CLINICAL NOTES Flashcards
(140 cards)
1
Q
Where does extravasation of Urine occur?
A
between scarp’s fascia and deep fascia
2
Q
What happens between scarp’s fascia and deep fascia in extravasation of urine?
A
fluid accumulates because the spongy urethra ruptures
3
Q
Where can the urine spread?
A
superiorly in anterior abdominal wall within the space
4
Q
Where can the urine not spread?
A
inferiorly into thigh because firm attachment of scarpa’s fascia to fascia lata
5
Q
Who is prone to extravasation of urine?
A
Males exclusive
6
Q
Why is extravasation of urine exclusive to males?
A
urethra is longer, more superficial, and more horizontally orientated than females
7
Q
Cause for extravasation of urine?
A
trauma
8
Q
What is low back pain associated with?
A
weak abdominal muscles
9
Q
What is a hernia?
A
abnormal protrusion of tissue through an opening
10
Q
What is an inguinal hernia?
A
abdominal viscera (usually small intestine) protrude through inguinal region
11
Q
Inguinal hernias are more common in males or females?
A
males
12
Q
Why are inguinal hernias more common in males?
A
large diameter of inguinal canal and scrotum is an out pounching of anterior abdominal wall making it a large potential space for viscera to fill
13
Q
What are the two types of inguinal hernias?
A
indirect and direct
14
Q
Where does an indirect inguinal hernia happen?
A
passes through deep inguinal ring, inguinal canal, and superficial inguinal ring before descending to scrotum
15
Q
Where does an indirect inguinal hernia pass the inferior epigastric vessel?
A
lateral
16
Q
Where does a direct inguinal hernia pass the inferior epigastric vessel?
A
medial
17
Q
Indirect inguinal hernia is
a) congenital
b) acquired
c) both
A
both congenital and acquired
18
Q
Direct inguinal hernia is
a) congenital
b) acquired
c) both
A
acquired, due to weakness in conjoint tendon
19
Q
Indirect inguinal hernia accounts for what % of inguinal hernias
A
75%
20
Q
Direct inguinal hernias account for what % of inguinal hernias
A
25%
21
Q
Does the Rectus abdominis play a role in preventing hernias?
A
no because it lies medial to inguinal canal
22
Q
Where do direct inguinal hernias happen?
A
punches directly through posterior wall of inguinal canal, bypassing deep inguinal ring
23
Q
What does a direct inguinal hernia cause
A
general bulging of anterior abdominal wall
24
Q
Femoral Hernia passes through what
A
passes through femoral canal
25
Where does femoral hernia occur
occurs inferior to inguinal ligament
26
Where does inguinal hernias occur
occurs superior to inguinal ligament
27
Is femoral hernia more common in males or females
females
28
Umbilical hernia occurs when
incomplete closure of anterior abdominal wall after ligation of umbilicus at birth or due to defect in linea alba
29
What affects male fertility
subluxation of L1,L2 (genitofemoral nerve)
30
Varicocele (varicous veins) form in what plexus
pampiniform plexus of veins
31
Varicocele can look like what
tumor when swelled together
32
What is cryptorchidism
undescended testes at birth
33
Cryptorchidism occurs in ____% of full term infants and ____% in premature infants
3, 30
34
Where are undescended testes usually found
in inguinal canal and usually unilateral
35
Most descend after few weeks after birth but if they don't what happens
infertility but androgen secretion is unimpaired
36
T/F Is undescended testes a greater risk for cancer?
true
37
Infections of Peritoneal cavity via uterine tubes occur in
Immunocompromised women or unsanitary conditions during birth
38
Is ascites a disease or a condition
condition
39
Ascites is what
accumulation of fluid within the peritoneal cavity
40
Ascites results in
imbalance between fluid production and absorption (more production)
41
Peritoneal cavity is used for what?
rabies vaccine, kidney dialysis
42
Causes of Ascites
malnutrition, congestive heart failure, liver failure, kidney failure, peritonitis
43
What is peritonitis
inflammation of peritoneum, usually results in infections
44
Causes of peritonitis
trauma, inflammatory bowel disease, vaginal infection, perforated ulcers
45
Where does peritonitis occur
adhesions between parietal and visceral peritoneum
46
What can cause these adhesions in peritonitis
surgery
47
In peritonitis under the diaphragm the phrenic nerve referes pain to what and causes what
pain to shoulder, hiccups
48
What is congenital hypertrophic pyloric stenosis?
increase in size of the pyloric spincter which reduces the size of the pyloric canal
49
What does congenital hypertrophic pyloric stenosis resemble?
