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Unit 5 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What causes pain in the thoracoabdominal nerves (T7-T11)? Where can the pain be referred to?

A

Pain from lower thoracic wall (due to pleurisy of costal pleura), may be referred to abdomen (T10 innervates umbilicus level)

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2
Q

What pain goes trhough subcostal nerve (T12)?

A

Pain from upper GI appendages (peptic ulcer), may refer to back

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3
Q

What pain is involved in iliohypogastric and ilioinguinal nerves (L1)?

A

Pain from ureters may refer to groin and scrotum

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4
Q

What does the superficial circumflex iliac artery anastomose with? (3)

A

Deep circumflex iliac artery, superior gluteal, and lateral femoral circumflex artery

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5
Q

What are the superficial vascular supplies of the anterolateral abdominal wall?

A

Superficial epigastric and superficial circumflex iliac arteries from the femoral artery

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6
Q

Where do lymphatics drain if they are above the umbilicus? Below?

A

Above – axillary

Below – superficial inguinal

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7
Q

What embryonic structure are abdominal muscles derived from?

A

Hypomere

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8
Q

What makes up the conjoint tendon (falx inguinalis)? Where are they attached?

A

The fusion of the lowermost fibers of internal oblique with the deeper fibers of transversus abdominis muscle arching over spermatic cord (or round ligament of the uterus) to attach to pubic crest and pecten pubis

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9
Q

What happens in the case of a weak conjoint tendon?

What about in the patent remnant of processus vaginalis?

What about one that pierces through the deep inguinal ring

A

Direct inguinal hernias

Indirect hernia

Indirect

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10
Q

What is Valsa’s maneuver?

A

Guarding is abdominal contraction due to palpation with cold hands (involuntary) or for protection (voluntary)

Rigidity is involuntary muscle spasms due to inflammatory irritation of abdominal muscle’s nerve supply (i.e., acute appendicitis)

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11
Q

What is in the inguinal canal? What is the difference between males and females?

A

Transmits thick spermatic cord in males and thin round ligament of the uterus in females

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12
Q

What are the boundaries of the inguinal canal?

A

Anterior wall — formed mainly by external oblique aponeurosis reinforced laterally by the internal oblique aponeurosis

Posterior wall — formed mainly by transversalis fascia reinforced medially by conjoint tendon

Roof — formed by arching fibers of internal oblique and transversus abdominis muscles

Floor — formed mainly by the inguinal ligament gutter

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13
Q

What are the two types of inguinal hernias? What are the differences? Which one is the most common?

A

Indirect – leaves abdominal cavity lateral to inferior epigastric artery. Commonly exits superficial inguinal ring to descend into scrotum or labium majus. It may be palpated at the superficial inguinal ring when asking patient to strain (with coughing)

Direct — leaves abdominal cavity medial to inferior epigastric artery. It pushes directly into the inguinal canal through or around a weak conjoint tendon, usually against inguinal (Hesselbach’s) triangle

Indirect is more common

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14
Q

What are the boundaries of the inguinal (Hesselbach’s) triangle?

A

Bound by inferior epigastric artery laterally, rectus abdominis medially, and inguinal ligament inferiorly

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15
Q

What is incisional hernia?

A

Protrusions of omentum or organs through the sites of surgical incisions, this may result from improper healing of abdominal wall following surgery or from weakness of the abdominal wall muscles following the cutting of their motor innervation

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16
Q

What are intraperitoneal organs?

A

Intraperitoneal — abdominal organs invaginate peritoneal sac from behind and suspends from the body wall by a double layer of peritoneum (mesentery)

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17
Q

What are retroperitoneal organs?

A

Retroperitoneal — abdominal organs are located posterior to peritoneum so that they only have anterior and lateral coverings

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18
Q

Which peritoneal ligament is a part of an momentum and which one is connected only to its adjacent organs?

A

Gastrosplenic ligament – connected to omentum

Splenorenal ligament – only connected to adjacent organs

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19
Q

Lowest part of pelvic cavity in standing position where abdominal fluids or blood from male/female genital organs (e.g., uterine tube) may accumulate

A

Rectovesical pouch — males

Rectouterine (Douglas) pouch — females

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20
Q

What causes peritonitis? How can it become life-threatening?

A

Peritoneal inflammation due to chemical irritation or bacterial, or fungal infections

Life-threatening condition — due to the large surface area of peritoneum and rapid absorption of bacterial toxins

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21
Q

Lowest part of abdominal peritoneal cavity in supine position between right lobe of the left and right kidney; infected fluid can freely enter this space from omental bursa or subphrenic recess (between liver and diaphragm)

A

Hepatorenal recess — Morison’s pouch/recess

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22
Q

How is bacterial peritonitis treated?

A

In bacterial peritonitis, patient is propped in a seated position (>45°) in order to force infected fluid to flow downward into pelvic cavity where absorption is slower and to reduce spreading of infection to pleura through diaphragm from subphrenic space

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23
Q

What are Peritoneal adhesions?

