Abdomen Clinical Supplement Flashcards
(246 cards)
1
Q
What are the 5 F’s for abdominal protrusions
A
Fat Fluid Fetus Flatus Feces
2
Q
Where is the gallbladder
A
intersection of semilunar line right and 9th intercostal space
3
Q
Where is the spleen found
A
under 9th-11th ribs on left midaxillary
4
Q
Where are the kidneys found
A
11th ribs along the scapular line
5
Q
Which kidney is more superior and why
A
left is more superior due to liver on right
6
Q
Dermatome of xiphoid process
A
T6
7
Q
Dermatome of Umbilicus
A
T10
8
Q
Dermatome of inguinal ligament
A
L1
9
Q
What is the cremaster reflex
A
stroking medial aspect of the upper thigh stimulates the ilioinguinal nerve and results in contraction of the cremaster via the genital branch of the genitofemoral nerve, retracts testes
10
Q
What level of the spinal cord does the cremaster reflex test
A
L1-L2
11
Q
What is the abdominal reflex
A
When you stroke skin of wall from lateral to medial at the level of the umbilicus there should be contraction of abdominal wall muscless ipsilaterally
12
Q
When the abdominal reflex is absent what is indicated
A
spinal cord injuries above T5-T6
13
Q
Direct inguinal hernias are found in which population
A
commonly found in old men with weak abdominal walls
14
Q
Where do direct inguinal hernias occur
A
medial to inferior epigastric vesicles through the Hesselbach triangle
15
Q
Do direct inguinal hernias go through the deep inguinal ring
A
no
16
Q
What are direct inguinal hernias covered by
A
visceral peritoneum and parietal peritonealium and transversalis fascia
17
Q
Do direct inguinal hernias enter inguinal canal
A
no
18
Q
What are the boundaries of Hesselbach’s triangle
A
Medial: rectus abdominis
Lateral: inferior epigastric vessels
Inferior: inguinal ligament
19
Q
How do you fix a direct inguinal hernia
A
suture the inguinal ligament and conjoint tendon together
20
Q
What population do indirect inguinal hernias occur in
A
younger children, males> females
21
Q
Where do indirect inguinal hernias occur
A
lateral to the inferior epigastric vessels
22
Q
Do indirect inguinal hernias enter inguinal canal
A
yes
23
Q
What coverings do indirect inguinal hernias have
A
same as spermatic cord
24
Q
What is the triangle of pain boundaries
A
inguinal ligament and testicular vessels
25
What is the clinical relevance of the triangle of pain
staples should be avoided due to genitofemoral nerve (femoral branch), femoral nerve, and lateral femoral cutaneous nerve are found here
26
What is the triangle of doom boundaries
vas deferens and testicular vessels
27
What is the clinical relevance of the triangle of doom
stable should be avoided because it includes external iliac vessels, deep circumflex iliac vessels, and genital branch of genitofemoral
28
What is an epigastric hernia
in the midline between the xiphoid and umbilicus
29
What is an esophageal/ hiatal hernia
herniation of the fundus of the stomach through the esophageal hiatus
30
What is congenital diaphragmatic hernia (bochdalek)
herniation thru left vertebrocostal trigone into pulmonary cavity; can involve gut, spleen, or retroperitoneal structures
31
What is femoral hernia
protrustion of gut loops through the femoral ring
32
Where is a femoral hernia found in relationship to pubic tubercle and femoral vein
lateral to pubic tubercle
| medial to femoral vein
33
What is De Garengeot's Hernia
femoral hernia that involves the appendix
34
What is an incisional hernia
herniation through a surgical wound
35
What are the two type of lumbar hernias
Grynfeltt
| Petit
36
What is Grynfeltt's hernia
herniation at superior lumbar triangle between 12th rib, quadratus lumborum, and internal oblique
37
What is Petit's hernia
herniation at inferior lumbar triangle, between latissimus dorsi, external oblique, and iliac crest
38
What is obturator hernia
herniation of viscera thru the obturator canal
39
What is supravesical hernia
herniating mass leaves thru the opening in the supravesical fossa between median umbilical ligament (urachus) and remnant of the umbilical artery (medial umbilical ligament)
40
What does supravesical hernia usually result in
intestinal obstruction
