Abdominal Wall Part 2 Flashcards by joseph dizon

Messentery

In the region of the stomach, the dorsal mesentery becomes the _____________ whereas in the region of the jejunum and ileum the dorsal mesentery becomes the __________

greater omentum,

mesentery proper

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In the region of the colon, the dorsal mesentery is known as the

Mesocolon

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During embryonic development, after the 270-degree counterclockwise rotation of the herniated midgut, the reduced mesentery achieves its ______

final fixation state

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Segments that are fixed to retroperitoneum

duodenum, ascending colon, and descending colon

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Messentery

Remain mobile

small intestinal mesentery,
transverse colon mesentery, and to a variable extent,
the sigmoid colon mesentery

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The root of the small intestinal mesentery wall normally courses in an oblique direction, from the __________

left upper quadrant at the ligament of Treitz to the right lower quadrant at the ileocecal valve and the fixed cecum

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Sclerosing mesenteritis

Sclerosing mesenteritis, also referred to as

mesenteric panniculitis or mesenteric lipodystrophy

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There is no gender or race predominance, but sclerosing mesenteritis is most commonly diagnosed in individuals

older than 50 years of age

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The etiology of this process is unknown, but its cardinal features are a ___________________ on histologic examination

nonneoplastic mesenteric mass
fibrosis and
chronic inflammation

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The mass may be up to

40 cm in diameter

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____________is the most frequent presenting symptom, followed by the presence of a ___________

Abdominal pain

nonpainful mass or intestinal obstruction

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CT cannot distinguish sclerosing mesenteritis from a

primary or secondary mesenteric tumor

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Surgical intervention is usually necessary, if only to establish a

diagnosis and rule out malignancy

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The extent of the disease process dictates the aggressiveness of the intervention, which may range from

simple biopsy,
to bowel and mesentery resection,
to colostomy (in the cases of colonic obstruction

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(1) Complete occlusion or stenois of mesenteric arteries by embolism, thrombosis or obliterative disease

Mesenteric Vascular Disease

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MVD

Thrombosis of mesenteric veins

(3) Extraluminal obstruction of mesenteric arteries . (
4) Aneurysms of the splanchnic arteries
(5) Traumatic injury to visceral vessels

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MVD

acute and complete (

resulting from emboli or thrombosis

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MVD

gradual and partial (

resulting from obliterative arterial disease

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MVD

Collateral vessels permit gradual occlusion of either the

celiac or the mesenteric artery to be tolerated

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MVD

Acute occlusion of the celiac or inferior mesenteric artery generally is a asymptomatic in an otherwise normal person; Acute occlusion of the superior mesenteric artery if untreated, results in

intestinal infarction and death

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MVD

The _____________________or close to the takeoff of its middle colic branch is the usual site of acute and chronic mesenteric arterial occlusion

superior mesenteric artery at its origin

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MVD

Complete occlusion of the interior mesenteric artery produces symptoms only if there is compromise

of collateral blood flow from the superior mesenteric or internal iliac (hypogastric) artery

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MVD

Clinically apparent venous occlusions are sudden and complete and invariably a consequence of

thrombosis

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MVD

Partial mesenteric venous occlusion usually is the result of _____________ and is asymptomatic

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external compression

MVD The relative incidence of mesenteric arterial as opposed to venous occlusions is

unknown

MVD 15 to 20% of all significant mesenteric vascular accidents are a result of primary ____________ and that approximately 50% are a result of ____________

venous thrombosis | primary arterial occlusion

MVD In the remaining 30 to 35% of cases intestinal infarction occurs in the absence of

major arterial or venous occlusion

Acute occlusive visceral ischemia Acute occlusion of the superior mesenteric artery may be the result of __________________ with the incidence of each being approximately equal

cardio arterial embolus or in situ thrombosis,

AOVI most likely target among the visceral vessels to receive embolic material from the heart

Superior messenteric artery

AOVI Thrombotic occlusion of the superior mesenteric artery typically occurs at the

vessel origin

AOVI The atherosclerotic plaque generally arises in the

visceral vessels

AOVI The atherosclerosis of the visceral arteries is localized to the

vessel origin

AOVI Less common causes of stenosis and occlusion of the visceral arteries include

