Abdomen Flashcards
palpate the abdomen
label the abdomen diagram
what are the functions of the GI system
ingestion, digestion, secretion, absorption, excretion (defecation)
fill out the digestion table
what are the stripy areas in an abdominal xray
rugae
what are the stripy bits in the large intestine
haustra
what does gas look like in xrays
not completely black, but a dark grey
where is gas usually found
stomach, rectum, sigmoid colon, large intestine
sometimes the small intestine
shouldn’t be anywhere else
what is a normal level of air fluid in the colon
2-3 loops
true/false, the large intestine is peripheral
true
is it normal to see air/fluid in the large intestine
no
what are abnormal findings in abdominal radiographs
extra luminal air (outside lumen): forms a crescent beneath diaphragm
calcification: chronic pancreatitis, endpoint of inflammation
organ size: liver, dilated bowel loops, distended bowl loops
is it important to also take chest radiographs
yes because the issue can start in the chest and present as abdominal pain/discomfort
what is the function of the oesophagus
peristalsis - transport of bolus by relaxation to swallow it and contraction to propel it
what is the purpose of the lower oesphageal sphincter
to stop regurgitation from the stomach (tensioned at rest)
common physiological pathologies of the oesophagus
dysphasia
excessive gastroesophaegeal reflux
what causes dysphasia
neurologic disorders
structural lesions
psychiatric disorders
resection
radiation fibrosis
medications
what does dysphasia lead to
deyhdration, malnutrition, pneumonia
how are oesophageal disorders diagnosed
contrast radiography, endoscopy, fluroscopy
is the oesophagus under voluntary or involuntary control
voluntary in the upper third (cervical), and then involuntary
what are common mechanical pathologies of the oesophagus
GORD
what is GORD
gastro-oesophageal reflux disease
gastric acid & pepsin begin to move into oesophagus and can cause necrosis of oesophageal mucosa and oesophageal stricture (e.g. scar tissue, narrowing, blockage)
what is the clinical presentation of GORD
acid reflux
ear infections
hoarse voice = issues with vocal chords
can lead to adenocarcinoma
what is GORD sometimes mistaken for
myocardial infarction (chest pain)
what causes GORD
weakening/malfunction of oesophageal sphincter and stomach begins to prolapse through diaphragmatic oesophageal hiatus
how can you diagnose GORD
CT (particularly for neoplasia concerns), barium study
what is an oesophageal stricture
narrowing or tightening of the oesophagus that causes swallowing difficulty
what is causes oesophageal stricture
intrinsic diseases that narrow the lumen through inflammation, fibrosis or neoplasia
extrinsic diseases that cause lymph node enlargement
diseases that disrupt peristalsis & lower sphincter function
how is oesophageal stricture diagnosed
barium studies
what causes oesophageal obstruction
progression of stricture, injury, tumour growth, food & foreign bodies
what is achalasia
failure of LES to relax resulting in impaired peristalsis & dysphagia
does the stomach contain rugae
yes
what are common stomach pathologies
ulcer, carcinoma
what causes ulcers
failure of stomach wall to protect against pepsin
risk factors are helicobacter pylori, NSAIDs by long term use because they decrease secretion mucus secretion which protects the lining
how is gastric ulcer (heliocbacter pylori) diagnosed
breath test for increased CO2
what is the purpose of the small intestine
- digestion by enzymes from pancreas
- absorption of digested nutrients & fluids
- neutralisation of gastric acid
- solubilisation of lipids by bile salts
what percentage of nutrient absorption occurs in the small intestine
90%
what causes small intestinal obstruction
- postoperative adhesions (most common)
- hernia
- crohn disease
- tumour
what is a small intestinal obstruction
proximal dilation due to accumulation of air secretions
what does a small intestinal obstruction look like in an xray
air in small intestine
no air in large intestine e.g. a blockage
pilcae are further apart
where are SI obstructions often located
intraluminal = bowel lumen (foreign bodies & gallstones)
intramural = bowel wall due to crohn’s, neoplasia, stricture, anastamoses
extraluminal = adhesions, surgery, volvulus
what is a volvulus & what does it lead to
twisting of the mesentery in which blood vessels are located
leads to ischaemia
high fatality rate
how do you identify blockages in the SI
xray, CT for exact location
what is the string of pearls sign
small bubbles of gas in small intestine
what is intussusception
segment of intestine telescopes into ajoining section causing obstruction
what are the consequences of intussusception
necrosis, due to blood vessels, so requires urgent treatment
how is intussusception diagnosed
contrast enema
what is crohn’s disease & where does it occur
any part, mainly illium, but occurs in patches
looks like abcesses and ulcers
what is the difference between CD & ulcerative colitis
CD is an idiopathic chronic inflammatory disease that can affect any part of the GIT from mouth to anus
it occurs in patches
UC causes inflammation & ulcers in the superficial lining of the large intestine (mucosa)
how is CD investigated
contrast studies (can’t be done with perforated bowel)
CT - helps differentiate CD & UC