41
What nerve is at risk with a supravesical hernia repair
iliohypogastric
42
What is an umbilical hernia
herniation through the umbilicus
43
What nerves are anesthetized in a vasectomy
ilioinguinal and genital branch of genitofemoral
44
What layers of fascia are cut in a vasectomy
Skin, Dartos fascia, external spermatic fascia, cremaster's fascia, internal spermatic fascia
45
What are neurovascular structures at risk in a vasectomy
testicular vessels, pampiniform plexus
| ilioinguinal and genitofemoral nerve
46
What is torsion of the testes
rotation and twisting of the spermatic cord, along with vascular occlusion
47
What is torsion of the testes associated with
deficient anchoring of the testicle to the tunica vaginalis and via gubernaculum
48
What are common S/S of testes torsion
sudden testicular pain and enlargement
nausea/vomiting
abnormal cremaster reflex
abnormal positioning of epididymis
49
What is the normal position of the epididymis
head is superior to testicle
| body is posterior and lateral
50
What is hydrocele of the testes
excessive accumulation of fluid in the cavity of the tunica vaginalis
51
What is a congenital hydrocele
accumulation of fluid in the tunica vaginalis and direct communication with the peritoneal sac via a persistent processus vaginalis
52
How can hydroceles be diagnosed
with transillumination
53
What is hematocele of the testis
collection of blood in the cavity of the tunica vaginalis
54
What causes hematocele
trauma to testicular veins
55
What is a varicocele
varicose veins involving the pampiniform plexus
56
Which side do varicoceles most commonly occur on
left side
57
What are S/S of varicocele
scrotum feels like a bag of worms
hematuria
flank pain
58
What causes varicocele
entrapment of the left renal vein by the SMA, backing up blood into the left testicular vein that drains into the renal vein
59
What is a spermatocele
benign, cystic accumulation of sperm in the head of the epididymis
60
How is a spermatocele identifiable on exam
mass is superior to testicle and is smooth, soft, and well circumscribed
transilluminates
61
How are the testes drained lymphatically
lumbar/para-aortic nodes
62
How is the scrotum drained lymphatically
superficial inguinal nodes
63
What is orchitis
inflammation of the testes
64
What is the phrenicocolic ligament
tethers the splenic flexure of the colon to the body wall
65
What does the phrenicocolic ligament restric
the flow of ascites in the abdominal cavity
66
What is peritonitis
inflammation of the peritoneum
67
When is peritonitis painful
when it involves parietal peritoneum
68
What causes peritonitis
infections, perforated ulces, appendicitis, diverticulitis, cirrhosis, cancer
69
What is Morrison's pouch
right subhepatic recess
70
What is important about Morrison's pouch
fluid can accumulate here in the supine position and can reach the right subphrenic space and irritate the diaphragm and the lesser sac via the epiploic foramen
71
What are peritoneal adhesions
fusion of parietal and visceral layers
72
What causes peritoneal adhesion
trauma or inflammation from surgery
73
What is guarding
reflexive contraction of the abdominal wall musculature to protect inflamed organs
74
What causes guarding
pain from appendicitis, ulcers, tumor, ectopic pregnancies
75
What is volvulus
abdominal organs that have a mesentery can twist and block flow of intestinal contents
76
What does volvulus result in
reduced blood flow and ischemia
77
What is ascites
accumulation of serous fluid in the peritoneal cavity
78
What is paracentesis
removal of ascites from the peritoneal sac
79
How is the patient positioned during paracentesis
supine
80
Where is paracentesis performed on the patient
t10 dermatome anesthetized and avoid the inferior epigastric artery
81
What are the layers passed in paracentesis
```
skin
campers fascia
scarpas fascia
external and internal obliques
transverse abdominus
transversalis fascia
parietal peritoneum
```
82
What is culdocentesis
removal of fluid from the recto-uterine pouch
83
How is culdocentesis performed
entering the peritoneal cavity via the posterior vaginal fornix
84
