joining the right Anterior Superior Iliac Spine with the umbilicus

Question 23

What is the most common position of the appendix?

Answer 23

Retrocecal

Question 24

What are the derivatives of the primitive foregut?

Answer 24

Esophagus
Stomach
Duodenum (1st and 2nd parts)
Liver
Pancreas
Biliary Apparatus
Gallbladder

Question 25

What are the derivatives of the primitive midgut?

Answer 25

Duodenum (2nd, 3rd, 4th parts)
Jejunum
Ileum
Cecum (with appendix)
Ascending Colon
Transverse Colon (proximal 2/3)

Question 26

What are the derivatives of the primitive hindut?

Answer 26

transverse colon (distal 1/3)
Descending Colon
Sigmoid Colon
Rectum (anal canal above pectinate line)

Question 27

What artery supplies the Foregut?

Answer 27

Celiac Artery

Question 28

Describe the parasympathetic innervation of the Foregut?

Answer 28

Preganglionic: DMN of Vagus Nerve

Postganglionic: Terminal GG

Question 29

Describe the sympathetic innervation of the Foregut?

Answer 29

Preganglionic: IML T5-T9; Greater Splanchnic nerve

Postganglionic: Celiac Ganglion

Question 30

Describe the Sensory Innervation?

Answer 30

DRG T5-T9

Question 31

Where is pain from the Foregut referred to?

Answer 31

The epigastrium

Question 32

What artery supplies the Midgut?

Answer 32

The Superior Mesenteric Artery

Question 33

Describe the Parasympathetic innervation of the Midgut

Answer 33

Preganglionic: DMN of the Vagus Nerve

Postganglionic: Terminal GG

Question 34

Describe the Sympathetic innervation of the Midgut?

Answer 34

Preganglionic: IML T10- T11; Lesser Splanchnic nerve

Postganglionic: Superior Mesenteric G.

Question 35

Describe the Sensory Innervation of the Midgut?

Answer 35

DRG T10- T11

Question 36

Where is pain from the midgut referred to?

Answer 36

Umbilical Region

Question 37

What artery supplies the Hindgut?

Answer 37

Inferior Mesenteric Artery

Question 38

Describe the Parasympathetic Innervation of the Hindgut?

Answer 38

Preganglionic: SPN S2-S4; Pelvic Splanchnic Nerve

Postganglionic: Terminal GG

Question 39

Desribe the Sympathetic Innervation of the Hindgut?

Answer 39

Preganglionic: IML L1-L2

Postganglionic: Inferior Mesenteric G

Question 40

Describe the Sensory Innervation of the Hindgut?

Answer 40

DRG L1-L2

Question 41

Where is pain from the Hindgut Referred to?

Answer 41

Hypogastrium