what is the function of the large intestine
absorb water from indigestible material (fibre), expulsion of waste products, vitamin production from bacteria
what are pathologies of the LI
diverticulosis
obstruction/dilation
tumour
inflammation
what is diverticulosis
small pouches commonly found in the colon that form from defects in the smooth muscle walls of intestine
common in > 70 yrs and diet related
mostly asymptomatic
what is a large intestine obstruction & is it an emergency
yes it’s an emergency
what causes LBO (large intestinal obstruction)
- neoplasia e.g. ovary, colon, pancreas, lymphoma
- volvulus
- post operative adhesions
- strictures
- hernia
what is an ileus
low gut motility, don’t need to do much, dissolves in 2-3 days
what is a sign of volvulus in an xray
distended inverted U-shaped colonic loop e.g. a large black pouch
what should be distinguished from LBO
LBO
what causes ileus
abdominal surgery
what is bowel cancer
malignant polyps in the bowel
benign polyps are common
how is bowel cancer screened
- occult blood (e.g. blood in stool), not always positive for bowel cancer but indicates need for colonoscopy
- colonoscopy
what is AP supine
patient is supine & lying on back
what is the function of the liver
filtration of blood draining digestive tract, metabolism of protein, carbs, lipids, chemicals, production of plasma proteins, bile salts, excretion of cholesterol & bilirubin
how is the liver supplied with blood
hepatic artery & hepatic portal vein
what does the portal vein do
carry blood from GIT & spleen to liver
has multiple anastomoses with systemic venous system
what is bilirubin
broken down haemoglobin, conjugated in the liver
why is faeces brown
bilirubin
is bilirubin water soluble
no
what are the pathologies of bilirubin
too much = jaundice, too much rb breakdown, or not being conjugated properly
too little =
what are liver pathologies
metastatic tumor
primary tumour
cirrhosis
trauma
vascular obstruction
what is a primary tumour
tumour developed in the organ itself
what are liver primary tumours caused by
repeated replacement of cells due to hep C, alcohol use, NAFLD
what is a hepatic carcinoma
primary tumour in the liver
how are hepatic carcinomas diagnosed
ultrasound
how do metastases occur in the liver
since it is a primary filtration site, it also filters tumour cells
what is cirrhosis & what does it look like on a CT
scarring as a result of chronic damage
can also be caused by blockage of hepatic arteries
on a CT: lobulated margins, varices
what is a common cause of death from abdominal trauma
liver rupture, because there is a massive blood supply to the liver
what causes vascular obstruction in the liver e.g. of the portal vein
cirrhosis, hepatic malignancy
what is collateral circulation
diversion of blood due to blockage
what does collateral circulation cause
oesophageal varices
they’re not designed for that amount of blood so there is a high risk of haemorrhage
how is vascular obstruction diagnosed
ultrasound
what is the gallbladder
storage, concentration & release of bile salts
describe the connection of the liver to the gallbladder and descending part of the duodenum
from the liver there are the right & left hepatic ducts
they form and become the common hepatic duct
from the gallbladder there is the cystic duct
it forms with the common hepatic duct to become the bile duct
the bile duct and main pancreatic duct connect into the duodenum
what are gallbladder pathologies
gallstones, inflammation
what are gallstones, are they symptomatic
no asymptomatic
formed form abnormal bile composition, mainly caused by cholesterol or pigment
western countries mainly get cholesterol (diet related)
pigment is mainly due to chronic biliary infection from calcium bilirubinate
what is cholelithiasis
gallstones
why can’t you see cholesterol gallstones in an xray
cholesterol is not radio-opaque
what is cholecystitis & the 2 types
acute inflammation of gallbladder wall, usually following obstruction of the cystic duct by stone
- gas from emphysematous cholecystitis (bacterial)
- clacification from carcinoma
how is cholecystitis investigated
ultrasound
what are the main factors that determine whether gallstones form
cholesterol secreted by liver cells, relative to bile salts
gallbladder stasis
obesity
diet
rapid weight loss
pregnancy
drugs
what is the function of the pancreas
exocrine function and production & secretion of proteases, lipases & amylase
endocrine is insulin & glucagon
on what anatomical side is the tali of the pancreas
left (right on image) tail ends at spleen
how is the pancreas evaluated
size, swelling indicates inflammation
shrinkage, indicates chronic infl. due to scar tissue formation
masses at the head (common bile duct) and tail (spleen)
what are pancreas pathologies
inflammation & tumours
what is prognosis for acute pancreatitis & causes
glands heal with no real effect or change
caused by alcohol, gallstones, drugs
what is prognosis for chronic pancreatitis & causes
recurs intermittently causing functional & morphological damage
visible signs of clacification on radiographs
how is pancreatitis diagnosed
ultrasound, CT in severe cases
how is pancreatic cancer found
very hard to detect, found by CT, very common but lowest 5 year survival rate
can only really see it when it’s a large size