Why is the peritoneum used for intraperitoneal delivery of drugs
large surface area permits rapid absorption of fluids within the peritoneal cavity
85
When is peritoneal dialysis performed
renal failure
86
Why is the peritoneum used for peritoneal dialysis
large surface area of the peritoneum allows it to be used as a dialysis membrane
87
What is ventriculoperitoneal shunt
excess CSF can be absorbed thru the peritoneum
88
What is pneumoperitoneum
gas introduced into the peritoneal cavity
89
When can pneumoperitoneum arise pathologically
any bowel performation= free subdiaphragmatic air
90
What is GERD
regurgitation of gastric contents
91
What are S/S of GERD
heartburn
dysphagia
sore throat
92
What are 4 physiological mechanisms that normally prevent reflux of stoamch into the esophagus
lower esophageal sphincter
folds of gastric mucosa that seal
angle of cardiac orifice
right crus of diaphragm
93
What is Barrett's esophagus
replacement of the stratified squamous esophageal epithelium with simple columnar glandular gastric epithelium from chronic reflux
94
What is barrett's esophagus related to clinically
premaligmnant condition, increased risk for esophageal carcinoma
95
How can gastric cancer spread locally
duodenum, pancreas, posterior body wall
96
How can gastric cancer spread lymphatically
celiac nodes--> supraclavicular--> periumbilical --> anterior axillary nodes
97
How can gastric cancer spread venous
liver
98
What are important nodes in gastric cancer
Virchow's node
sister Mary Joseph node
Irish node
99
In gastric cancer, where is Virchow's node
supraclavicular node on the left
100
In gastric cancer, where is sister Mary Joseph node
periumbilical
101
In gastric cancer, where is Irish node
anterior axillary node
102
What are gastric ulcers
erosion of gastric mucosa, can erode thru walls and damage adjacent structures
103
What structures are at risk with a 1st part duodenal ulcer
gastroduodenal artery
common bile duct
portal vein
104
What structures are at risk with a 2nd part duodenal ulcer
right renal vessels
| IVC
105
What structures are at risk with a 3rd part duodenal ulcer
```
right ureter,
IVC
aorta
Psoas major
gonadal vessels
```
106
What structures are at risk with a 4th part duodenal ulcer
left sympathetic trunk
left psoas major
aorta
left renal vessels
107
What is the consequence of any perforation of the stomach, small intestine, large intestine
intraperiotoneal air
108
How can intraperitoneal air be identified
free subdiaphragmatic air
109
What is Wilkie's SMA syndrome
compression of the 3rd part of the duodenum between the SMA and aorta
110
What does Wilkie's SMA syndrome result in
obstruction (nausea, vomiting, abdominal pain, malnutrition)
111
Who is Wilkie's SMA syndrome more common in
young, anorexic women
112
What is Meckel's diverticulum
persistent vitelline duct
113
What are symptoms of Meckel's diverticulum
asymptomatic
hematochezia
periumbilical pain
114
Where does Meckel's diverticulum occur
2 feet from ileocecal valve
115
What can causes Ischemia of the intestine
blood clot can deprive and result in necrosis and severe visceral pain and ileus
116
What is Chrohn's disease
chronic inflammatory condition of the intestine, most often the ileum, that leads to fibrosis and obstructive symptoms
117
What are S/S of Chrohn's disease
abdominal pain
diarrhea
fistulas and obstruction
118
WHat are three dispositions of the appendix to infection
Long thin tube that can collect fecal material
narrow lumen, easily blocked
abundant collection of lymphatic tissue
119
Does the appendicular artery have significant anastomoses
no
120
What can result if the appendicular artery is compressed
necrosis, gangrene, perforation
121
What is the most common cause of acute abdomen pain
appendicitis
122
How does pain occur in appendicitis
vague, dully achy pain around the umbilicus at first
irritation of the parietal peritoneum results in a sharp, well-localized somatic pain in RLQ
123
What is McBurney's point
the middle third of a line connecting the ASIS and umbilicus
124
What is McBurney's point used for
surgically approximate the appendix
125
