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Clinical A and P > Abdomen > Flashcards

Abdomen Flashcards

1
Q

A patient presents with RUQ pain. What’s on the differential diagnoses?

A

Gall bladder issues, liver, RLL pneumonia, cardiac ischemia

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2
Q

A patient presents with epigastric pain. What’s on the differential?

A

Anything with pancreas, stomach, PUD, dyspepsia, cardiac ischemia, early appendicitis

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3
Q

A patient presents with flank pain. What’s on the differential?

A

Renal colic, pyelonephritis, AAA

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4
Q

A patient presents with generalized pain. What’s on the differential?

A

Mesenteric ischemia, AAA, bowel obstruction, endometriosis

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5
Q

A patient presents with dermatomal pain. What’s on the differential?

A

Herpes zoster

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6
Q

What quadrant is the GB located?

A

RUQ

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7
Q

What quadrant is the pylorus and duodenum located in?

A

RUQ

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8
Q

What quadrant is the spleen located in?

A

LUQ

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9
Q

What quadrant is the cecum and appendix located in?

A

RLQ

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10
Q

What quadrant is the sigmoid colon in?

A

LLQ

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11
Q

What is something else to consider in LLQ pain in males and females?

A

diverticulitis

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12
Q

Vena caval foramen, area for liver is near what vertebra?

A

T8

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13
Q

Esophageal hiatus leads to stomach near what vertebra?

A

T10

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14
Q

Abdominal aorta enters abdomen anterior to lumbar and what vertebra?

A

T12

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15
Q

Abdominal aorta bifurcates at what vertebra?

A

L4

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16
Q

Long fibrous sheath made from the aponeuroses of the 3 flat abdominal muscles

A

Rectus sheath

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17
Q

What does the rectus sheath contain?

A

The rectus abdominus muscle, pyramidalis muscle if present, anterior rami of lower 6 thoracic nerves, superior and inferior epigastric vessels and lymph nodes.

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18
Q

All 3 aponeuroses pass _______ to the rectus muscle, leaving the rectus sheath deficient ________ at this level at the ___________.

A

Anterior, posterior, arcuate line

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19
Q

Aponeurosis of external abdominal oblique muscle joins _____ layer of rectus sheath

A

Anterior

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20
Q

Aponeurosis of transversus abdominis muscle joins _______ layer of rectus sheath

A

posterior

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21
Q

What ribs do external obliques run off of?

A

5-12

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22
Q

What ribs do internal obliques run off of?

A

9-12

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23
Q

What ribs do transverse abdominal muscles run off of?

A

6-12 at costal margin, thoracolumbar fascia and iliac crest

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24
Q

True or false: External oblique, internal oblique, and transversus abdominus are NOT considered true posterior structures.

A

True

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25
Q

Strain of what muscle causes a lot of lower back pain?

A

Quadratus lumborum

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26
Q

Valsalva maneuver

A

When the airway is closed and increased intra-abdominal pressure expels contents of rectum, bladder, uterus

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27
Q

What are the branches of the lumbar plexus?

A 
Interested In Getting Lunch On Friday?
Iliohypogastric (T12-L1)
Ilioinguinal (L1)
Genitofemoral (L1, L2)
Lateral femoral cutaneous (L2,L3)
Obturator (L2-L4)
Femoral (L2-L4)
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28
Q

Compression of what nerve can cause neuralgia paresthetica? Can also be from pregnancy and obesity or tight clothing

A

Femoral nerve

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29
Q

What nerve runs anterior to psoas, runs between the transversus and internal oblique, and gives motor supply to those two muscles and sensory supply to lateral hip and skin over hypogastric area and iliac crest?

A

Iliohypogastric nerve

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30
Q

What nerve gives motor supply to transversus abdominus, internal oblique and sensory supply to pubic symphasis, lateral labia majora/scrotum, and superiomedial thigh?

A

Ilioinguinal nerve

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31
Q

What nerve passes through deep inguinal ring and gives sensory info to scrotum/labia majora and motor component to cremaster muscle?

