Abdomen Flashcards
1
Q
Foregut
Blood supply
Referred pain
A
Celiac artery
Epigastric
2
Q
Midgut
Blood supply
Referred pain
A
SMA
umbilicus
3
Q
Hindgut
Blood supply
Referred pain
A
IMA
Hypogastric
4
Q
Compartment of the pharynx
A
Nasopharynx
Oropharynx
Laryngopharynx
5
Q
Stratified squamous
Upper 1/3 striated
Mid 1/3 mixed
Lower 1/3 smooth muscle
A
Esoohagus
6
Q
10 inches
18-25 cm
Muscular tube
Begins at cricoid (C6) and ends at esophageal hiatus (cardia)
Has cervical, thoracic and abdominal parts
A
Esophagus
7
Q
Esophageal hiatus level
A
T10
8
Q
Esophageal hiatus content
A
Esophagus
Left gastric artery and vein
Left and right vagus nerves
Lymphatics
9
Q
Cervical esophagus blood supply
A
Inferior thyroid artery of
Thyrocervical trunk
Subclavian artery
10
Q
Thoracic esophagus
Blood supply
A
Bronchial arteries
Aorta
11
Q
Abdominal esophagus
Blood supply
A
Left gastric artery
Inferior phrenic artery
12
Q
Constrictions of the Esophagus
A
Cervical constriction (UES) at cricoid cartilage
Bronchoaortic constriction
Diaphragmatic constriction (LES)
13
Q
Hypertensive LES
Aperistalsis of Esophageal Body
Failure of LES to relax
A
Achalasia
14
Q
Surgical tx for achalasia
A
Heller’s myotomy
+/- Partial fundoplication
15
Q
Type 1
Esophageal Hernia
A
Sliding Hernia
GEJ at thorax
Hernia content GEJ
16
Q
Type II
Esophageal hernia
A
Rolling/Paraesophageal Hernia
GEJ in abdomen
Hernia content in fundus
17
Q
Type III
Esophageal Hernia
A
Mixed
Sliding and Paraesophageal
GEJ thorax
Hernia content GEJ + Stomach
18
Q
Type IV
Esophageal Hernia
A
Mixed + another organ
most commonly spleen
19
Q
Weak spot between inferior constrictor and cricopharyngeus
A
Killian’s triangle
20
Q
Killian’s triangle is the most common site of
A
Zenker’s Diverticulum
21
Q
Most common site of esophageal perforation
A
Killian’s triangle
22
Q
Diagnosed by Barium swallow
Tx: 2 cm or less pharyngomyotomy
> 2cms Diverticulectomy
Diverticulopexy
A
Zenker’s Diverticulum
23
Q
Most common esoohageal diverticulum
A
Zenker’s diverticulum
24
Q
Between the transverse and oblique fibers
Pseudodiverticula
A
Zenker’s diverticulum
25
Typically arises in the mid esophagus
Includes mucosal, submucosal, and muscular layers of the esophagus
True diverticulum
From the pull of an adjacent mediastinal scar such as in granulomatous infection
Traction diverticula
26
Inadequate relaxation of either the upper or lower esophageal sphincter resulting in increased intraluminal pressure and subsequent herniation of the esophageal wall at an area of weakness
Pulsion diverticulum
| Ex Zenker’s
27
False diverticula contains only
Submucosa
Mucosa
More common
28
Columnar lined epithelium of the esophagus rather than squamous epithelium
Hallmark of intestinal metaplasia is the presence of:
Barett’s esophagus
Goblet cell
29
May lead to ulcer, stricture formation and dysplasia and cancer
30 - 125x increased risk of developing adenocarcinoma
Barett’s esophagus
30
Most common presenting symptom
| 60% of esophageal lumen is infiltrated
Dysphagia
Others: stridor, cough, choking, aspiration pneumonia, bleeding, hoarseness, jaundice and bone pain
anorexia and weight loss
31
Esophageal cancer treatment with best chance for cure and provides effective palliation
Surgery
32
Trans-thoracic esophagectomy
Ivor-Lewis procedure
| wider lymphadenectomy
33
Trans-hiatal esophagectomy
Orringer’s procedure
Avoids thoracotomy
Less morbidity
34
Linear laceration of esophagus
Common in alcoholics with history of forceful retching or vomiting
Mallory-Weiss Tear
35
Thin submucosal ring in the lower esophagus
Schatzki’s ring
36
Squamous Cell CA
Esophageal web
Atrophic glossitis
IDA
Plummer Vinson Syndrome
37
A true surgical emergency
Mostly follows a therapeutic or diagnostic procedure
Pain: striking and consistent symptom
Esophageal rupture
38
Spontaneous rupture of the esophagus
Usual history of resisting vomiting
High mortality due to misdiagnosis and delay in treatment
Usually occurs into the left pleural cavity or just above the gastroesophageal junction
Esophageal perforation
39
Quadrant lines
Transumbilical plane
| Median plane
40
Duodenum lies above the
umbilicus
41
Bifurcation of the aorta
Iliac crest
Vertebral level?
