abdomen clinical correlates Flashcards
(139 cards)
1
Q
what is paracentesis?
A
passing a needle through structures of abdominal wall to access peritoneal space for excess fluid removal
2
Q
where is paracentesis performed? (hint: 2 places in the abdomen)
A
anteriorly - either midline through linea alba or laterally through muscular wall
3
Q
generally, where do preganglionic sympathetic fibers synapse?
A
in prevertebral ganglia
4
Q
what is the exception to preganglionic sympathetic synapsing?
A
the suprarenal medulla
(preganglionic sympatheti fibers from greater splanchnic nerve synapse directly on chromaffin cells located in suprarenal medulla)
5
Q
what is the level of the greater splanchnic nerve?
A
T5-T9
6
Q
where do preganglionic sympathetic fibers that synapse on the suprarenal medulla bypass?
A
celiac ganglion
7
Q
ANS sympathetic visceromotor functions include:
A
decreased peristalsis and gland secretion
vasoconstriction
closure of sphincters
8
Q
ANS parasympathetic visceromotor function includes:
A
increased peristalsis and gland secretion
vasodilation
opening of spinchters
9
Q
what are esophageal varices?
A
enlarged veins in the esophagus
10
Q
do esophageal varices occur proximally or distally?
A
distally
11
Q
where do distal esophageal varices occur?
A
between tributaries of the left gastric vein (portal) and esophageal veins (caval)
12
Q
what causes esophageal varices?
A
increased pressure in portal vein causing back flow of venous blood into smaller veins and dilation
13
Q
what is portal hypertension?
A
an increase of pressure in the portal vein
14
Q
what causes portal hypertension?
A
cirrhosis of the liver which casuses scar tissue
15
Q
true or false: very little blood returns through the hepatic vein into the inferior vena cava
A
true
16
Q
true or false: scar tissue obstructs blood flow through liver
A
true
17
Q
what causes a barrett esophagus?
A
GERD (gastroesophageal reflux disease)
18
Q
what is the clinical importance of metaplastic invasion that occurs with barrett esophagus?
A
almost all lower esophageal adenocarcinomas occur as a sequela
19
Q
why does the liver’s position change with respiration?
A
due to the relationship with the diaphragm and thoracic cage
20
Q
with expiration, the diaphragm is _____ and the liver is ______
A
diaphragm = domed
liver = elevated
21
Q
with inspiration, the diaphragm is ____ and the liver is _____
A
diaphragm = flattened
liver = depressed
22
Q
mobility of the liver during respiration can aid in palpation to assess what?
A
palpation of the inferior margin to assess liver size and position
23
Q
what is palpation of the inferior margin important for?
A
screening for hepatitis and metastatic carcinoma (causes hepatomegaly)
24
Q
when the liver is enlarged, what happens to the inferior margin?
A
it can be easily palpated because it extends well beyond the inferior border of the ribs
25
what does liver cirrhosis cause?
portal hypertension
26
in liver cirrhosis, what does increased type 1 collagen narrow?
the diameter of the sinusoid
27
what is caput medusae?
portal hypertension clinically represented by varicosities around umbilical anastomosis where the paraumbilical veins in the subcutaneous fascia of anterior abdominal wall become distended
28
what causes caput medusae?
when blood flow in the portal vein is reversed and forced into the caval system at portal caval anastomosis
29
what is caput medusae named after?
the appearance of the varicosities resembles the head of the medusa
30
what is an abdominal aortic aneurysm?
a true aneurysm which
1. the diameter of the aortic lumen is 50% larger than that of the normal aortic lumen diameter
2. dilation is segmental
3. full thickness of vessel is affected
31
where do abdominal aortic aneurysms mostly occur? what level is this at?
between the renal and inferior mesenteric arteries (L1-L3)
32
what are risk factors for abdominal aortic aneurysms? (hint: 5)
1. being male
2. atherosclerosis
3. hypertension
4. family history
5. age
33
what are abdominal aortic aneurysms symptoms (pre-rupture)
1. abdominal, back, or flank pain
2. poor circulation
3. potential ischemia in lower limbs
34
what are symptoms of a ruptured abdominal aortic aneurysm?