What structures are palpable on a DRE for males
```
prostate
rectal wall
bladder
seminal vesicles
ductus deferens
perineal body
bulb of penis
```
126
What structures are palpable on a DRE for females
vagina, cervix, perineal body
127
What are S/S of bowel obstruction
pain, nausea, vomiting
constipation
hyperactive bowl sounds
128
If blood supply is interrupted in bowel obstruction what must occur
surgical emergency
129
What is diverticular disease
inflammation of diverticula, small pouches extending from the intestinal lumen
130
Where are diverticula commonly found
large intestine (sigmoid colon--LLQ pain)
131
What are S/S of diverticular disease
pain, nausea
constipation
peritonitis, bleeding, rupture
132
What is ulcerative colitis
inflammation of large intestine most commonly in the rectum
133
What is chronic ulcerative colitis associated with
increased risk of colorectal cancer
134
What is intussusception
telescoping of one part of the intestine into an adjacent part
135
What can intussusception result in
ischemia and necrosis
136
What is the presentation of intussusception
infant is lathargic, vomiting, abdominal pain, palpable mass, currant jelly stool
137
What are S/S of colorectal carcinoma
bright red bloody stool
weight loss
changes in stool
malaise
138
How does colorectal carcinoma spread locally
peritoneum, pelvic organs
139
How does colorectal carcinoma spread lymphatically
drainage to corresponding nodes
140
How does colorectal carcinoma spread venous
liver, lungs, vertebra, brain
141
What is colostomy
proximal portion of colon is sutured to an opening along the anterior abdominal wall thru the rectus abdominis where waste products are expelled
142
What is rectal prolapse
protrusion of the rectal wall into the anal canal or thru the anal opening
143
What are S/S of rectal prolapse
reddish mucosal mass protrusion into the anal canal
constipation
malnutrition
prior rectal trauma
144
What is a rectocele
weakness in puborectalis and pubovaginalis muscles that cause bulging of rectal wall into posterior vaginal wall
145
What are S/S of a rectocele
painful intercourse
sense of fullness
constipation
painful bowel movements
146
What is considered an upper GI bleed
proximal to the ligament of Treitz
147
What are S/S of an upper GI bleed
vomiting blood or melena black stool
148
What are causes of an upper GI bleed
stomach cancer
ulcers
gastritis
esophageal varices
149
What is considered a lower GI bleed
distal to the liagment of Treitz
150
What are S/S of a lower GI bleed
hematochezia (red stool)
151
What are causes of a lower GI bleed
```
diverticular disease
hemorrhoids
polyps
anal fissures
cancer
IBD
```
152
What is ischemic colitis
inflammation of the colon as a result of poor blood flow
153
What are causes of ischemic colitis
atherosclerosis
hypovolemia
hypoperfusion
sickle cell anemia
154
What are S/S of ischemic colitis
pain and blood stool
155
What are important watershed areas in ischemic colitis
Griffith's point
| Sudeck's point
156
What is Griffith's point
splenic flexure: middle colic to left colic artery
157
What is Sudeck's point
recto-sigmoidal junction: last sigmoidal to superior rectal artery
158
What can cause a spleen rupture
ribs 9-11 fracture on the left
159
What are S/S of a spleen rupture
left shoulder pain when ruptured spleen irritates the diaphragm
160
What is Kehr's sign
when spleen irritates the diaphragm and causes left shoulder pain
161
What are causes of hepatomegaly
heart failure
cancer
alcoholic cirrhosis
162
What is the lymphatic drainage of the liver
most to hepatic nodes
bare area: phrenic nodes
falciform ligament: parasternal
Round ligament: umbilical nodes
163
What is the significance of lymphatic drainage of the liver and breast
connections to superficial lymph channels provide a direct route for breast cancer to metastasize to liver
164
What is Calot's Triangle
cystic duct, common hepatic duct, and base of the liver
165
What does Calot's triangle contain
cystic artery and veins
lymph nodes
autonomic fibers
166
What is Pringle's maneuver
clamping vessels of the portal triad at the free edge of the lesser omentum to control bleeding during hepatic procedures