Dermatomal level?
AOG?
L4
T10
20 weeks
42
Planes of the abdomen
Midclavicular
Subcostal
Transtubercular
43
3rd part of the duodenum
Origin of IMA
is on this plane at
the level of?
Subcostal plane
| L3
44
Transtubercular plane is at vertebral level?
L5
45
This plane contains pylorus of stomach
Duodenojejunal junction
Neck of pancreas
Hila of kidneys
Vertebral level?
Transpylori
L1
46
Superficial fascia
| Outer fatty layer
Camper fascia
47
Superficial fascia
| Inner membranous layer
Scarpa fascia
48
The Scarpa fascia is continuous with the
Dartos fascia of scrotum
| Colles fascia of superficial perineal fascia
49
Layers of the Abdomen
```
9:
Skin
Subcutaneous layer
Superficial fascia (Camper and Scarpa)
External oblique muscle
Internal oblique muscle
Transversus abdominis muscle
Transversalis fascia
Preperitoneal adipose and areolar tissue
Peritoneum
```
50
The external oblique gives rise to
Inguinal Poupart ligament
External/superficial inguinal ring
External spermatic fascia
51
The internal oblique gives rise to
Splits
Conjoint tendon
Middle Cremaster spermatic fascia and muscle
52
The transversalis fascia gives to
Internal spermatic fascia
| Internal/deep inguinal ring
53
Above the arcuate line (semicircular line 4-5cm below umbilicus)
Anterior?
Posterior?
Anterior:
external oblique aponeurosis
anterior lamina of internal oblique aponeurosis
Posterior layer:
posterior lamina of internal oblique
transversus abdominis aponeurosis
54
Below the arcuate line:
Anterior?
Posterior?
Anterior:
External oblique aponeurosis
Internal oblique aponeurosis
Transversus abdominis aponeurosis
Posterior:
Only transversalis fascia
55
Structures within the rectus sheath:
```
Rectus abdominis muscle
Pyramidalis
Superior epigastric artery
Inferior epigastric artery
Lower 6 intercostal nerves
Subcostal nerve
```
56
Paracentesis approach
Flank
```
Skin
Superficial fascia (Camper, Scarpa)
EO
IO
TA
TF
Preperitoneal fat
Peritoneum (parietal)
```
57
Paracentesis
Midline approach
```
Skin
Superficial fascia (Camper, Scarpa)
Linea alba
Transversalis fascia
Preperitoneal fat
Peritoneum (parietal)
```
58
Counterpart of superficial fascia
Camper
Scarpa
in the covering of the scrotum
Camper - Dartos
| Scarpa - Colles
59
Where extravasated urine occupies
| Between the superficial fascia and external oblique muscle
Superficial perineal space
60
External oblique counterpart in scrotum and testes
External spermatic fascia
61
Internal oblique muscle counterpart
Cremasteric fascia and muscle
62
Transverse abdominis counterpart in scrotum and testes
Does not continue into scrotal area
63
Transversalis fascia counterpart in scrotum and testes
Internal spermatic fascia
64
Extraperitoneal fat counterpart in scrotum and testes
Extraperitoneal fat
65
Parietal peritoneum counterpart in scrotum and testes
Tunica vaginalis
66
Midline fibrous line formed by fusion of the layers of the rectus sheath attached superiorly to the xiphoid and inferiorly to the pubic symphysis
Linea alba
67
Curved line on the ventral abdominal wall parallel to the midline halfway between it and the side of the body that marks the lateral border of the rectus abdominis muscle
Linea semilunaris
68
Most common cause is trauma
Most commonly occurs on the right side, below the umbilicus
Rupture of Inferior epigastric vein
Rectus sheath hematoma
69
Rectus sheath hematoma is most commonly caused by rupture of the
Inferior epigastric veins
70
Palpable abdominal mass that remains unchanged with contraction
Fothergill sign
71
Dx for rectus sheath hematoma
Tx?
