Peritoneum/Foregut/Pancreas Flashcards

1
Q

what is a mucous plug & why is it important?

A

-blocks external opening of uterus -prevents infection but allows sperm to pass

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2
Q

what is the serosa?

A

covering of peritoneum

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3
Q

what is peritonitis?

A

bacterial contamination during surgery or trauma after a rupture of the peritoneal cavity

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4
Q

what is general peritonitis?

A

occurs when an ulcer perforates wall of stomach or duodenum; spills acid into peritoneal cavity

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5
Q

excess fluid in peritoneal cavity?

A

ascitic fluid

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6
Q

what is paradoxical abdominothoracic rhythm?

A

-abdomen drawn in during chest expansion -indicates peritonitis or pneumonitis

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7
Q

what is an adhesion?

A

scar tissue

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8
Q

what is a volvulus?

A

when intestine becomes twisted around adhesion and causes chronic pain or intestinal obstruction

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9
Q

what is an adhesiotomy?

A

surgical separation of adhesions

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10
Q

what is a paracentesis?

A

surgical puncture of peritoneal cavity for aspiration or drainage of fluid

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11
Q

where would a needle for paracentesis go?

A

-anterolateral abdominal wall into peritoneal cavity through linea alba -superior to empty urinary bladder to avoid inferior epigastric artery

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12
Q

what is an intraperitoneal injection used for?

A

anesthetic to peritoneal cavity because peritoneum is a semipermeable membrane (rapid uptake)

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13
Q

what is peritoneal dialysis?

A

removal of excess water and solutes from blood (because of renal failure) by transfer across peritoneum

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14
Q

what is the function of the greater omentum?

A

-prevents visceral peritoneum from adhering to parietal peritoneum -makes adhesions around diseased viscera

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15
Q

what is an abscess?

A

formation of pus because of duodenal ulcer perforation, rupture of gall bladder, or perforation of appendix

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16
Q

why are the peritoneal recesses of clinical importance?

A

they determine extent and direction of fluid spread during infection or disease of an organ

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17
Q

what are paracolic gutters?

A

lateral attachments of ascending/descending colon to posterolateral abdominal wall

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18
Q

why are paracolic gutters important?

A

provide pathway for ascitic fluid flow and spread of infection and cancer

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19
Q

how can fluid get into the omental bursa?

A

perforation of posterior wall of stomach and inflamed pancreas

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20
Q

if part of the intestine perforates into the omental foramen, why can’t you simply cut the boundaries of the foramen?

A

all boundaries have blood vessels, so the intestine must be emptied with a needle and put back in place

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21
Q

what is a cholecystectomy and what artery must be ligated during it?

A

-gall bladder removal -cystic artery

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22
Q

what is the most frequently injured organ in the abdomen?

A

spleen (ex: ruptured spleen from trauma)

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23
Q

how is a ruptured spleen treated?

A

repair is difficult, so splenectomy is preferred

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24
Q

what’s important about a sub-total (partial) splenectomy?

A

rapid regeneration

25
Q

what are the side effects of splenectomy?

A

no major side effects; higher risk for bacterial infection

26
Q

what is splenomegaly and when does it happen?

A

-enlargement of spleen -side effect of granulocytic leukemia & anemia

27
Q

what is clinical important about an accessory spleen?

A

if not detected & removed during splenectomy, symptoms may still persist

28
Q

what’s important about the relationship of the costodiaphragmatic recess and the spleen?

A

splenic needle biopsy and splenoportography can cause pleuritis if material enters the CD recess during these procedures

29
Q

where is an important blockage site of a gallstone?

A

gallstones can lodge into hepatopancreatic ampulla and cause backup of bile and pancreatic juices

30
Q

what causes pancreatitis?

A

bile backup from gallstone that enters pancreatic duct (normally prevented by hepatopancreatic sphincter)

31
Q

what is endoscopic retrograde cholangiopancreatography used for?