167
What are 3 causes of jaundice
Pre-hepatic
Hepatic
Obstructive
168
WHat is pre hepatic jaundice
excessive RBC breakdown
169
What is hepatic jaundice
disruption of liver function
170
What is obstructive jaundice
if bile cannot escape gallbladder or biliary tree due to gall stones, it enters blood and causes jaundice
171
What is liver cirrhosis
hepatocytes are replaced by fatty or fibrous connective tissue which obstructs blood flow through the liver
172
What does liver cirrhosis result in
```
hepatomegaly
ascites
edema
jaundice
splenomegaly
portal hypertension
```
173
What is Budd-Chiari syndrome
rare thrombic or non-thrombotic obstruction of hepatic venous outflow, caused by maligancy or hypercoaguable states
174
What are S/S of Budd-Chiari syndrome
```
hepatosplenomegaly
ascites
abdominal pain
jaundice
edema
prominence of collateral veins
```
175
What are the 3 portal-caval anastomosis
left gastric-esophageal veins
superior rectal to middle/inferior rectal
paraumbilical to epigastric
176
What does left gastric --> esophageal veins anastomosis result in
esophageal varices
| hematemesis
177
What does superior rectal--> middle and inferior rectal anastomosis result in
heorrhoids and rectal bleeding
178
What does paraumbilical--> epigastric anastomosis result in
caput medusa
179
When is a porto caval shunt performed
in patients with HTN
180
What is a porto caval shunt
portal vein to IVC
| Splenic vein and left renal vein
181
What is blood flow in the portal vein
right lobe of the liver receives mainly blood from the intestines
left lobe quadrate and caudate lobes receive blood mainly from the stomach and spleen
182
If cancerous cells from the stomach invade the portal system, which part of the liver will they most likely invade
left lobe
183
Where are 3 places for gallstones to be commonly lodged
fundus at the neck of the gallbladder
bile duct
hepatopancreatic ampulla
184
What is cholecystectomy
surgical removal of gallbladder
185
What needs to be performed in order to do a cholecystectomy
pringle's maneuver to ligate vessels and find Calot's triangle to ligate cystic artery
186
What is cholecystitis
inflammation of the gallbladder
187
Where does pain from cholecystitis initially show up
in epigastric region
188
Where does pain from cholecystitis shift to
right hypochondriac region at the 9th costal cartilage junction and linea semilunaris
189
Where will somatic pain show up from cholecystitis
C3-C5 region of shoulders
190
What is pancreatitis
inflammation of the pancreas
191
What can cause pancreatitis
gallstones and retrograde flow of bile into the pancreatic duct
192
Where does the pancreas drain lymphatically
celiac and superior mesenteric nodes
193
Where do cancers of the pancreas often spread to
lumbar nodes
194
What are S/S of pancreatic cancer
```
obstruction of bile/pancreatic ducts
weight loss
abdominal and back pain
jaundice
painless and palpable gallbladder
```
195
Where does pancreatic metastasis occur
regional to adjacent organs and any peritoneal surface, local nodes, and liver
196
What may pancreatic cancer obstruct
portal vein or IVC
197
What occurs during pancreatic hemorrhage
filling in lesser sac and greater omentum
198
What is at risk during a splenectomy
tail of the pancreas
199
What occurs if the tail of the pancreas is damaged
digestive enzymes are relased into the abdominal cavity
200
What is an abdominal aortic aneurysm
congenital or acquired dilation of the wall of the aorta, palpated left of the midline; fatal if it ruptures
201
What is aortic dissection
tear in the intimal layer of the aorta and hemorrhage between the layers of the vessel
202
What are S/S of aortic dissection
acute onset of chest/back pain
lower extremity ischemia and neuropathy
pulse defacit in lower extremities
203
What is obliteration of the abdominal aorta
gradual build-up of plaque in the abdominal aorta at the bifurcation
204
What can obliteraltion of the abdominal aorta cause
claudication
impotence
Leriche Syndrome
205
What are 4 aorta-aorta anastomoses
1. Intercostals, subcostal, lumbar--> iliolumbar, superior gluteal, internal iliac
