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Anatomy > Abdomen 2 > Flashcards

Abdomen 2 Flashcards

1
Q

Intraperitoneal organs

A 
Duodenum, first part
Liver and gallbladder
Pancreas, tail 
Stomach 
Spleen
Jejunum and ileum
Cecum and appendix
Transverse colon
Sigmoid colon
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2
Q

Retroperitoneal organs

A 
Kidneys
Ureters
Suprarenal glands
Abdominal aorta
Inferior vena cava
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3
Q

Secondarily retroperitoneal

A

Duodenum, second part, third and fourth part
Ascending and descending colon
Rectum
Pancreas, head, neck and body

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4
Q

Contains the greater sac

Lesser/omental sac

A

Peritoneal cavity

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5
Q

Peritoneal fluid amount

A

50 mL

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6
Q

Connection between the greater and lesser sac

A

Epiploic foramen of Winslow

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7
Q

Anterior to the epiploic foramen of Winslow

A

Hepatoduodenal ligament

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8
Q

Posterior to epiploic foramen of Winslow

A

IVC

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9
Q

Hepatoduodenal ligament contains the

A

Portal vein
Hepatic artery
Common bile duct

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10
Q

Aka hepatorenal recess

A

Morrison pouch

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11
Q

Most dependent portion of the abdominal cavity in the supine position

A

Morrison pouch

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12
Q

Most dependent area in the upright position

A

Rectouterine pouch of Douglas

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13
Q

Access to rectouterine pouch

A

Posterior fornix of vagina

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14
Q

Scrotum layers

A 
Skin
Dartos - Camper
Colles - Scarpa
External spermatic fascia - EO
Cremasteric muscle - IO 
NO TRANSVERSUS ABDOMINIS
Internal spermatic fascia - Transversalis fascia
Tunica vaginalis - Peritoneum 
Tunica albuginea
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15
Q

Part of stomach that Secretes mucus

A

Cardia

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16
Q

Part of stomach that houses parietal cell
secretes IF and HCl

chief cell - pepsin

A

Fundus and body

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17
Q

Part of the stomach that houses G cells secreting gastrin

A

Pyloric antrum

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18
Q

At the level of the stomach, the

anterior nerve

posterior nerve

A

Left vagus

Right vagus

LARP

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19
Q

Gives rise to hepatic branch

Nerves of Laterjet (Anterior)

A

Left/Anterior Vagus nerve

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20
Q

Gives rise to celiac branch

Nerves of Laterjet (posterior)

A

Right/posterior vagus

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21
Q

50% of the stomach is innverated by

A

Criminal nerve of Grassi

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22
Q

Innervates the fundus and body of stomach

A

Nerves of Laterjet

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23
Q

Innervates the antrum

A

Crow’s foot

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24
Q

Denervated structure in truncal vagotomy

A

Hepatic and celiac branch
Fundus and body
Antrum (needs drainage procedure)

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25
Q

Denervated structure in selective vagotomy

A

Fundus
Body
Antrum

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26
Q

HSV/Parietal/Proximal cell vagotomy denervated structures

A

Fundus

Body

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27
Q

Modified Johnson Classification of PUD

Type I

A

Along lesser curvature

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28
Q

MJ Type II

A

One gastric

One duodenal/prepyloric

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29
Q

MJ Type III

A

Prepyloric ulcer

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30
Q

MJ Type IV

A

Proximal gastroesophageal

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31
Q

MJ Type V

A

Anywhere (associated with chronic NSAID use)

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32
Q

Ulcer type associated with increased gastric acid secretion:

A

Type II and III

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33
Q

Unique features of the colon

A

Taenia coli (rectosigmoid junction)
Appendices epiplocae
Haustra

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34
Q

Cecum -> Splenic flexure

Blood supply

A

SMA

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35
Q

Descending colon -> upper rectum

A

IMA

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36
Q

Meandering mesenteric artery

Union of middle colic artery and left colic artery

A

Marginal artery of Drummond

Arc of Roilan

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37
Q

Immunologic organ
Secretes IgA
Part of galt associated lymphoid tissue

A

Appendix

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38
Q

Inflammation of the appendix

Most common acute surgical abdomen

Most frequent in the 2nd and 3rd decade of life

Rare in very young

M/F ratio 1:1 prior to puberty
2:1 at puberty

A

Acute appendicits

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39
Q

Obstruction of the lumen leads to increase intraluminal pressure

A

Appendicitis

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40
Q

Most common cause of appendicits

A

Fecalith

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41
Q

Hypertrophy of the lymphoid tissue
Inspissated barium
Vegetable and fruit seeds
Intestinal worms (ascaris)

