Interval 3 Flashcards
(82 cards)
1
Q
What causes varicose superficial epigastric varicosities?
A
-obstruction of either the IVC or hepatic portal vein
2
Q
Obstruction of the IVC or hepatic portal vein can cause what?
A
-varicosities in superficial epigastric veins
3
Q
Ascites
A
-accumulation of fluid in the peritoneal cavity and may be caused by peritonitis or result from congestion of venous drainage of abdomen
4
Q
What nerves innervate the skin, fascia, and muscles of the anterolateral abdominal wall?
A
- Lower intercostal nerves (T7-T11)
- Subcostal nerve (T12)
- Iliohypogastric nerve (L1)
- Ilioinguinal nerve (L1)
5
Q
Cremasteric reflex utilizes sensory and motor fibers in the ___________. Describe the reflex and nerves involved.
A
- Ventral rami of L1 spinal nerve
- Stroking of skin of superior and medial thigh stimulates sensory fibers of the ilioinguinal nerve
- Motor fibers from genital branch of genitofemoral nerve cause the cremaster muscle to contract
6
Q
Torsion
A
-results in a sudden onset of testicular pain and loss of cremasteric reflex
7
Q
4 types of abnormal cysts in spermatic cord
A
- Hydrocele
- Hematocele
- Spermatocele
- Varicocele
8
Q
Hydrocele
A
-accumulation of serous fluid in tunia vaginalis or in a persistent part of process vaginalis in the cord
9
Q
Hematocele
A
-accumulation of blood in tunica vaginalis and results form rupture of testicular blood vessels after traumu to spermatic cord or testis.
10
Q
Pain associated with trauma to the testis may be referred over the ___________ dermatome
A
T11-L1
11
Q
Spematocele
A
-Cyst containing sperm that develops in epididymis just above testis
12
Q
Varicocele
A
-results from dilations of tributaties of the testicular vein in the pampiniform plexus
13
Q
When are varicosities of pampiniform plexus seen and not able to be seen?
A
-Observed when patient is standing and disappear when lying down
14
Q
A varicocele may be caused by ______.
A
defective valves in pampiniform plexus or by compression of testicular vein (more often the left) in abdomen
15
Q
A malignant neoplasm of the testis (most commonly a seminoma) metastasizes directly to the __________ distinguishing it from a malignancy of the scrotum which metastasizes initially to _______>
A
- Lumbar nodes
- Superficial inguinal nodes
16
Q
What is the most common cause of a painless testicular mass?
A
-malignancy
17
Q
Carcinoma of the fundus of the uterus may metastasize to ___________ along lymphatic vessels that course with the round ligament.
A
-Superficial inguinal nodes
18
Q
Inguinal hernia categories
A
-direct or indirect
19
Q
Which type of inguinal hernia may emerge through the superficial inguinal ring and pass superficial to inguinal ligament?
A
-both direct and indirect
20
Q
Most common type of inguinal hernia
A
-indirect
21
Q
Mechanism of formation of indirect inguinal hernia
A
- protrude through the anterior abdominal wall lateral to the inferior epigastric artery and vein, enter the deep inguinal ring, and appear at the superficial ring after traversing the length of the inguinal canal
22
Q
Indirect inguinal hernias may follow a persistent _________ through the inguinal canal, are covered by _____________ and may descend into the __________. Where can females develop indirect hernias?
A
- Processus vaginalis
- Peritoneum and 3 fascial layers of spermatic cord
- Scrotum
-Canal of nuck
23
Q
Direct hernia formation mechanism
A
-protrude through posterior wall of the inguinal canal medial to the inferior epigastric artery and vein
24
Q
Which hernias are more likely to tear through transversalis fascia and lie adjacent to contents of spermatic cord? What is this hernia usually covered by then?
A
- Direct inguinal hernia
- external spermatic fascia and lie adjacent to contents of spermatic cord and obliterates processus vaginalis at superficial inguinal ring
25
Which location of hernias are more common in males? females?
- Males get inguinal hernias more often
| - Females get femoral hernias more often
26
Femoral hernia mechanism of formation
- enter anterior thigh after passing through the femoral ring deep to the inguinal ligament
- have highest rate of bowel incarceration of any type of hernia
27
Where is the femoral ring?
- Medial to the femoral vein
| - Lateral to lacunar ligament, an extension of inguinal ligament
28
After passing deep to the inguinal ligament, femoral hernias may protrude ___________.
