100 Concepts Set 2 Flashcards
What is the Rectouterine (Douglas) Pouch
Deeper point of peritoneal space in vertical position of the female body between the rectum and the cervix of the uterus
Space of the Pelvic Abcess Location
What is Culdocentesis?
Aspiration of fluid from the cul-de-sac of Douglas (rectouterine pouch) by a needle puncture of the posterior vaginal fornix near the midline between the uterosacral ligaments
Why can the Rectouterine pouch collect inflammatory fluid (pelvic abcess)?
Because it is the lowest portion of the female peritoneal cavity
Erosion of which structure is common in posterior gastric ulcer?
Splenic Artery
Due to proximity of artery to this wall
Describe a potential course for a Posterior Gastric Ulcer?
Erode through posterior gastric wall into the omental bursa (lesser peritoneal sac) and affect the PANCREAS
this will result in referred pain to the back
What is Meckel’s Diverticulum?
Congenital anomaly- persistent vitellointestinal duct
vitellointestinal duct- connection from the midgut to the yolk sac incorporated into the umbilical cord, normally degenerates 2-3 mo after gestation
Meckel’s Diverticulum is normally asymptomatic. When does it become inflamed?
If it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration
What is the Rule of 2s for Meckel’s Diverticulum?
- located on ileum TWO feet before ileocecal junction
- occurs in 2 percent of patients
- 2 inches long
What artery supplies Meckel’s Diverticulum?
The Superior Mesenteric Artery
Why is Meckel’s Diverticulum clinically important?
B/c diverticulitis, liberation, bleeding, perforation, and obstruction are complications requiring surgical intervention
Frequently mimic the symptoms of acute apendicitis
What are some features of the Large Intestine?
- Epiploic Appendices
- Sacculations (Haustrations)
- Taeniae Coli (meet together at base of appendix where they form a complete longitudinal coat for the appendix)
Describe the Ascending Colon?
- lies retroperitoneally
- lacks a mesentery
Where does the Ascending Colon become continuous with the the transverse colon?
the Right Hepatic Flexure
Describe the Transverse Colon
Has its own mesentery called the Transverse Mesocolon (intraperitoneal position)
Where does the Transverse Colon become continuous with the descending colon?
The Left Splenic Flexure
Describe the Sigmoid Colon
Suspended by the sigmoid mesocolon (intraperitoneal position)
Where is the First Pain referred to in appendicits?
Around the Umbilicus
What produces visceral pain in appendicitis?
Distension of lumen or spasm of its (appendix’s) muscle
Describe the course of the Afferent Pain Fibers involved in Appendicitis?
- Enter spinal cord at level of T10 segment
- A vague, referred pain is felt in the region of the umbilicus (T10 dermatome)
What happens if the Parietal Peritoneum gets involved in Appendicitis?
The pain is shifted laterally to McBurney’s point. Here the somatic pain is precise, severe, and localized (second pain)
What does McBurney’s Point indicate?
Surface Marking of the Base of the Appendix
Where is McBurney’s Point?
At the junction between the lateral 1/3 and medial 2/3 of a line joining the right Anterior Superior Iliac Spine with the umbilicus
What is the most common position of the appendix?
Retrocecal
What are the derivatives of the primitive foregut?
Esophagus Stomach Duodenum (1st and 2nd parts) Liver Pancreas Biliary Apparatus Gallbladder
What are the derivatives of the primitive midgut?
Duodenum (2nd, 3rd, 4th parts) Jejunum Ileum Cecum (with appendix) Ascending Colon Transverse Colon (proximal 2/3)
What are the derivatives of the primitive hindut?
transverse colon (distal 1/3)
Descending Colon
Sigmoid Colon
Rectum (anal canal above pectinate line)
What artery supplies the Foregut?
Celiac Artery
Describe the parasympathetic innervation of the Foregut?
Preganglionic: DMN of Vagus Nerve
Postganglionic: Terminal GG
Describe the sympathetic innervation of the Foregut?
Preganglionic: IML T5-T9; Greater Splanchnic nerve
Postganglionic: Celiac Ganglion
Describe the Sensory Innervation?
DRG T5-T9
Where is pain from the Foregut referred to?
The epigastrium
What artery supplies the Midgut?
The Superior Mesenteric Artery
Describe the Parasympathetic innervation of the Midgut
Preganglionic: DMN of the Vagus Nerve
Postganglionic: Terminal GG
Describe the Sympathetic innervation of the Midgut?
Preganglionic: IML T10- T11; Lesser Splanchnic nerve
Postganglionic: Superior Mesenteric G.
Describe the Sensory Innervation of the Midgut?
DRG T10- T11
Where is pain from the midgut referred to?
Umbilical Region
What artery supplies the Hindgut?
Inferior Mesenteric Artery
Describe the Parasympathetic Innervation of the Hindgut?
Preganglionic: SPN S2-S4; Pelvic Splanchnic Nerve
Postganglionic: Terminal GG
Desribe the Sympathetic Innervation of the Hindgut?
Preganglionic: IML L1-L2
Postganglionic: Inferior Mesenteric G
Describe the Sensory Innervation of the Hindgut?
DRG L1-L2
Where is pain from the Hindgut Referred to?
Hypogastrium