1. hypotension
2. delirium
3. severe central abdominal pain that radiates to spine
4. abdominal mass with pulse (in 50% of cases)
35
what is the BBC approach for interpreting abdominal radiographic images?
bowel (and other organs)
bones
calcifications (and calcifications)
36
what is the purpose of a stepwise fashion for interpreting radiographic images?
minimizes errors and maximizes the effectiveness of a treatment plan
37
what should you look for in small and large bowels during imaging analysis?
mucosal fold patterns
38
explain small bowel folds
span the fill width of the bowel
39
explain large bowel folds
do not completely traverse the large bowel
40
what is the stepwise fashion for all radiology besides bowel?
lungs
liver
gallbladder
stomach
psoas muscles
kidney
spleen
bladder
bones
calcifications and artifacts
41
what part of the lungs are assessed for pathology?
the bases
42
what quadrant is the liver in, and what should be assessed for the liver in radiology?
right upper quadrant - assess size
43
what organ is difficult to see on an x-ray?
the gallbladder
44
where are the psoas muscles located?
in the lumbar region
45
what should be analyzed on the psoas muscle in radiology?
demarcation on the lateral edge (psoas fat plane)
46
which kidney is more visible in radiology?
the right kidney
47
where does the spleen lie? (what quadrant and next to what organ?)
left upper quadrant
superior to left kidney
48
spleen _____ should be looked for in radiology
enlargement
49
the variable size of the bladder depends on ______
its fullness
50
bones are used for ______ when assessing organ radiology
landmarks
51
what is the order you should proceed in when analyzing bones
ribs > lumbar vertebrae > sacrum > coccyx > pelvis > proximal femurs
52
what are examples of calcifications that can be visualized on abdominal x-rays?
gallstones, renal stones
pancreatic, vascular, and costochondral calcifications
53
what are examples of artifacts that may be visualized on abdominal x-rays?
surgical clips, jewelry (umbilicus), intrauterine device
54
T or F: gas patterns can be visualized in abdominal x-rays
true
55
what is essential for diagnostic and interventional radiology?
a solid understanding of the spatial arrangement of structures
56
what is the systematic approach to interpreting abdominal CT images?
identifying abdominal wall layers, peritoneal spaces/structures, normal fat planes, and solid organ location and features.
57
you should work ______ to _____ for a thorough interpretation of abnormal anatomy and pathology
superficial to deep
58
when viewing axial CT images, the patients feet are _____ __ of the plane of the image and the head is _____ the plane of the image
feet = coming out
head = into
59
organizing viscera into ______ _____ can help to determine positions in stacked (CT) images
abdominal quadrants
60
where does excess peritoneal fluid collect?
in the rectovesicle pouch (men)
in the rectouterine pouch (females) (pouch of douglas)
61
where is excess peritoneal fluid accessed in males?
through the umbilicus
62
where is excess peritoneal fluid accessed in females?
posterior fornix of the cervix
63
visceral pain fibers (GVA) from the appendix travel with the ______ fibers back to the T__ spinal cord segment
sympathetic fibers back to the T10
64
referred visceral pain from the appendix is located where?
around the umbilicus
65
what dermatome is the umbilicus?
T10
66
Inguinal hernias are described as being either ____ or _____.
direct or indirect
67
An inguinal hernia results from abdominal contents—typically _____ ______—protruding through the abdominal body wall in the inguinal region.
small bowel
68
A _____ inguinal hernia occurs medial to the inferior epigastric vessels, where contents typically protrude through the superficial ring in the inguinal (Hesselbach) triangle.
direct
69
An _____ hernia occurs lateral to the inferior epigastric vessels, where contents protrude through the deep inguinal ring and canal into the scrotum
indirect
70
Direct inguinal hernias are more common in _____ males
aged
71
Indirect inguinal hernias are more common in _____ males
younger
72
indirect inguinal hernias are often a result of ____ ______ _____
patent processus vaginalis
73
______ of the peritoneum can occur as a result of visceral rupture (e.g., appendix), visceral fluid escape into the peritoneal cavity, penetration of the peritoneal cavity (e.g., stab wound), or contact between enlarged viscera and surrounding peritoneum
inflammation
74
Inflammation of the parietal peritoneum presents with....
sharp, localized pain, rebound tenderness and reflexive guarding with palpation in the area of inflammation
75
what is peritonitis?
inflammation and infection of the peritoneum
76
how is peritonitis treated?
cavity washout with sterile saline and antibiotics
77
The ______ _______ plays a protective role during inflammation and infection in the peritoneal cavity such that it can isolate and seal off the damaged region and acts as the principle site for migration and proliferation of macrophages and neutrophils.