-anteriorly through the saphenous hiatus, a fault in the fascia lata that transmits saphenous vein
29
Referred pain of GI tract
-stimulation of visceral pain fibers that innervate a GI structure results in a dull, aching, poorly localized pain that is referred over the T5-L1 dermatomes
30
Where do the sites of referred pain generally correspond to?
-Spinal cord segments that provide the sympathetic innervation to the affected GI structure
31
A colicky type is pain is a _______________. pain symptomatic of what?
- rhythmic, recurring pain
| - Symptomatic of ileus, an obstruction of a GI structure
32
What causes colicky pain?
-results from recurrent smooth muscle contractions against the obstruction
33
Colic
-severe form of colicky pain
34
What does biliary or renal colic result from?
-recurring smooth muscle contractions against a gall stone lodged in the biliary system or a calculus lodged in ureter
35
Parietal peritoneum innervation
- sensitive to pain
- innervated by lower intercostal nerves (T7-T11), subcostal nerve (T12), iliohypogastric and ilioinguinal nerves (L1) and branches of phrenic nerve (C3-C5)
36
Patients with inflamed parietal peritoneum may exhibit _______ and ________ over the site of inflammation.
- Rebound tenderness: pain that is elicited after the pressure of palpation over affected area is removed
- Guarding: reflex spasms of abdominal muscles in response to palpation which may be ecident over region of inflamed peritoneum
37
Cause of gastroesophageal reflux, or heartburn,
- May result from incompetent lower esophageal sphincter
| - patients may complain of substernal burning that is worse when lying down
38
Achalasia of esophagus
- smooth muscle sphincter of esophagus gfails to relax
- Patients have difficulty swallowing liquids and solids
- dilated esophagus and experience abnormal contractions of smooth muscle of esophagus proximal to affected segment
39
How is achalasia similar to Hirshsprung's disease?
-Both may be caused by absence of terminal parasympathetic ganglia
40
Epiphrenic diverticulum
- may develop just superior to lower esophageal sphincter
| - false diverticula/pulsion diverticula that do not consist of all of the layers of the esophagus
41
False diverticula are most common ________.
In sigmoid colon
42
Surgical access to omental bursa may be obtained by?
-Incising the lesser omentum, the gastrocolic ligament, or gastrosplenic ligament
43
What would have to be avoided in surgicial access to omental bursa via the 3 mechanisms mentioned.
- Lesser omentum: right and left gastric arteries
- Gastrocolic ligament: middle colic artery
- Gastrosplenic ligament: short gastric arteries and left gastro-omental artery
44
Carcinomas of the stomach commonly develop in the _______ part and metastasize to the ________ and through the _________ to the __________.
- pyloric part
- cisterna chylia
- thoracic duct
- left brachiocephalic vein
45
What is a sentinel node for gastric carcinoma?
-Left supraclavicular node of Virchow
46
In an occlusion of the celiac artery at its origin from the abdominal aorta, collateral circulation may develop in the ______ of the pancreas by way of anastomoses between the ________________.
-pancreaticduodenal branches of both the SMA and GDA
47
What are the 3 branches of celiac circulation that may be subject to erosion if an ulcer penetrates the posterior wall of the stomach or duodenum
- Splenic artery if posterior wall of stomach
- Left gastric if ulcer of lesser curvature
- GDA is posterior wall of 1st part of duodenum
48
Why do some patients have pain referred to the shoulder?
-Air escapes through the ulcer and stimulates peritoneum covering inferior aspect of diaphragm
49
Contents of a penetrating ulcer of posterior wall of stomach or duodenum may enter the _______. If they leak out via the epiploic forament, they will spill into the _________
- omental bursa
| - subhepatic recess (Morison's pouch)
50
Which rib fractures may puncture the spleen?
-9-11th rib on the left
51
Primary carcinomas originating in the abdominopelvic structures below the diaphragm commonly spread to the _______.
-Liver
52
Cystohepatic triangle of Calot
-cystic artery, cystic duct, and common hepatic duct
53
The _________ is a common site of an impacted gallstone.
-hepatopancreatic ampulla
54
Stone blocking the cystic duct may cause enlargement of the gallbladder. Patients may exhibit biliary colic that begins in the epigastric region but moves to a point where the _________.
-9th costal cartilage intersects the lateral border of the rectus sheath
55
Inflamed gallbladder may adhere to the duodenum and develop a ________.
- Fistula
| - Allows gallstone to pass into the duodenum
56
Gallstone may become lodged at the ileocecal junction, forming a ________.