2. intercostals, subcostal, lumbar--> circumflex iliac--> external iliac
3. IMA--> middle/inferior rectals--> internal iliac
4. Subclavian--> internal thoracic--> superior epigastric-->inferior epigastric--> external iliac
206
How can the IVC be obstructed
abdominal masses or build up of clots around an IVC filter
207
What are caval-caval anstomoses
1. Inferior--> superior epigastric
2. Superficial epigastric--> lateral thoracic
3. vertebral/lumbar veins and Batson's plexus--> azygos system
208
How can we treat recurring blood clots arising from the lower extremity
placing a filter/screen in the IVC
209
What is psoas major covered by
investing fascia
210
How may an infection spread to the psoas muscle
from vertebra thru the investing fascia of the psoas major muscle
211
How can an infection spread from the psoas muscle
underneath the sheath deep to the inguinal ligament
212
What is the relevance of the Psoas test/sign
inflammation of viscera can affect function of the iliopsoas muscle
213
What can impact function of right psoas major muscle
inflamed retrocecal appendix
214
How is the psoas test/sign performed
ask patient to actively flex the thigh at the hip
| abdominal pain=positive test
215
What is the thomas test used for
diagnose dysfunction/contracture of the psoas major muscle
216
How is the Thomas test performed
patient lays on their back and examiner flexes the unaffected hip towards the chest while the affected hip remains flat on the table
217
What is a positive Thomas test
dysfunction indicated when the test reveals flexion of the contralateral hip
218
When do we see iliohypogastric nerve injury
```
inguinal hernia surgery
hysterectomy
appendectomy
pregnancy
abdominal muscle tears
```
219
When do we see ilioinguinal nerve injury
inguinal hernia surgery
abdominal surgery
pregnancy
placement of femoral catheter
220
When do we see genitofemoral nerve injury
hernia repair
appendectomy
retroperitoneal hematoma
221
When do we see lateral femoral cutaneous nerve injury
entrapment in sartorius or inguinal ligament
222
What is meralgia paresthetica
entrapment of the lateral femoral cutaneous nerve
223
What are renal cysts
large, fluid-filled cysts, commo in older individuals
224
Multiple renal cysts may lead to what
renal failure
225
What does renal carcinoma metastasis spread locally
adrenal gland
| posterior abdominal wall
226
Where does renal carcinoma metastasis spread lymphatically
lumbar nodes
227
Where does renal carcinoma spread venous
bone, brain, liver, lung
228
Where does renal carcinoma arise from
tubular epithelium
229
What is renal carcinoma associated with
hematuria and back pain
230
What is renal hypertension
stenosis of a renal artery or supra-renal artery reduces blood flow to the kidney
231
What does renal hypertension result in
humoral response for the kidney in an attempt to raise normal blood pressure
232
WHat are accessory renal arteries
end arteries that do not anastomose with branches from the renal arteries
233
What can blockage of renal arteries lead to
renal infarct
234
Which kidney is used for transplantation and why
left kidney
| renal vein is longer
235
Where are transplanted kidneys placed
iliac fossa
236
Where are transplanted kidneys placed arterial
internal iliac artery
237
What is nephroptosis
inferior displacement of the kidney due to insufficient peri-renal adipose tissue
238
What may nephroptosis causes symptom wise
flank or groin pain
| hematuria
239
Where are 4 places the ureters are contricted and a stone can become lodged
renal pelvis and ureter
crossing pelvic inlet
passage thru the wall of the bladder
testicular/ovarian vessels cross the ureter
240
What are consequences of urinary obstruction
hydronephrosis
241
What is hydronephrosis
enlargement of the ureter, renal pelvis, and or calyces
242
What can hydronephrosis lead to
renal failure
243
What are causes of hydronephrosis
stones, tumors, prostatic hypertrophy
244
What are S/S of kidney stones
flank to groin pain
nausea
vomiting
hematuria
245
What is the arterial supply to the abdominal ureter
medial side
246
What is the arterial side to the pelvic ureter
lateral side
