Peritoneum/Foregut/Pancreas

Question 1

what is a mucous plug & why is it important?

Answer 1

-blocks external opening of uterus -prevents infection but allows sperm to pass

Question 2

what is the serosa?

Answer 2

covering of peritoneum

Question 3

what is peritonitis?

Answer 3

bacterial contamination during surgery or trauma after a rupture of the peritoneal cavity

Question 4

what is general peritonitis?

Answer 4

occurs when an ulcer perforates wall of stomach or duodenum; spills acid into peritoneal cavity

Question 5

excess fluid in peritoneal cavity?

Answer 5

ascitic fluid

Question 6

what is paradoxical abdominothoracic rhythm?

Answer 6

-abdomen drawn in during chest expansion -indicates peritonitis or pneumonitis

Question 7

what is an adhesion?

Answer 7

scar tissue

Question 8

what is a volvulus?

Answer 8

when intestine becomes twisted around adhesion and causes chronic pain or intestinal obstruction

Question 9

what is an adhesiotomy?

Answer 9

surgical separation of adhesions

Question 10

what is a paracentesis?

Answer 10

surgical puncture of peritoneal cavity for aspiration or drainage of fluid

Question 11

where would a needle for paracentesis go?

Answer 11

-anterolateral abdominal wall into peritoneal cavity through linea alba -superior to empty urinary bladder to avoid inferior epigastric artery

Question 12

what is an intraperitoneal injection used for?

Answer 12

anesthetic to peritoneal cavity because peritoneum is a semipermeable membrane (rapid uptake)

Question 13

what is peritoneal dialysis?

Answer 13

removal of excess water and solutes from blood (because of renal failure) by transfer across peritoneum

Question 14

what is the function of the greater omentum?

Answer 14

-prevents visceral peritoneum from adhering to parietal peritoneum -makes adhesions around diseased viscera

Question 15

what is an abscess?

Answer 15

formation of pus because of duodenal ulcer perforation, rupture of gall bladder, or perforation of appendix

Question 16

why are the peritoneal recesses of clinical importance?

Answer 16

they determine extent and direction of fluid spread during infection or disease of an organ

Question 17

what are paracolic gutters?

Answer 17

lateral attachments of ascending/descending colon to posterolateral abdominal wall

Question 18

why are paracolic gutters important?

Answer 18

provide pathway for ascitic fluid flow and spread of infection and cancer

Question 19

how can fluid get into the omental bursa?

Answer 19

perforation of posterior wall of stomach and inflamed pancreas

Question 20

if part of the intestine perforates into the omental foramen, why can’t you simply cut the boundaries of the foramen?

Answer 20

all boundaries have blood vessels, so the intestine must be emptied with a needle and put back in place

Question 21

what is a cholecystectomy and what artery must be ligated during it?

Answer 21

-gall bladder removal -cystic artery

Question 22

what is the most frequently injured organ in the abdomen?

Answer 22

spleen (ex: ruptured spleen from trauma)

Question 23

how is a ruptured spleen treated?

Answer 23

repair is difficult, so splenectomy is preferred

Question 24

what’s important about a sub-total (partial) splenectomy?

Answer 24

rapid regeneration

Question 25

what are the side effects of splenectomy?

Answer 25

no major side effects; higher risk for bacterial infection

Question 26

what is splenomegaly and when does it happen?

Answer 26

-enlargement of spleen -side effect of granulocytic leukemia & anemia

Question 27

what is clinical important about an accessory spleen?

Answer 27

if not detected & removed during splenectomy, symptoms may still persist

Question 28

what's important about the relationship of the costodiaphragmatic recess and the spleen?

Answer 28

splenic needle biopsy and splenoportography can cause pleuritis if material enters the CD recess during these procedures

Question 29

where is an important blockage site of a gallstone?

Answer 29

gallstones can lodge into hepatopancreatic ampulla and cause backup of bile and pancreatic juices

Question 30

what causes pancreatitis?

Answer 30

bile backup from gallstone that enters pancreatic duct (normally prevented by hepatopancreatic sphincter)

Question 31

what is endoscopic retrograde cholangiopancreatography used for?