Takayasu’s arteritis, periarteritis nodosa, and thromboangiitis obliterans

AOVI Extrinsic compression of the ___________________ (medium arcuate ligament syndrome) may produce a chronic visceral pain syndrome

celiac artery by diaphragmatic fibers

AOVI The initial effect of proximal occlusion of the superior mesenteric artery is to cause

intense spasm of its distal branches

AOVI Acute occlusion of the origin of the superior mesenteric artery produces ischemia of the small intestine from the level of the

ligament of Treitz ileocecal vaive and of the ascending colon and proximal 2/3 of the transverse colon

AOVI Patency of the celiac artery can result in viability of the proximal 10 to 12 cm of jejunum owing to anastomoses between the

superior pantreaticoduodenal artery (celiac-based) | inferior pancreaticoduodenal artery (first branch of the superior mesenteric artery

AOVI Acute occlusion of distal branch vessels, such as the ___________________ results in segmental intestinal ischemia that might infarct depending on the status of the collateral circulation

middle colic, right colic, and ileocolic arteries

AOVI The mucosa is the layer of the intestinal wall most sensitive to ___________________, are early pathophysiologic events that may be recognized endoscopically

ischemia, mucosal sloughing and ulceration, often manifest as gastrointestinal bleeding

As the ischemia process progress to infarction, over a period of approximately 6 h in the setting of profound complete ischemia, the bowel wall becomes

dusky, then cyanotic, and ultimately frankly gangrenous and perforated

AOVI Abdominal pain is acute in onset, intense and diffuse, may be accompanied by vomiting, and is unresponsive to

narcotic administration

AOVI Early abdominal examination is remarkable for a ______________s. Localization of abdominal pain and development of peritoneal signs mark the onset of _____________

paucity or absence of finding | intestinal necrosis

AOVI history of ________________ should raise suspicion of embolic occlusion of the superior mesenteric artery

atrial fibrillation or of a previous cardioarterial embolic event

AOVI Laboratory investigation is too non-specific to rule out the diagnosis of acute intestinal ischemia; the diagnosis must be made on clinical grounds and requires a high index of suspicion. The leukocyte count often increases to greater than

20,000/mm3

AOVI A notable exception is that of ___________because of submucosal edema, which is indicative of intestinal ischemia

thumbprinting of the bowel wall Hemoconcentration, manifest as a high hematocrit, secondary to fluid accumulation in the extravascular compartment and vomiting. Metabolic acidosis is related to the extent and duration of the intestinal ischemic process. Plain film findings occur late, and cannot be relied on for diagnosis

AOVI , remains the single most important diagnostic maneuver in evaluation of the patient with suspected acute mesenteric ischemia

Contrast arteriography, including lateral aortography and selective injection of the superior mesenteric artery

AOVI Once the diagnosis of acute mesenteric ischemia has been established at arteriography, continuous infusion of a vasodilator, such as _______________, may be begun directly into the superior mesenteric artery if the origin of this vessel is patent and can be cannulated

papaverine or nitroglycerine

AOVI At operation, through a____________initial decision regarding treatment is based on the extent and severity of intestinal ischemia

long midline incision,

AOVI Methods of ____________ will be vastly different depending on the cause of the ischemic insult

surgical revascularization

AOVI Embolic or atherosclerotic occlusion, only intestine that is _____________ should be resected initially, followed by an attempt at revascularization

frankly necrotic

AOVI Only a short segment of intestine appears ischemic from an embolus to a distal branch of the ileocolic artery, ______________________ may be sufficient

resection of the affected intestine with primary anastomosis and anticoagulation

AOVI Revascularization of the ischemic intestine by

Embolectomy

AOVI After anticoagulation with heparin and control of the superior mesenteric artery with a traumatic vascular clamps or doubly looped vessel tapes, a transverse arteriotomy is made and a _________________ is passed proximally

small Fogarty balloon embolectomy catheter

AOVI At the laparotomy after successful mesenteric revascularization, it is often found that bowel that appeared to be of questionable viability initially is now clearly viable look” laparotomy after successful mesenteric revascularization, it is often found that bowel that appeared to be of questionable viability initially is now clearly viable

At the “second look”

AOVI This avoids the consequences of massive intestinal resection, such as _____________ and lifelong parenteral nutrition is frequently an important adjunct in the postoperative period

short-guy syndrome

AOVI The mortality rate after sudden onset of mesenteric ischemia is as high as

85%

AOVI Mortality is higher after acute occlusion bythrombosis compared with

Embolism

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Messentery The mesentery develops from mesenchyme that attaches the _____________________ to the posterior abdominal wall

foregut, midgut, and hindgut

Abdominal Wall Part 2 Flashcards

(59 cards)