A

Genital branch of genitofemoral nerve

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32
Q

What nerve passes underneath the inguinal ligament and DOES NOT run through the canal? It gives sensory input to upper, anterior thigh and travels with what artery?

A

Femoral branch of genitofemoral nerve. Travels with external iliac artery.

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33
Q

What nerve is sensory only and gives info to lateral thigh? It passes UNDER inguinal ligament and is related to meralgia paresthetica

A

Lateral femoral cutaneous nerve

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34
Q

Arterial supply of rectus abdominus and superior part of anteriolateral wall

A

Superior epigastric A off internal thoracic artery

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35
Q

Arterial supply of rectus abd. m and medial part of anterolateral wall?

A

Inferior epigastric A off external iliac A

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36
Q

Arterial supply of iliacus and inferior part of anterolat. wall?

A

Deep circumflex iliac A off external iliac A

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37
Q

Arterial supply of subcutaneous tissue and skin over inferior part of anterolat wall?

A

Superficial circumflex iliac A off femoral A

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38
Q

Arterial supply of subcutaneous tissue and skin over suprapubic region?

A

Superficial epigastric A off femoral A

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39
Q

Transverse incisions ar emade between what two things?

A

Linea alba at midline to linea semilunaris

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40
Q

What kind of abdominal incision is muscle splitting?

A

Gridiron (over ASIS)

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41
Q

What kind of abdominal incision is good for gallbladder removal?

A

Subcostal incision

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42
Q

What kind of abdominal incision is good for appendectomy?

A

Transverse incision

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43
Q

What kind of abdominal incision is good for exploratory operations?

A

Median or midline incision or left paramedian incision

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44
Q

When Scarpa’s fascia attaches to the pubic arches, what is it called?

A

Colles’ fascia

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45
Q

What forms the tubular sheath for the penis or clitoris?

A

Scarpa’s fascia and fascia lata of thigh

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46
Q

What fascia plays a role with DIRECT hernias?

A

Transversalis fascia

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47
Q

Around what vertebra does the abdominal aorta begin?

A

T12, bifurcates at L4

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48
Q

Dilation of all walls of the vessel

A

Aneurysm

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49
Q

Tear of the intima (within the wall tear) or longitudinal cleavage (end up with a double lumen)

A

Dissection

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50
Q

Where do most aortic aneurysms rupture?

A

Retroperitoneal space (presents as back pain)

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51
Q

Who is most likely to get an aortic aneurism, and where do they usually occur?

A

Males 4-8x more than females.
98% are infrarenal (inferior from where renal vessels take off from abdominal aorta).
Repair all aneurysms >5cm

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52
Q

Signs of retroperitoneal hemorrhage

A

Cullen’s sign, Grey-Turner’s sign, Scrotal hematoma. Most common misdiagnosis is renal colic

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53
Q

What is an aortic dissection and who will get it?

A

Hemodynamic forces cause tear in aortic wall. Male > females 2-3:1. 2-3 times more common than ruptured AAA.

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54
Q

How does an aortic dissection present?

A

Pain occurs in 75% (sudden, tearing, ripping, often migrates to chest, neck, back)

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55
Q

Where does an aortic dissection usually occur?

A

Ascending aorta is most common location (needs surgical repair). Descending aorta can usually be managed with meds.

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56
Q

Where do most aortic aneurysms rupture?

A

Into the retroperitoneal space,

98% are infrarenal

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57
Q

Treatment of aortic aneurysm?

A

repair all that are over 5 cm.

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58
Q

How do aortic aneurysms present?

A

back pain, hypotension, tachy, cullen’s sign, grey-turner’s sign, scrota hematoma

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59
Q

What is more common, an aortic dissection or ruptured AAA?

A

Aortic dissection is 2-3 times more common

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60
Q

Cutaneous lymph vessels above umbilicus drain to:

A

Anterior axillary lymph nodes

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61
Q

Cutaneous lymph vessels BELOW the umbilicus drain to:

A

Superficial inguinal lymph nodes

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62
Q

Deep lymph vessels follow what? Where do they drain?