greater omentum
78
what is nutcracker syndrome?
compression of the left renal vein by overlaying superior mesenteric artery
79
explain the course of the left renal vein
courses across the abdominal aorta, just posterior to the SMA to reach
the left kidney
80
compression of the left renal vein limits/occludes in what?
drainage of venous blood from the left kidney to the IVC
81
what does nutcracker syndrome cause?
left flank pain and renal hypertension with subsequent venous
rupture within the kidney, resulting in blood in the urine (hematuria)
82
how does nutcracker syndrome differ from SMA syndrome (wilkie syndrome)?
wilkie syndrome compresses the horizontal 3rd part of the duodenum causing visceral obstruction (not vascular obstruction)
83
what is Gastroesophageasl reflux disease?
the symptoms or mucosal damage produced by the abnormal reflux of gastric contents through the lower esophageal sphincter (LES) into the esophagus
84
describe the pathological findings of GERD
1. hyperemia (engorgement of blood)
2. superficial erosions and ulcers which appear as vertical linear streaks
3. hydropic changes in the stratified squamous epithelium along
4. increased lymphocytes, eosinophils, and neutrophils.
85
describe clinical features of GERD
1. heartburn (pyrosis), which may worsen when bending or lying down
2. regurgitation
3. dysphagia (difficulty in swallowing)
86
what are causes for dysphagia?
esophageal cancer (adenocarcinoma from barrett metaplasia or squamous cell carcinoma)
87
A hiatal hernia occurs when a portion of the stomach herniates through the
_______ _____ in the diaphragm
esophageal hiatus
88
what are the 2 categories of hiatial hernias?
sliding and paraesophageal
89
In a ______ hiatal
hernia, the Z-line that marks the mucosal transition between the esophagus
and stomach slides superiorly with the herniation of stomach (cardia).
sliding
90
In a ________ hiatal hernia, the normal anatomical location of the Z-line is
maintained, and the portion of stomach (fundus) and associated peritoneum
protrudes through the hiatus, just anterior to the esophagus.
paraesophageal
91
what is Primary biliary cirrhosis?
an autoimmune disease characterized by
a CD8+ cytotoxic T-cell–mediated attack on intrahepatic bile ductules
92
_______ _______ has been speculated to initiate the T-cell–mediated attack in primary biliary cirrhosis
Molecular mimicry
93
Molecular mimicry occurs when....
foreign antigens stimulating an immune response have enough similarity to “self” proteins that the
immune response “spills over” to attack normal tissues.
94
_____ is characterized by the presence or formation of gallstones either in the gallbladder (called cholecystolithiasis) or common bile duct (called choledocholithiasis).
cholelithiasis
95
what do most gallstones consist of?
cholesterol (major component)
bilirubin
calcium
96
what stones are yellow to tan, round or faceted, smooth, and single or multiple. These stones are composed mainly of cholesterol.
cholesterol stones
97
what stones are black, irregular, glassy upon cross section, and <1 cm in diameter. They are composed mainly of calcium bilirubinate, bilirubin polymers, other calcium salts, and mucin.
black pigment stones
98
what stones are brown, spongy, and laminated. They are composed mainly of calcium bilirubinate, cholesterol, and calcium soaps of fatty acids.
brown pigment stones
99
______ is the clinical manifestation of inflammation of the pancreas
pancreatitis
100
_____ ______ is characterized by a sudden onset of epigastric pain that is often exacerbated when the patient is supine
acute pancreatitis
101
what is the primary cause of pancreatitis?
obstruction of the hepatopancreatic ampulla from a gallstone
102
T or F: the main pancreatic duct can lose patency with swelling of the pancreatic head.
true
103
_______ ____ of pancreatic products and bile may also occur as a
result of the blockage
retrograde flow
104
On __, the pancreas typically
looks enlarged with poorly defined margins due to edema
CT
105
_____ _____ _____ is the most common cause of chronic pancreatitis.
chronic alcohol abuse
106
type ___ diabetes marked by autoantibodies and an insulitis reaction that results in the destruction of pancreatic β cells
type 1
107
T or F: type 1 diabeties is a multifactorial disease
true
108
The clinical features of type I diabetes include
hyperglycemia, ketoacidosis, and exogenous insulin dependence
109
Long-term clinical effects of type I diabetes include...
neuropathy, retinopathy leading to blindness, and nephropathy leading to kidney failure.