A

Appendicits

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42
Q

Closed loop obstruction (primary block)
Continuing normal secretion of appendiceal mucosa
Rapid distention (stimulation of visceral nerve pain fibers)
Rapid bacterial multiplication
Capillaries and venules occluded
Vascular engorgement and congestion (reflux nasura and vomiting)

A

Appendicitis

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43
Q

Inflammatory process involve serosa of the appendix (stimulation of somatic nerve)
RUQ pain
Absorption of necrotic tissue and bacterial toxin (fever, tachycardia and leukocytosis)
Progressive distention
Infarction (compromise blood supply)
Perforation

A

Appendicitis

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44
Q

Prime symptom of appendicits

A

R LQ pain

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45
Q

Constant symptom in diagnosis

A

Anorexia

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46
Q

75% of patients with Acute Appendicits will present with

A

Vomiting

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47
Q

Sequence of symptoms in Acute Appendicitis

A

Anorexia 95%
Abdominal pain
Vomiting

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48
Q

Classic sign of acute appendicits

A

Direct tenderness at McBurney’s point (lateral 1/3 from ASIS to umbilicus)

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49
Q

Pain at RLQ when palpatory pressure exerted at LLQ

A

Rovsing’s sign

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50
Q

Area supplied by spinal nerves on the R T10, T11 and T12

A

Cutaneous hyperesthesia

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51
Q

Patient lies on the left side, examiner then slowly extends the right thigh, stretching the iliopsoas muscle

(+) if extension produces pain

A

Psoas sign

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52
Q

Hypogastric pain on stretching the obturator internus muscle; performed by passive internal rotation of the flexed thigh with the patient in supine position

A

Obturator sign

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53
Q

Lab finding in acute appendicits

A

WBC Moderate leukocytosis (10,000-18,000) uncomplicated

>18,000 complicated

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54
Q 
ALVARADO SCORE
Migratory right iliac fossa pain
Anorexia
Nausea or Vomiting
Rebound tenderness right iliac fossa
Fever >/= 36.3
Shift to the left of neutrophils

All receive a score of

A

1

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55
Q

ALVARADO SCORE

that receives a score of 2

A

Tenderness: right iliac fossa

Leukocytosis >/= 10 x 10^9 cells/L

56
Q

An ALVARADO score of <3

A

Low likelihood of appendicitis

57
Q

An ALVARADO score of 4-6

A

Consider further imaging

58
Q

An ALVARADO score of >/= 7

A

High likelihood of appendicits

59
Q

Components of appendicits inflammatory response score

A

Vomiting 1
Pain in the right inferior fossa 1
Rebound tenderness or muscular defense: light 1, medium 2, strong 3
Body temperature >/= 38.5 1
PMN 70-84% 1, >/=85 2
WBC 10-14.9 1, >15 2
C-RP concentration 10-48 g/L 1, >/= 50 g/L 2

60
Q

Appendicits inflammatory response score interpretation

0-4
5-8
9-12

A

0-4 low probability, outpatient follow-up
5-8 indeterminate group, active observation or diagnostic laparoscopy
9-12 high probability, surgical exploration

61
Q

Imaging studies for acute appendicits

Inexpensive
Does not require contrast
Applicability among pregnants

Sign: wall thickening, peri-appendiceal fluid

A

Grade compression US

62
Q

Imagig studies for acute appendicits

More sensitive and specific

A

CT Scan

63
Q

Sign of acute appendicits in CT

Thickened cecum that funnels contrast into appendiceal orifice

A

Arrowhead sign

64
Q

Accuracy of pre-operative diagnosis in acute appendicits should be >

A

> 85%

65
Q

Rupture of acute appendicits is higher in the

A

pediatric and geriatric age groups

66
Q

Differential diagnosis for acute appendicits

A

Acute abdomen

Acute mesenteric lymphadenitis
No organic pathologic condition
Acute PID
Twisted ovarian cyst or ruptured Graafian follicle
AGE
67
Q 
Gangrene &amp; rupture occur earlier during the course of acute appendicits
Inability to give accurate history 
Diagnostic delays
High frequency of GI distress
Underdeveloped greater omentum

Children <5 years of age
Negative appendectomy rate = 25%
Perforation rate = 45%

A

Appendicits in the Young

68
Q

Most common extrauterine surgical emergency
Rare in third trimester
Incidence = 1:766
Negative appendectomy rate = 25% (2nd trimester)
Consider when there is new onset abdominal pain
Laboratory evaluation is not helpful

Imaging: US or MRI
Incidence of fetal loss = 4%
Risk of early delivery = 7%

Pregnancy does not alter the location of the appendiceal base more than 2cms from McBurney’s point

A

Appendicits in Pregnancy

69
Q

Urgent 12-24h
Emergent <12h

No significant difference
Number of complicated appendices
Rate of SSI, intra-abdominal abscess formation
Operative time
Conversion to open procedure in case of laparoscopy
Surgeon and institution dependent