A

they follow the arteries. They drain into internal thoracic, external thoracic, posterior mediastinal and lumbar (para-aortic) lymph nodes

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63
Q

GI innervation that is INTRINSIC

A

enteric nervous system (3rd division of the ANS)

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64
Q

GI innervation that is EXTRINSIC

A

parasympathetic and sympathetic nervous system

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65
Q

Two plexuses of the ENS

A 
Myenteric plexus (Auerbach's plexus) in muscularis externa
Submucosal plexus (Meisner's plexus) located in the submucosal layer
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66
Q

Neurons in the ENS can inhibit or stimulate what?

A

Motility, secretion, absorption, immune function

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67
Q

ENS can control GI tract without input from CNS. What’s another name for the ENS?

A

“little brain”

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68
Q

When the CNS influences the ENS, it has more influence on _____ and less influence on ______.

A

more influence in esophageal function and gastric motility

Less influence on intestinal peristalsis/secretion

69
Q

Enteric N.S. is deinnervated in the colon, typically diagnosed in childhood. Can develop distended colon and fecal impaction

A

Hirschsprung’s Disease

70
Q

What innervates the esophagus, stomach, gallbladder, pancreas, proximal intestine, cecum and proximal colon?

A

vagus nerve

71
Q

what innervates distal colon and rectum?

A

pelvic nerve

72
Q

At the time of synapse both PNS and SNS preganglionic nerves release what? What does this activate?

A

Acetylcholine

nicotinic receptors

73
Q

Postganglionic PNS nerves release _________. Postganglionic SNS nerves release _______.

A

PNS: ACh and peptides
SNS: Norepinephrine

74
Q

Under normal circumstances, does PNS or SNS dominate?

A

PNS dominates SNS

75
Q

During stressful situations, does the PNS or SNS dominate?

A

SNS dominates

76
Q

What secretes serous fluid to lubricate and facilitate free movement between the viscera?

A

Peritoneum

77
Q

Potential space between parietal and visceral layers. Closed in males, open in females

A

Parietal cavity

78
Q

Pain arising from foregut comes from where? Localizes where?

A

Comes from esophagus, stomach, pancreas, duodenum, liver, biliary tree.
Localizes to epigastric region

79
Q

Pain arising from midgut comes from where? Localizes where?

A

Comes from small intestine distal to bile duct, cecum, appendix, ascending colon, transverse colon. Localizes in periumbilical region

80
Q

Pain arising from hindgut comes from where? Localizes where?

A

Comes from distal transverse colon, descending colon, sigmoid and rectum. Localizes in the hypogastric region

81
Q

Inflamed parietal peritoneum is extremely sensitive to what? What kind of tenderness does this cause?

A

Sensitive to stretching. Causes rebound tenderness.

82
Q

T of F: Tenderness due to irritation of nerves by unilateral lesion is not usually felt on the opposite side of the body.

A

True

83
Q

Connects the stomach to the liver and encloses the portal triad

A

Lesser omentum

Hepatoduodenal ligament

84
Q

Connects the stomach to the spleen

A

Gastrosplenic omentum

85
Q

Connects the stomach to the transverse colon

A

Greater omentum

86
Q

Organs with mesentery have more/less mobility?

A

More

87
Q

Space between parietal and visceral layers of the peritoneum

A

Greater sac

88
Q

How does the greater sac communicate with the lesser sac?

A

Omental (epiploic) foramen of winslow

89
Q

Extends from the diaphragm into the pelvis

A

Greater sac (main compartment)

90
Q

Lies behind the stomach and lesser omentum. Extends upward to diaphragm and downward between layers of greater omentum

A

Lesser sac (omental bursa)

91
Q

Formed by spleen, gastrosplenic omentum, and lienorenal ligament

A

Left margin of lesser sac

92
Q

Opens into the greater sac of peritoneal cavity through foramen of Winslow

A

Right margin of lesser sac

93
Q

Area of potential herniation of small bowel

A

Foramen of Winslow

94
Q

If the cystic artery is cut during a cholecystectomy, hemorrhage is controlled by compressing what?