A

Tough fibrous tissue bridges, which may complicate peritonitis of any reason and can be the source of chronic abdominal pain and/or bowel or uterine tube obstruction and infertility

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24
Q

What is GERD? What can it lead to?

A

Incompetent gastroesophageal junction may cause gastric acids to regurgitate to lower esophagus. It can lead to Barret’s esophagus where esophageal epithelium undergoes metaplastic change (stratified squamous epithelium is reversible replaced by columnar), prone to ulceration and stricture, causing dysphagia — may progress to esophageal cancer

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25
Q

Enumerate the three esophageal constrictions and how they occur

A

Cervical constriction — caused by upper esophageal sphincter at pharyngo-esophageal junction

Thoracic constriction — caused by the arch of the aorta, left main bronchus

Diaphragmatic constriction — caused by lower esophageal sphincter at esophageal hiatus of diaphragm

26
Q

What causes the pyloric stenosis?

A

Infantile (hypertrophic) type — a congenital disorder due to hypertrophy of smooth muscle pyloric sphincter in 4-8 weeks old infants; it inhibits gastric emptying with severe projectile, non-bile stained vomiting and abdominal distention due to gastric dilation — it is rare in adults

27
Q

Enumerate the two hiatal hernias and their differences

A

Upward slide of part (or all) of stomach into thoracic cavity due to enlarged esophageal hiatus of the diaphragm; may cause heartburn or indigestion

Sliding hiatal hernia — more common, usually causes heartburn (pyrosis) due to gastric contents’ regurgitation into esophagus

Paraesophageal hiatal hernia — less common; usually no regurgitation of gastric contents

28
Q

What is the name for the union of the common bile duct and main pancreatic duct? Where does it insert?

A

Hepato-pancreatic ampulla, drains at the 2nd part of the duodenum

29
Q

What causes 90% of gastric ulcers? Which is more common, gastric or duodenal ulcers?

If there’s a gastric ulcer, what is likely to be affected?

A

90% of gastric ulcer is due to H. pylori infection. Duodenal ulcers are more common than gastric ulcers

Gastroduodenal artery, pancreas

30
Q

Where do most duodenal ulcers develop?

A

Duodenal ulcer usually develops in duodenal cap or ampulla (1st or superior part); cause epigastric pain that may occur shortly after eating

31
Q

What arteries may be involved in the complication of duodenal ulcers?

A

It may penetrate the posterior wall causing severe hemorrhage from eroding gastroduodenal branch of celiac artery and peritonitis

32
Q

What is the difference between melena and hematochezia?

A

Distinguishes between upper and lower GI bleeding, e.g., hematemesis (vomiting of blood

Melena (black, tarry stool) — upper GI bleeding

Hematochezia (bring red rectal bleeding) — lower GI bleeding may occur

33
Q

What is Ileal (Meckel’s) diverticulum?

A

Anomalous persistance of proximal part of the vitelline duct. It may become inflamed or infected causing pain mimicking appendicitis; may contain ectopic gastric or pancreatic tissue causing rectal hemorrhage (escape of blood from ruptured vessel); may cause bowl obstruction and perforation

34
Q

What is intussusception? Where does it commonly occur? What are the complications if left untreated?

A

Telescoping of a proximal (leading) segment (intussusceptum) into a more distal part (intussuscipiens)

Iliocecal junction usually is the most common place causing iliocolic intussusception

If untreated, it may cause intestinal obstruction, ischemia, and necrosis

35
Q

What is a volvulus? What is the most affected part?

A

It is a self mesenteric twist that may involve an intestinal part; sigmoid mesocolon is by far the most the most affected

Excessively long sigmoid mesocolon may predispose to volvulus with high risk of intestinal obstruction and infarction

36
Q

What is Hirschsprung disease?

A

Congenital absence of autonomic parasympathetic ganglia within intestinal wall segment resulting in failed peristalsis and constriction of this segment with dilated intestinal part (megacolon) proximal to the affected segment

It is the most common cause of neonatal colon obstruction

It mostly affects the rectum and sigmoid colon causing neonatal abdominal enlargement and constipation, which usually appears shortly after birth

37
Q

What composes the portal triad? Where do they enter the liver?

A

Proper hepatic artery, common bile duct, hepatic duct

They enter the liver through the portal hepatis

38
Q

What is cholecystitis? Cholangitis? Cholelithiasis? Choledocholithiasis?

A

Cholecystitis – inflammation of the gallbladder

Cholangitis – bile duct inflammation

Cholelithiasis – is gallstones in the gallbladder

Choledocholithiasis – is presence of stones in bile ducts

39
Q

What can cause obstructive common bile duct?

A

Obstruct CBD (60% of cases) and bile backs-up to blood stream with jaundice of body tissues (e.g., skin and mucous membranes)

40
Q

What is the most frequently ruptured abdominal organ with life-threatening hemorrhage from blunt trauma to the abdomen or fracture lower left ribs (9-11)?