A

Uncomplicated appendicits

70
Q

Management for complicated appendicitis

A

Perforated appendicits commonly associated with abscess or phlegmon
2/10000 per year

Standard treatment
-immediate appendectomy

Non operative management

  • confined abscess/phlegmon
  • limited peritonitis

Tx - antibiotics, fluids, bowel rest, percutaneous drainage

71
Q

If appendicits is not found

A

Cecum and mesentery should be inspected
Retrograde evaluation of the small bowel
Look for Crohn’s or Meckel’s diverticulitis
Inspect reproductive organs (females)
Extend the incision if pus or bilious fluid is encountered

72
Q

Clinical syndrome of the right lower quadrant or right iliac fossa pain secondary to a perforated peptic ulcer

A

Valentino syndrome

Valentino appendix

73
Q

Incidental appendectomy

Indications

A

Children about to undergo chemotherapy
Disabled individuals
Crohn’s disease (cecum must be healthy)
Individuals about to travel to remote places

Routinely performed in Ladd’s procedure

74
Q

Most common site of GI carcinoid

A

Appendix

75
Q

Usually small, firm circumscribed, yellow brown tumor

Usually located at the tip

A

Carcinoid tumor with best prognosis

Malignant potential related to size

76
Q

Adenocarcinoma of appendix kinds:

A

Mucinous adenocarcinoma

Signet ring carcinoma (rarest, lowest survival)

77
Q

Adenocarcinoma of appendix tx:

A

Right hemicolectomy

78
Q

Cystic dilatation of the appendix containing mucoid material

A

Mucocoele

79
Q

From non-inflammatory occlusion of the proximal lumen of the appendix

A

Benign Mucocele

80
Q

Malignant mucocoele

A

Cystadenocarcinoma

81
Q

Mucocoele tx:

A

Appendectomy
Wide resection of the mesoappendix and all appendiceal lymph nodes
Collection and cytologic examination of intraperitoneal mucus

Right hemicolectomy
+ tumor at the base
+ periappendiceal lymph nodes

82
Q

Diffuse collection of gelatinous fluid and mucinous implants on peritoneal surfaces and omentum
(peritoneal surface of bowel spared)

More common in women
Abdominal pain, distention, mass

CT scan (preferred)

Tx: thorough surgical debulking appendectomy, omentectomy, TAHBSO

A

Pseudomyxoma peritonei

83
Q

Extremely uncommon tumor of the appendix
Presents as appendicits

CT scan findings
Appendiceal diameter >2.5cms
surrounding soft tissue thickening

Treatment:
Appendectomy: confined to appendix
Right hemicolectomy: cecal and mesosppendix involvement

A

Lymphoma of appendix

84
Q

Anatomical division of the liver is by

A

Falciform ligament

85
Q

Physiologic division of liver is by

A

Cantlie line

86
Q

Connects the fundus of the gallbladder with the center of the inferior vena cava

Divided according to the portal division of blood supply

A

Cantlie line

87
Q

Cantlie’s line runs between the medial borders of segment

A

IV and V/VIII

88
Q

Blood supply of liver

A

Hepatic artery 25%

Portal vein 75%

89
Q

Valves of Heisted

A

Cystic duct

90
Q

The biliary tree is made up of the

A

Cystic duct
Right and left hepatic ducts
CBD
Ampulla of Vater

91
Q

Biliary tree drains at

A

posteromedial wall of the 2nd part of the duodenum

92
Q

Ventral pancreas

A

Head, inferior
Uncinate process
Main/major pancreatic duct

93
Q

Dorsal pancreas

A 
Head, superior 
Neck
Body 
Tail 
Accesorry/minor pancreatic duct
94
Q

Most common congenital anomaly of pancreas

A

Pancreas divisum

95
Q

Failure of fusion of dorsal and ventral pancreatic primordia
Bulk of the pancreas drains through the dorsal pancreatic duct and fhe small caliber minor papilla

Predisposes to chronic pancreatitis

A

Pancreas divisum

96
Q

Bulk of pancreas drains through the

A

dorsal pancreatic duct

small-caliber minor papilla

97
Q

Band-like ring of normal pancreatic tissue that encircles 2nd portion of duodenum

Assoc with other congenital anomalies

Presents as duodenal obstruction (gastric distention, vomiting)