Answer 31

diagnosis of pancreatic and biliary disease

Question 32

where is accessory pancreatic tissue likely to develop and what's its importance?

Answer 32

- stomach and duodenum - can produce insulin and glucagon

Question 33

what is removed during a pancreatectomy?

Answer 33

the body and tail of the pancreas (can't remove entire head)

Question 34

other than diabetes, what other major problem can occur with the pancreas?

Answer 34

rupture of the pancreas due to trauma, which can cause pancreatic juice to enter parenchyma & invade other tissues

Question 35

what's the major cause of extrahepatic obstruction of biliary ducts?

Answer 35

cancer of the pancreatic head

Question 36

an enlarged gallbladder and jaundice most likely indicates?

Answer 36

cancer of the pancreatic head

Question 37

cancer of the pancreatic neck & body can cause?

Answer 37

obstruction of inferior vena cava and hepatic portal vein

Question 38

why is pancreatic cancer so difficult to control/detect?

Answer 38

the pancreas lymph drains to relatively inaccessible lymph nodes and it metastastizes to liver via hepatic portal vein

Question 39

where are subphrenic abscesses likely to be?

Answer 39

right side subphrenic recess because of ruptured appendices and perforated duodenal ulcers

Question 40

where is a subphrenic abscess drained?

Answer 40

incision inferior to or through the bed of the 12th rib (unnecessary to cut pleura or peritoneum)

Question 41

what is the relevance of the fact that the left and right hepatic arteries/veins/ducts do not communicate?

Answer 41

hepatic lobectomies can be done with little bleeding

Question 42

damage to the liver or cancer of the liver can be removed by?

Answer 42

hepatic segmentectomies (must use ultrasound to detect individual segments)

Question 43

what is common source of aberrant right hepatic artery? left?

Answer 43

- right: superior mesenteric artery - left: left gastric artery

Question 44

in most people, the right hepatic artery crosses ___________ to hepatic portal vein?

Answer 44

anterior

Question 45

in most people, the right hepatic artery crosses _________ to common hepatic duct

Answer 45

posterior

Question 46

what can cause hepatomegaly?

Answer 46

- congestive heart failure, bacterial and viral diseases such as hepatitis - metastatic carcinoma

Question 47

hepatic cirrhosis causes?

Answer 47

- replacement of hepatocytes with fat and fibrous tissue - portal hypertension - mostly occurs in alcoholics

Question 48

how is advanced hepatic cirrhosis treated?

Answer 48

surgical creation of portosystemic or portocaval shunt to anastomose the portal and systemic venous systems

Question 49

where does a liver biopsy take place?

Answer 49

through right 10th ICS in midaxillary line

Question 50

what's clinically important about a mobile gallbladder?

Answer 50

- gallbladder is suspended from liver by mesentary - subject to vascular torsion and infarction

Question 51

what is a cholelithiasis made of?

Answer 51

gallstone: cholesterol

Question 52

why does cholecystitis occur?

Answer 52

blockage of cystic duct via gallstone--\> bile accumulation, enlargement of gallbladder

Question 53

where can gallstones collect in a diseased gallbladder?

Answer 53

abnormal sacculation called Hartmann pouch at junction of neck of gallbladder and cystic duct

Question 54

what causes a cholecysto-enteric fistula?

Answer 54

- inflamed gallbladder from gallstone can cause adhesions with nearby viscera and break down tissues between them - duodenum and transverse colon - gallstone can then enter GI tract & obstruct bowel

Question 55

where does the cystic artery usually come from?

Answer 55

right hepatic artery in cyctohepatic triangle (calot triangle)

Question 56

what are the borders of the cystohepatic triangle?

Answer 56

inferior: cystic duct medially: common hepatic duct superiorly: inferior surface of liver

Question 57

varicose veins of lower esophagus indicate?

Answer 57

portal hypertension & caput medusae around umbilicus

Question 58

how is portal hypertension treated?

Answer 58

- creating anastomose between hepatic portal vein and IVC (portosystemic shunt) - join splenic vein to left renal vein after splenectomy (spenorenal shunt)