110
Type __ diabetes is marked by insulin resistance of peripheral tissues and abnormal a cell function and is often associated with obesity
type 2
111
T or F: type 2 diabetes is multifactorial
True
112
how is type 2 diabetes found
often detected during routine screening by detection of hyperglycemia or by patient complaining of polyuria.
113
splenomegaly can be caused by what 3 things?
hepatic pathology, hematologic pathology, and infection
114
T or F: the liver should not be easily palpated in the normal person
true
115
what is An ileal diverticulum (Meckel diverticulum)?
occurs when a remnant of the vitelline duct persists, thereby forming an outpouching located
on the antimesenteric border of the ileum
116
where is an ileal diverticulum usually located?
sually located about 30 cm proximal to the ileocecal valve in infants and varies in length from 2 to 15 cm
117
Heterotopic gastric mucosa may lead to...
ulceration, perforation, or GI bleeding, especially if a large number of parietal cells are present
118
list symptoms of ileal diverticulum
symptoms resembling appendicitis and bright red or dark red stools (i.e., bloody).
119
what is chron disease?
a chronic inflammatory bowel disease that usually appears in teenagers and young adults
120
chron disease usually affects...
the ileum and the ascending right colon.
121
what is chron disease caused from?
etiology of CR is unknown, although epidemiologic studies have indicated a strong genetic predisposition, and immunologic studies have indicated a role of cytotoxic T cells in the damage to the intestinal wall
122
explain pathological findings of chron disease
Pathologic findings include
1. transmural nodular lymphoid aggregates
2. noncaseating epithelioid granulomas
3. neutrophil infiltration of the intestinal glands that ultimately destroys the glands leading to ulcers
4. coalescence of the ulcers into long, serpentine ulcers (linear ulcers) oriented along the long axis of the bowel
123
what is a classic feature of chron disease?
he clear demarcation between diseased bowel segments located directly next to uninvolved normal bowel and a cobblestone appearance that can be seen grossly and radiographically.
124
what is appendicitis?
acute inflammation of the appendix caused by blockage of theorgan’s small lumen by fecal concretion (older patients) or by lymphoid hyperplasia(younger patients).
125
Luminal obstruction causes distention and may lead to ______ of the appendix
rupture
126
explain referred pain that occurs with appendicitis
The pattern of referred visceral pain associated with appendicitis begins in the periumbilical region (dull in nature) and migrates to the lower right quadrant.
127
list signs and symptoms of appenndicitis
Nausea, vomiting, and fever are often present. Irritation of the parietal peritoneum adjacent to the appendix often causes severe pain, which presents with rebound tenderness and guarding
128
Pressure over the ________ point (midpoint along the line from the right anterior superior iliac spine to theumbilicus) produces this point tenderness
McBurney
129
T or F: CT and utrasound can be used to assess appendicitis
true
130
what is ulcerative colitis? (UC)
an idiopathic inflammatory bowel disease
that usually appears in teenagers and young adults
131
UC always involves the _______ and may extend proximally for varying distances into the _______ colon
rectum
descending colon
132
what are the pathological findings of UC?
aw, red, and granular mucosal surface;
continuous inflammation (i.e., no “skip areas” as in Crohn disease); a diffuse, chronic inflammatory infiltration in the lamina propria; damage to the intestinal glands (crypts); inflammatory pseudopolyps; areas of friable, bloody residual mucosa; “collar-button” ulcers; and “lead-pipe” appearance in the chronic state.
133
EMBRYO: what is an omphalocele?
omphalocele occurs when abdominal contents herniate through the umbilical ring and persists outside the body, covered variably by a
translucent peritoneal membrane sac (a light gray, shiny sac) protruding from the base of the umbilical cord.
134
what is the difference between large and small omphalocele?
Large omphaloceles may contain stomach, liver, and intestines. Small omphaloceles contain only intestines.
135
omphaloceles are usually associated with other congenital anomalies and with increased levels of alpha _________
fetoprotein
136
______ ______ (Hirschsprung disease) is caused by the arrest of the caudal migration of neural crest cells.
Colonic aganglionosis
137
________ hernias in newborns occur at the site of an incompletely closed umbilicus
Umbilical
138
in umbilical hernias, what may herniate?
peritoneum, fat, or bowel
139
Unlike ________, umbilical hernias do not involve failed return of intestines from the umbilical cord back into the abdominal cavity.
omphaloceles