A

The proper hepatic artery in the foramen winslow

95
Q

What are the two fossas found in the peritoneum?

A

Duodenal fossa, cecal fossa

96
Q

What area lies between the diaphragm and the liver/spleen and provides sites for pus to drain?

A

Subphrenic spaces

97
Q

What area should you assess for fluid after trauma, abscess, or suspected peritonitis?

A

Morrison’s pouch (subphrenic space continuous with heptaorenal recess)

98
Q

Lies on the lateral and medial sides of the ascending and descending colons respectively. Provides channels for accumulation and movement of fluid in the peritoneal cavity

A

Paracolic gutters

99
Q

Hernia through linea alba, obesity, age >40 years

A

epigastric hernia

100
Q

Hernia occurring at any incision site, more common with infection

A

Incisional hernia

101
Q

True or false: Inguinal canal runs the same length as the ligament.

A

False

102
Q

Inguinal canal runs parallel and just superior to the (medial/lateral) half of the inguinal ligament.

A

Medial

103
Q

What tendon reinforces the posterior wall of the posterior wall?

A

Conjoint tendon

104
Q

Hernia passes through anterior abdominal wall. Sac is a persistent process vaginalis, bulge occurs over inguinal ligament and may herniate into scrotum

A

Indirect inguinal hernia

105
Q

Indirect inguinal hernia may extend _______ to pubic tubercle

A

Superior and medial

106
Q

Femoral hernia extends ______ to pubic tubercle

A

Inferior and lateral

107
Q

Herniating bowel passes ______ to inferior epigastric vessels in indirect inguinal hernias.

A

Lateral

108
Q

Protrudes through posterior wall of the inguinal canal

A

Direct inguinal hernia

109
Q

Results from a weakness in the anterior abdominal wall musculature. Hernia sac is peritoneum and transversalis fascia

A

Direct inguinal hernia

110
Q

Where are you most likely to have an inguinal hernia?

A

Hesselbach’s triangle (inguinal ligament, rectus abdominus, and inferior epigastric artery)

111
Q

Herniating bowel passes ____ to inferior epigastric vessels in direct hernia.

A

Medial

112
Q

Gastric arteries supply what part of the stomach?

A

Lesser curvature

113
Q

Gastroepiploic arteries supply what part of the stomach?

A

Greater curvature

114
Q

Short gastric arteries supply what part of the stomach?

A

Fundus

115
Q

Nerve supply of the stomach comes off what spinal nerves?

A

T6-T9

116
Q

All lymph from the stomach eventually passes to the ______ nodes.

A

celiac

117
Q

How many liters of gastric secretion occur daily?

A

7

118
Q

True or false: The duodenum is mostly retroperitoneal

A

True

119
Q

How many parts are the duodenum divided into?

A

4

120
Q

Common bile and pancreatic ducts unite at the duodenum and form what?

A

Major duodenal papilla

121
Q

Controls bile and pancreatic secretions into small bowel

A

Sphincter of Oddi

122
Q

Arteries proximal to the bile duct entry

A

Superior Pancreaticoduodenal artery

123
Q

Arteries distal to bile duct entry

A

Inferior pancreaticoduodenal artery

124
Q

Second half of duodedum drains to what nodes?

A

Superior mesenteric nodes

125
Q

What part of the small intestine is wider, thicker, and more red than the ileum?

A

Jejunum

126
Q

Occupies lower right abdominal cavity, has Peyer’s patches

A

Ileum

127
Q

SNS nerve supply of small intestines

A

superior mesenteric plexus

128
Q

Pain fibers to large intestine

A

T10-L2

129
Q

Pain fibers to distal sigmoid colon/rectum

A

L1-S4

130
Q

Blind-ended pouch in right iliac fossa covered with peritoneum with no mesentery

A

Cecum

131
Q

Where is the ascending colon located?

A

Retroperitoneal

132
Q

What artery supplies the proximal 2/3 of the transverse colon? What about the distal 1/3?

A

Proximal: Middle colic artery
Distal: Left colic artery
Drained by SMV and IMV veins

133
Q

Nerve supply of transverse colon?