tumor
50
When is congenital hypertrophic pyloric stenosis present?
at birth
51
Congenital hypertrophic pyloric stenosis is more common in males or females?
males
52
What is a symptom of congenital hypertrophic pyloric stenosis?
projectile vomitting
53
How is congenital hypertrophic pyloric stenosis fixed?
surgery
54
What is pylorospasm?
spasmodic contraction of pyloric sphincter, no change in size
55
Is pylorospasm present at birth?
sometimes
56
What is causes because of pylorospasm?
food does not pass easily from stomach to duodenum causing stomach to become overly full sometimes resulting in vomiting
57
Subluxations of what thoracics may play a role in pylorospasms?
T5-T9
58
What is a gastic ulcer look like?
crater like depression in mucosa of stomach
59
What does the stomach secrete to protect from gastric ulcers?
alkaline mucus which is viscous (sticky) and forms a barrier between stomach acid and mucosa
60
Gastric ulcer occurs when
alkaline mucus is inadequate in spots and gastric acid erodes stomach mucosa forming an ulcer
61
What are some factors of gastric ulcers?
excess acid secretion (related to stress) and inadequate mucus barrier (related to presence of bacteria - Heliobacter Pylori which erodes mucosa)
62
What controls the secretion of gastric acid?
vagus nerve
63
What can happen with a duodenal ulcer?
erosion of the gastroduodenal artery by a perforated duodenal ulcer can result in severe hemorrhage
64
What is a duodenal ulcer?
mucosa in the duodenum is eroded to form a crater like depression
65
Where is a duodenal ulcer commonly located?
duodenal cap
66
What is a perforated duodenal ulcer
allows contents to escape into peritoneal cavity causing peritonitis
67
Duodenal Ulcer flow of fluid
fluid travels from subhepatic recess to the right paracolic gutter to the right iliac fossa
68
What does a perforated duodenal ulcer commonly damage
liver, pancreas, and gall bladder because of its proximity
69
What thoracic level is associated with gastric and duodenal ulcers? and why?
mid thoracic because of greater splanchic nerve supplies sympathetic innervation to stomach and duodenum
70
What is Ileal (meckel's) diverticulum
common malformation of the digestive tract
71
What is the Ileal diverticulum a remnant of?
embryonic vitelline duct
72
What does a Ileal diverticulum look like
finger-like pouch which projects from distal ileum
73
What layers does the Ileal diverticulum contain
contains all layers of the ileum and may contain gastric or pancreatic tissue
74
What does Ileal diverticulum resemble if the diverticulum becomes inflamed?
appendicitis
75
What is Crohn's disease
inflammatory bowel disease which most commonly affects distal ileum and adjacent colon, but can affect any part of digestive tract
76
What Crohn's affects?
all layers of intestine and results in thickening and ulceration of the affected segment
77
What does Crohn's result in?
pain, diarrhea, and malabsorption
78
What is the etiology for Crohn's
unknown, produces a cobble stone radiographic appearance
79
What segments of the thoracic when subluxations present are associated with Crohn's
lower thoracics (affect motility which is controlled by vagus, greater and lesser splanchnic nerves)
80
What is appendicitis
inflammation of the appendix
81
What is the most common intra-abdominal inflammatory condition in the world?
appendicitis
82
What are the symptoms of appendicitis
begin as umbilical pain which then localizes to right lower quadrant
83
What happens if appendicitis is untreated
appendix may rupture, leading to peritonitis
84
What causes appendicitis?
obstruction of lumen due to lymphoid hyperplasia and fecal impaction
85
What is diverticulosis
herniation of the mucosa of the colon throughout the muscular layer
86
Is diverticulosis associated with inflammation?
no inflammation
87
Diverticulosis is most common with people?
over the age of 40
88
What location does diverticulosis most commonly occur?
sigmoid colon
89
What happens if the diverticuli become inflammed?
it is called diverticulitis
90
What does diverticulosis result in?
abdominal pain, diarrhea, and some cases abscess
91
Characteristics of Diverticulosis?
radiographically it looks like numerous outpouchings along the colon
92
Diverticulosis is treated with what?
laser endoscopy
93
What kind of diet is diverticulosis related to?
low fiber diet
94
What is ulcerative colitis
severe inflammation and ulceration of the rectum and lower colon
95
Where does ulcerative colitis occur?
mucosa
96
What are the symptoms of ulcerative colitis
abdominal pain and diarrhea
97
What could occur with ulcerative colitis
bowel perforation
98
How does ulcerative colitis look radiographically?