A

Annular pancreas

98
Q

Aberrantly situated pancreatic tissue

A

Ectopic pancreas

99
Q

Favored sites of ectopic pancreas

A 
Stomach 
Duodenum 
Jejunum 
Meckel diverticula 
Ileum
100
Q

May cause localized inflammation or mucosal bleeding

A

Ectopic pancreas

101
Q

Main pancreatic duct drains to the

A

Main pancreatic duct of Wirsung drains to the Major duodenal papilla

102
Q

Accessory pancreatic duct of Santorini drains to the

A

Minor duodenal papilla

103
Q

Reversible pancreatic parenchymal injury associated with inflammation

Most common etiologies are alcoholism 65%
Biliary tract disease 35-60%

A

Acute Pancreatitis

104
Q

Causes of acute pancreatitis

A

Duct obstruction
Acinar cell injury
Defective intracellular transport

105
Q

Activated enzymes in acute pancreatitis

A

Interstitial inflammation and edema
Proteolysis (proteases)
Fat necrosis (lipase, phospholipase)
Hemorrhage (elastase)

106
Q

Acute Pancreatitis causes

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpio sting
Hyperlipidemia/hypercalcemia
ERCP
Drugs (sulfa drugs)
107
Q

Proteolytic destruction of pancreatic parenchyma

Destruction of blood vessels and subsequent intersitial hemorrhage

A

Acute Pancreatitis

108
Q

Ranson Criteria

Admission

A 
Glucose >200
AST > 250
LDH > 350
Age > 55
WBC > 16000

GALAW

109
Q

Ranson Criteria

Initial 48 hours

A 
Calcium <8
Hct drop >10% 
Oxygen <60
BUN >5 
Base deficit >4
Sequestration >6L

CHOBBS

110
Q

Necrotizing pancreatitis signs

A 
Grey Turner Sign (flank)
Cullen sign (umbilicus)
111
Q

What is the most appropriate treatment for acute pancreatitis?

A

Bowel rest NPO

112
Q

What is the most appropriate analgesic for patient with acute pancreatitis? Why?

A

Meperidine

doesn’t cause dysfunction of Sphincter of Oddi

113
Q

Inflammation of the pancreas with irreversible destruction of exocrine pancreas

Most common cause of chronic pancreatitis is long-term alcohol abuse

A

Chronic pancreatitis

114
Q 
Activation of proteolytic enzymes
Activation of clotting cascade
Inflammation
Vascular injury
Acinar cell injury 
Resolution
A

Acute Pancreatitis

115
Q

Ethanol
Oxidative stress
Injury

Inflammation
TGFB
TGFB
PDGF

Collagen secretion
ECM remodelling

Pancreatic fibrosis
Acinar cell loss

A

Chronic pancreatitis

116
Q

Parenchymal fibrosis
Reduced number and size of acini
Dilation of pancreatic ducts

A

Chronic pancreatitis

117
Q

Localized collect of necrotic-hemorrhagic material rich in pancreatic enzymes

Lack an epithelial lining

Usually arise in the following settings:
after an episode of acute pancreatitis
chronic alcoholic pancreatitis

A

Pancreatic pseudocyst

118
Q

Fourth leading cause of cancer death

A

Pancreatic adenocarcinoma

119
Q

Strongest environmental influence is cigarette smoking

Localization 
60% head of the pancreas
15% in the body
5% in the tail
20% diffusely involves the entire gland
A

Pancreatic adenocarcinoma

120
Q

Spleen size

A

1 x 3 x 5 inches

121
Q

Spleen weight

A

7 oz

122
Q

Spleen is situated

A

between ribs 9-11

123
Q

Splenorenal ligament contents:

A

Splenic vessels

Tail of pancreas

124
Q

Gastrosplenic ligament contents:

A

Short gastric vessels

125
Q

Compression of the third part of the duodenum

A

Superior mesenteric artery syndrome

126
Q

Renal vein entrapment syndrome

A

Nutcracker syndrome

127
Q

Most common site of aneurysm

A

Abdominal aneurysm

Infrarenal

128
Q

SMV + Splenic vein makes up the

A

Portal vein

129
Q

The portal vein is located

A

behind the neck of the pancreas

130
Q

Hepatic portal systems drains

A

Lower 1/3 of esophagus to upper 1/2 of anal canal

131
Q

Tributaries of the splenic vein

A

Short gastric vein
Left gastroepiploic vein
Inferior mesenteric vein
Pancreatic vein

132
Q

Sites of anastomoses between portal and caval systems

A

Umbilicus
Rectum
Esophagus
Retroperitoneal organs

133
Q

Paraumbilical veins
Superficial veins of the anterior abdominal wall
Caput medusae

A

Umbilicus

134
Q

Superior rectal vein
Middle and inferior rectal veins
Internal hemorrhoids

A

Rectum

135
Q

Gastric vein
Veins of the lower esophagus
Esophageal varices

A

Esophagus

136
Q

SMV and IMV
Veins of the posterior abdominal wall
Not clinically relevant

A

Retroperitoneal organs

Anatomy (13 decks)

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