A

SNS: Sup. and Inf. mesenteric plexus
PNS: pelvic splanchnic nerve

134
Q

Proximal 2/3 of transverse colon drains where? (lymph) distal 1/3 drains where?

A

Proximal: colic lymph nodes then SML
distal: colic lymph nodes then IML

135
Q

SNS and PNS supply of sigmoid colon

A

SNS: inf. mesenteric plexus
PNS: splanchnic nerves

136
Q

What is the most common cause of intestinal obstruction in children? Adults?

A

Children: hernia 38%
adults: adhesions

137
Q

Where does the bare area of the liver lie?

A

between coronary ligaments, directly in contact with diaphragm

138
Q

What vessels enter the hilus of the liver?

A

proper hepatic artery

Portal vein

139
Q

Hepatocytes are surrounded by a “cage” of supporting __________ cells, which also play a role in what?

A

reticuloendothelial cells
phagocytosis and cytokine secretion.
When not functioning, they contribute to hepatic necrosis and cirrhotic fibrosis

140
Q

What vein drains blood from small intestine?

A

SMV

141
Q

What does the splenic vein drain blood from?

A

spleen, IMV, pancreatic vein, gastroepiploic veins

142
Q

The hepatic portal vein is formed by the union of what?

A

superior mesenteric and splenic veins

143
Q

What type of blood does the portal vein connect?

A

Deoxygenated, nutrient rich blood

144
Q

What type of blood does the liver receive from hepatic artery?

A

oxygenated blood

145
Q

Normal liver span

A

4-8 cm in midsternum

6-12 cm in right midclavicular line

146
Q

What is at the neck of the gallbladder?

A

Hartmann’s pouch (infundibulum)

147
Q

Portion of common bile duct prior to entry of the cystic duct

A

common hepatic duct

148
Q

portion after the entry of the cystic duct

A

common bile duct

149
Q

Nerve supply of gall bladder

A

Celiac plexus T6-9

150
Q

Connects neck of GB to common hepatic duct; forms the common bile duct

A

cystic duct

151
Q

union of common hepatic and cystic ducts

A

common bile duct

152
Q

Irritation of the phrenic nerve can cause referred pain where?

A

shoulder

153
Q

What is a sensitive test that can show cystic duct obstruction but can’t identify stones?

A

HIDA scan

154
Q

The tail of the pancreas extends to the spleen via what ligament?

A

lienorenal ligament

155
Q

Nerve supply of pancreas

A

Vagal nerves from celiac, splanchnic, and superior mesenteric plexuses (T5-9)

156
Q

How many liters of fluid does the pancreas secrete/day?

A

1.5

157
Q

True or false: pancreatic secretions are acidic.

A

False—

Alkaline. Help neutralize acid from the stomach

158
Q

CCK is released in response to what?

A

fats

159
Q

What type of bacteria in particular does the spleen help protect you from?

A

encapsulated

160
Q

What modifications do you have to take on if you lose your spleen?

A

Immune support with pneumovax, HIB, and meningococcal vaccines

161
Q

What level (vertebrae) do the kidneys lie at?

A

T12 to L3

162
Q

Renal veins drain into the ______, ureteral veins drain into ________.

A 
renal = IVC
ureteral = testicular or ovarian veins
163
Q

where does renal lymph drain to?

A

lateral aortic lymph nodes. Ureters also drain to iliac nodes

164
Q

The right adrenal gland has a ______ shape while the left has a ______ shape.

A

R: triangular
L: semilunar

165
Q

Produces aldosterone (renin-angiotensin-aldosterone axis). Most superficial

A

Zona glomerulosa (most superficial layer of adrenal cortex)

166
Q

Produces glucocorticoids (cortisol)

A

Zona fasciculata (middle layer of cortex)

167
Q

Produces androgens

A

Zona reticularis (deepest layer)

168
Q

What does the adrenal medulla produce?

A

Chromaffin cells—Epinephrine (80%) and NE (20%)

169
Q

Where does renal lymph drain?

A

aortic lymph nodes

Clinical A and P (5 decks)

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