Abdominal Wall, Omentum, Mesentery, and Retroperitoneum Flashcards
(14 cards)
A cutaneous malignanyc of the anterior abdominal wall 2 inches above the umbilicus will drain to which lymphatic basin
Axillary
- The Lymphatic drainage of the anterior abdominal wall is pricipally to the axillary nodal basin and the inguinal nodal basin
- The area of demarcation is the ARCUAT line (SEMILUNAR LINE OF DOUGLAS) at the level of the anterior iliac spine
The appropriate managemnt of rectus abdominis diastasis
Observation
- Rectus abdominis diastasis
- separation of the two rectus abdominis muscular pillars
- CT scanning can provide an accurate measure of the distance between the rectus pillars and will differentiate rectus diastasis from a true hernia
Persistence of the vitelline duct can lead to which of the following?
Omphalomesenteric duct cyst
- During the 3rd trimester, the vitelline duct regresses
- persistence of the vitelline duct remant on the ileal border results in a MEckel diverticulum
- Complete failutr of the vitelline duct to regress in a vitellie duct fistula which is associated with drainage of Small intestinal contents from the umbilicus
The usual presentation of arectus sheath hematoma
Sudden abdominal pain
- Can follow from trauma, vigorous coughingm sneezingm or extreme exertion
- elderly, anticoagulant therapy
- not accompanied by peritoneal signs
A 40 year old woman who underwent total abdominal clectomy for familial adenomatous polyposis (FAP) 5 years ago presents with a gradually expanding painless 4 cm mass of the anterior abdominal wall. A biopsy is returned as “desmoid tumor with no sign of malignancy” The correct management is ____________
Wide local excision
- Desmoid tumors of the abdominal wall are fibrous neoplasms
- sporadically or in the setting of familial adenomatous poyposis
- aggressive local growth
- medical treatment: doxorubicin, decarbazine, carboplatin can produce remission
- prognosis of advanced desmoid is poort
Reoair of a new 5 cm midline postoperative ventral hernia in an otherwise healthy patient is best accomplished with
Repair with synthetic mesh
Post-incisional hernias have an unacceptably high incidence of recurrence after primary suture repair
Umbilical hernia
Umbilical hernias are present in 10% of all newborns
- more common in premature infants
- close spontaneously by 5 years of age
- repair should be delayed until examination shows persistence of the hernoa before the child enters school
- adults wil small uncomplicatd, unincarcerated umbilac hernias can be followed until symptom occur
Spigelian hernias
On the lateral border of the rectus abdominis muscle
- Spigelian line or zone - an aponeurotic band of variable width at the lateral border of the rectus abdominis
- The most common location of these hernias are at the level of the arcuate line
- These hernias ar enot always apparent on PE and may cause local pain or incarceration
Laparoscopic repair of incisional hernias is associated with
Reduced wound infection
- Short term recurrence rates did not differ significantly and laparoscopic repairs were associated with higher in hospital costs despite generally shorter lenghts of stay
Omental infarctation
Most cases do not require surgery
- Rare
- depending on the location of infarcted tissue
- symptoms may mimic acute appendicitis, acute cholecystitis, acute diverticulitis or perforated ulcer
- Diagnosis is inferred from abdominal CT scan
- localized inflammatory-appearing mass of the omentum
- Surgical resection can hasten recovery but clinically stable patients can be managed conservatively
A 60 year old woman presents with abdominal pain and CT scan reveals an omental mass. The msot likely diagnosis is
Metastatic carcinoma
- Primary tumors are rare
- Metastatic ovarian carcinoma having the highest preponderance of omental involvement
- Melanoma, uterine and renal cancer can metastasize to the omentum
Failure of fixation of the small intestinal and right colonic mesentery during gestation can result in
Intestinal malrotation
- the mesentery of the duodenum small intestine, and proximal colon become fixed to the retroperitoneum
Sclerosing mesenteritis
- Etiology is unknown
- increased tissue density within the mesentery
- associated wutg a discreet non neoplastic mass ir it can be more diffuse involving large swaths of thickened nesentery without well defined borders
- discovered incidentally in CT scnas
- self limited abd nay demonstrate regression on follow-up imaging studies
The primary treatmetn of retroperitoneal fibrosis is
Corticosteroids
- Once malignancy, drug induced diseasem and infectious etiologies are ruled out, corticosteroids are the mainstay of medical therapy
- Surgical intervention is reserved for uterolysis or ureteral stenting or endovascualr interventions for ileocaval obstruction