A

diagnosis of pancreatic and biliary disease

32
Q

where is accessory pancreatic tissue likely to develop and what’s its importance?

A
  • stomach and duodenum
  • can produce insulin and glucagon
33
Q

what is removed during a pancreatectomy?

A

the body and tail of the pancreas (can’t remove entire head)

34
Q

other than diabetes, what other major problem can occur with the pancreas?

A

rupture of the pancreas due to trauma, which can cause pancreatic juice to enter parenchyma & invade other tissues

35
Q

what’s the major cause of extrahepatic obstruction of biliary ducts?

A

cancer of the pancreatic head

36
Q

an enlarged gallbladder and jaundice most likely indicates?

A

cancer of the pancreatic head

37
Q

cancer of the pancreatic neck & body can cause?

A

obstruction of inferior vena cava and hepatic portal vein

38
Q

why is pancreatic cancer so difficult to control/detect?

A

the pancreas lymph drains to relatively inaccessible lymph nodes and it metastastizes to liver via hepatic portal vein

39
Q

where are subphrenic abscesses likely to be?

A

right side subphrenic recess because of ruptured appendices and perforated duodenal ulcers

40
Q

where is a subphrenic abscess drained?

A

incision inferior to or through the bed of the 12th rib (unnecessary to cut pleura or peritoneum)

41
Q

what is the relevance of the fact that the left and right hepatic arteries/veins/ducts do not communicate?

A

hepatic lobectomies can be done with little bleeding

42
Q

damage to the liver or cancer of the liver can be removed by?

A

hepatic segmentectomies (must use ultrasound to detect individual segments)

43
Q

what is common source of aberrant right hepatic artery? left?

A
  • right: superior mesenteric artery
  • left: left gastric artery
44
Q

in most people, the right hepatic artery crosses ___________ to hepatic portal vein?

A

anterior

45
Q

in most people, the right hepatic artery crosses _________ to common hepatic duct

A

posterior

46
Q

what can cause hepatomegaly?

A
  • congestive heart failure, bacterial and viral diseases such as hepatitis
  • metastatic carcinoma
47
Q

hepatic cirrhosis causes?

A
  • replacement of hepatocytes with fat and fibrous tissue
  • portal hypertension
  • mostly occurs in alcoholics
48
Q

how is advanced hepatic cirrhosis treated?

A

surgical creation of portosystemic or portocaval shunt to anastomose the portal and systemic venous systems

49
Q

where does a liver biopsy take place?

A

through right 10th ICS in midaxillary line

50
Q

what’s clinically important about a mobile gallbladder?

A
  • gallbladder is suspended from liver by mesentary
  • subject to vascular torsion and infarction
51
Q

what is a cholelithiasis made of?

A

gallstone: cholesterol

52
Q

why does cholecystitis occur?

A

blockage of cystic duct via gallstone–> bile accumulation, enlargement of gallbladder

53
Q

where can gallstones collect in a diseased gallbladder?

A

abnormal sacculation called Hartmann pouch at junction of neck of gallbladder and cystic duct

54
Q

what causes a cholecysto-enteric fistula?

A
  • inflamed gallbladder from gallstone can cause adhesions with nearby viscera and break down tissues between them
  • duodenum and transverse colon
  • gallstone can then enter GI tract & obstruct bowel
55
Q

where does the cystic artery usually come from?

A

right hepatic artery in cyctohepatic triangle (calot triangle)

56
Q

what are the borders of the cystohepatic triangle?

A

inferior: cystic duct
medially: common hepatic duct
superiorly: inferior surface of liver

57
Q

varicose veins of lower esophagus indicate?

A

portal hypertension & caput medusae around umbilicus

58
Q

how is portal hypertension treated?

A
  • creating anastomose between hepatic portal vein and IVC (portosystemic shunt)
  • join splenic vein to left renal vein after splenectomy (spenorenal shunt)