Gallstone ileus
57
Adenocarcinomas of the pancreas commonly develop in the ______________ and may result in what?
- Head of pancreas
| - compression of bile duct and main pancreatic duct
58
What can cause duodenal compression and what do patients experience?
- Superior mesenteric vessels may compress the horizontal part of the duodeunum
- Patients experience epigastric or umbilical pain, nausea after a meal, and bilious vomiting
59
Hematemesis
- vomiting of blood, commonly results from bleeding into the lumen of esophagus, sotmach, or duodenum proximal to ligament of Treitz
- commonly causes by duodenal ulcer, gastric ulcer, or esophageal varices
60
Hematochezia
- blood in stool
| - usually due to bleeding into lumen of jejunum, ileum, colon, or rectum distal to ligament of Treitz
61
Melena
-refers to black, tarry stools that contain blood altered by gastric secretions
62
Melanemesis
-coffe-ground appearance of vomit
63
Ileal/Meckel's Diverticulum
- remnant of fetal vitelline duct which persists in postnatal life as outpocketing of ileum
- true diverticulum
64
Define diverticulum
-Outpocketing of a tubular or saccular organ such as GI tract or bladder
65
True vs. False/pulsion diverticula
- True:protrusions that include all of the layers of the affected structure
- False/pulsion: protrusions do not contain all tissue layers
66
Appendicitis pain localization
- Stimulate visceral pain fibers which course pack in lower splanchnic nerves and result in colicky pain referred over umbilical region
- Irritation of parietal peritoneum may result in pain localized over base of appendix (McBurney's point)
67
Psoas sign and Obturator sign with appendicitis
- Psoas sign: where pain from the irritated parietal peritoneum is accentuated when the right thigh is extended at the hip against resistance
- Obturator sign: pain from irritated parietal peritoneum is accentuated when the right thigh is flexed and then internally rotated
68
Why is there a risk for direct hernia with appendectomy?
- Iliohypogastric nerve may be lesioned
| - Weakening of anterior abdominal wall and direct inguinal hernia may result
69
Sigmoid volvulus
- sigmoid colon twists around the sigmoid mesocolon and may become obstructed
- Left side colicky pain, abdominal distension, and hematochezia
70
Sigmoid colon is common site of multiple _________.
- Pulsion diverticula
| - mucosa and submucosa herniate through smooth muscle of sigmoid colon
71
Diverticulosis vs. Diverticulitis
1) diverticula that are not inflamed
| 2) diverticula that are inflamed
72
"Left-Sided" appendicitis is likely what issue?
-Sigmoid colon diverticulitis rupture
73
2 common sites of ischemic bowel infarction
1. transverse colon
| 2. rectum
74
3 sites of portacaval anastomoses
1. in wall of esophagus at junction of capillary beds draining into left gastric (coronary) vein (portal system) and esophageal tributaries of the azygos vein (caval system)
2. wall of rectum at junction of internal rectal plexus which drains into the superior rectal vein (portal system) and external rectal plexus which drains into the middle of inferior rectal veins (caval)
3. Anterior abdominal wall at junction of paraumbilical veins, which course in falciform ligament (postal system) and tributaties of superficial epigastric veins which train into anteral abdominal wall (caval system)
75
Caput medusa
-pattern of varicose superficial epigastric veins that radiate away from umbilic
76
Interlobular artery occlusion
- these are end arteries
| - occlusion may result in avascular necrosis, leaving a shallow scar in renal cortex
77
Proximal part of ureter may be compressed by an _________
- Aberrant renal artery which commonly arises inferior to renal artery and passes anterior to origin of ureter.
- Can cause hydronephrosis of renal pelvis
78
A male patient may have varicocele (more commonly on left) due to what?
-Compression of left renal vein by an aneurysm of SMA near origin of artery from abdominal aorta
79
Kidney transplants
- only upper part of ureter which is supplied by renal artery is transplanted with renal vessels and kidney
- usually place kidney in pelvis where upper part of ureter is attached to the bladder and renal artery is joined to external iliac artery
80
3 narrow points of ureter
- 1. origin of ureter form renal pelvis
2. where ureter crosses pelvic brim
3. point at which ureter enters bladder
81
Aortic Aneurysm
- common site is proximal to bifurcation at level of L4
| - Pulsating painless mass in midline
82
Krukenberg tumors
-carcinomas of stomach that that spread to ovaries