constricted, tear drop deformity
99
What is irritable bowel syndrome
common condition involving recurrent abdominal pain and diarrhea with no inflammation or deterioration in health
100
What happens with irritable bowel syndrome
abnormal muscular contractions of the colon
101
What causes irritable bowel syndrome?
unknown but it is linked to stress and anxiety
102
Ischemic bowel disease is what?
blood clot in bowel
103
What can ischemic bowel disease lead to?
bowel infarction, mortality rate is 95%
104
What is chronic constipation an increase risk for?
increased risk of hiatal hernia, inguinal hernia, diverticulosis, and colon cancer
105
Diarrhea, constipation, and other colon problems are associated with what vertebral segments?
lower thoracic, upper lumbar, sacral subluxations
106
What is the most common organ for metastasis of colon cancer?
liver
107
What is cirrhosis of the liver?
condition characterized by destruction of hepatic cells and their replaced by fibrous tissue and fat
108
What occurs to liver in cirrhosis of liver?
becomes nodular and hard, tends to constrict portal vein at the porta hepatis causing hypertension
109
What causes cirrhosis of liver?
alcoholism, hepatitis, chronic obstruction of bile duct, and congestive heart failure
110
What is portal hypertension
abnormal elevation of pressure within the portal system often due to cirrhosis of liver
111
What happens in portal hypertension
portal vein (no valves) is constricted within portal hepatis and blood flow is reversed causing blood to bypass the liver
112
Where does the blood then accumulate in portal hypertension
back up into caval system in the region where portal-caval anastomoses occurs
113
Portal hypertension does what to the veins?
varicose veins (dilated, twisted, thin) may rupture
114
Portal-Caval anastomoses has 3 sites
distal esophagus, around umbilicus, rectum/anal canal
115
Portal-Caval anastomoses = Distal esophagus are associated with what caval vein and what portal vein
caval - esophageal; portal - left gastric
116
Portal-Caval anastomoses = around umbilicus are associated with what caval vein and what portal vein
caval - superficial veins of anterior abdominal wall; portal - paraumbilical
117
Portal-Caval anastomoses = rectum/anal canal are assocatied with what caval vein and what portal vein
caval - middle and inferior rectal; portal - superior rectal
118
In Portal-Caval anastomoses in the distal esophagus can result in what
esophageal varices causing hemorrahge = fatal bleeding
119
In Portal-Caval anastomoses in around umbilicus can result in what
caput medusae (only in severe cases) snake like veins radiating around umbilicus
120
In Portal-Caval anastomoses in rectum/ anal canal can result in what
hemorrhoids
121
Numonic to remember Portal-Caval anastomoses
Gut (esophageal varices), butt (hemorrhoids), caput (caput medusae)
122
What is jaundice
yellow discoloration of the skin, sclera of the eye, and mucous membranes
123
What causes jaundice
due to release of bilerubin into circulation due to liver damage
124
What are gallstones
hard masses formed by solidification of bile constituents
125
What are gallstones composed of?
cholesterol crystals
126
Where are gallstones commonly located
distal end of the hepatopancreatic ampulla (spincter of ampulla) because it is narrowest part in biliary passages
127
Blockage of gallstones at this location result in what
back up of bile throughout pancreatic duct, acute pancreatitis results
128
Upper abdominal diseases involving liver, gall bladder, or stomach refer pain to what lower thoracic levels?
T8-T12
129
Gall bladder attacks cause pain where?
right upper quadrant of abdomen (30% of patients pain referred to right subscapular region of back)
130
Risk factors for gallstones?
females, obesity, pregnancy, high fat diet
131
Rupture of Pancreas occurs?
when there is forceful compression of the abdomen, as in auto accident (pancreas is smashed)
132
Rupture of pancreas causes
release of digestive enzymes into body cavity causing alot of damage to adjacent tissues
133
Where is pain from the pancreas referred to?
lower thoracic segments
134
Where is pain referred to from the head of the pancreas
right vertebral column
135
Where is pain referred to from the body and tail of the pancreas
left vertebral column
136
Rupture of spleen occurs?
vulnerable to blows to left hypochondrium region
137
What is the most common injured abdominal organ?
spleen
138
What does a ruptured spleen cause
severe hemorrhage and shock
139
Spleens become more fragile in
mononucleosis, malaria, sickle-cell anemia, septicemia
140
When the spleen is removed what takes over its function
kupffer cells of the liver (phagocytize- worn out red blood cells)