A

Spleen is the most frequently ruptured abdominal organ with life-threatening hemorrhage from blunt trauma to the abdomen or fracture lower left ribs (9-11). However, it is not vital for life and can be removed without major health hazards

41
Q

What are the two ligaments that suspend the spleen? What innervates the spleen?

A

Gastrosplenic and splenorenal ligaments suspend the spleen. It is innervated by the celiac nerve

42
Q

What supplies the foregut, midgut, and hindgut?

A

Celiac trunk, SMA, IMA, respectively

43
Q

What are the components of the foregut?

A

Abdominal portion of the esophagus, stomach, duodenum (as far as 2nd part)

44
Q

What arteries come off of the common hepatic artery?

A

It gives off the gastroduodenal artery, which goes to the stomach, head of the pancreas, and the duodenum

It also gives off the proper hepatic artery, going to the liver, gallbladder, and the stomach

45
Q

What gives rise to the gastroduodenal artery?

In order, what comes off of the gastroduodenal artery?

A

Gastroduodenal artery comes off of the common hepatic artery

It gives rise to the posterior superior pancreaticoduodenal artery, anterior superior pancreaticoduodenal artery. It then splits into the omental arteries and the right gastroepiploic arteries

46
Q

What gives rise to the inferior pancreaticoduodenal arteries?

A

Directly from the superior mesenteric artery

47
Q

Name the branches of the SMA

A

Inferior pancreaticoduodenal artery (head of pancreas and duodenum

Middle colic artery (gives rise to marginal)

Right colic artery (to ascending colon)

Jejunal/ileal branches

Ileocolic artery (terminal ileum, cecum, ascending colon, and appendix)

48
Q

What are the branches of the IMA?

A

Left colic artery (descending colon)

Sigmoid artery and superior rectal artery (includes anal canal)

49
Q

What provides a collateral circulation that may prevent infarction if one of the abdominal branches is obstructed or has to be ligated?

A

The marginal artery provides an anastomosis between the SMA na IMA

50
Q

What drains into the hepatic portal vein?

A

It is formed by the union of splenic vein and superior mesenteric vein. GI veins and their terminal portal vein form the portal circulation

51
Q

What is the significance of the hepatic portal vein in cancer?

A

It can disseminate malignant cells from the GI tract to the liver

52
Q

What are the different parts of the thoracic splanchnic nerves? Where do they come from? What does the thoracic splanchnic nerve target

A

Greater splanchnic (T5-9), lesser splanchnic (T10-11), and least splanchnic (T12)

Mainly targets the foregut and midgut organs

53
Q

Where does the lumbar splanchnic nerve come from? What does it target?

A

L1-2, occasionally L3. It targets the hindgut organs

54
Q

Describe the prevertebral ganglia in terms of where they lie and the organs that they target

A

Celiac trunk (celiac ganglia to foregut organs)

Superior mesenteric artery (superior mesenteric ganglion to midgut organs)

Inferior mesenteric artery (inferior mesenteric ganglion to hindgut)

Renal arteries (aorticorenal ganglia to kidneys)

55
Q

What do the branches of the prevertebral ganglia nerve fibers innervate?

A

Celiac ganglia nerve fibers — follow celiac trunk branches to foregut derivatives: duodenum, liver, gallbladder, pancreas

Superior mesenteric ganglia fibers — superior mesenteric artery branches to midgut derivatives

Inferior mesenteric ganglia nerve fibers — follow inferior mesenteric artery branches to hindgut derivatives

Aorticorenal ganglia fibers — follow renal artery branches to the kidneys and adrenal glands

56
Q

Where is the right diaphragm found during expiration? Left?

What happens to the diaphragm during inspiration?

A

The right diaphragm is found on the 5th rib, left dome is found on the 5th intercostal space during expiration

During inspiration, they can go down 1 intercostal space

57
Q

Which is better in relationship to tissue scarring, if incisions are done parallel or perpendicular to tension lines? Why?

A

Parallel, less scarring

58
Q

What is the significance of Scarpa’s fascia?

A

It is continuous with superficial fascia of scrotum and perineum. Extravasated urine from a ruptured penile urethra or infection may spread upward into anterior abdominal wall deep Scarpa’s fascia

59
Q

Can fluid from the abdominal region migrate down into the thigh?

A

No because of the blending of Scarpa’s fascia with fascia lata

60
Q

Which muscles participate in trunk rotation?

A

Simultaneous contraction of one-side internal oblique and contralateral side external oblique

61
Q

Which veins are a collateral channel for returning blood to the heart in the obstruction of superior or inferior vena cava?

A

Anastomoses between the superficial epigastric vein and the lateral thoracic vein of the axilla form the thoracoepigastric vein, which is a collateral channel for returning blood to the heart in the obstruction of superior or inferior vena cava

Unit 5 (11 decks)

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