Does not cross the midline
CT
Ice pack, resuscitation
72
Connection between the superficial and deep inguinal ring
Inguinal canal
73
Inguinal canal content
Spermatic cord
Round ligament
Ilioinguial nerve
Genital branch of the genitofemoral nerve
74
Boundaries of inguinal canal
Roof:
Internal oblique muscle
Transversus abdominis muscle
Anterior wall:
Aponeurosis of external oblique
Aponeurosis of internal oblique
Floor:
Inguinal ligament
Lacunar ligament
Posterior wall:
Transversalis fascia
Conjoint tendon
75
Poor gubernacular fixation -> torsion
Homologue of gubernaculum in females
Bell clapper deformity
76
Formation of hydrocele
Formation of indirect hernia
arises from
peristent processus vaginalis
77
Hesselbach/Inguinal triangle boundaries:
Superiorly: Inguinal ligament
Medially: Rectus abdominis
Laterally: Inferior epigastric vessels
78
Located medial to inferior epigastric vessels
Direct hernia
79
Hernia superolateral to the inferior epigastric vessels
Indirect inguinal hernia
80
Projects through inguinal ring
| Below and lateral to inferior epigastric vessels
Indirect inguinal hernia
81
Projects through abdominal wall
| Medial to epigastric vessels
Direct inguinal hernia
82
The deep inguinal ring in relation to the inferior epigastric vessel
Is lateral hence indirect if lateral to inferior epigastric vessel since it goes down the inguinal ring
83
```
Infants
Congenital
Lateral to inferior epigastric vessels
Deep inguinal ring leaving out through the superficial inguinal ring
Narrow neck
```
Indirect inguinal hernia
84
```
Old men
Weak musculature
Medial to inferior epigastric vessels
Traverses the Hesselbach’s triangle
Wide neck
```
Direct inguinal hernia
85
Type of hernia more prone to obstruction/strangulation
Indirect hernia
86
Test that differentiates between epididymitis and torsion?
Phren’s test
87
Positive Phren
Pain relief with lifting the affected testicle
Dx?
Epididymitis
88
Negative Phren’s sign
Loss of cremasteric reflex
30% of males with normal testicle have absent cremasteric reflex though
Testicular torsion
89
Continuous with the transversalis fascia
Has 3 compartments
Femoral sheath
90
Medial compartment of femoral sheath is the
Femoral canal
| Contains lymphatics
91
Middle compartment of femoral sheath contains the
Femoral vein
92
Lateral compartment of the femoral sheath
Femoral artery
93
Femoral nerve with respect to the femoral sheath
Lateral
94
Upper opening of femoral canal
Femoral ring
95
Anterior to the femoral ring
Inguinal ligament
96
Posterior to the femoral ring
Pectineal ligament
97
Medial to the femoral ring
Lacunar ligament
98
Lateral to the femoral ring
Femoral vein
99
Most common hernia in females
Inguinal hernia
100
Femoral hernia is more common in
females
101
Inguinal ligament relation with
Inguinal hernia
Femoral hernia
Inguinal hernia: above
Femoral hernia: below
102
Pubic tubercle relation with
Inguinal hernia
Femoral hernia
Medial to the inguinal hernia
| Lateral to the femoral hernia
103
Parietal peritoneum
nerve supply
pain quality?
Somatic nerves
Sharp, localized
104
Visceral peritoneum
Nerve supply
Pain quality?
GVA fibers from autonomics
Diffuse, aching or cramping
105
Lining epithelium of peritoneum
Mesothelium (simple squamous)
also in pleura, peritoneum, mediastinum, pericardium
106
Faciform ligament
Content?
Embryonic structure?
Round ligament
Umbilical vein
107
Median umbilical fold
Content
Fetal sturcture?
Median umbilical ligament
Allantois
108
Medial umbilical fold
Content?
Fetal structure
Medial umbilical ligament
Umbilical artery
109
Lateral umbilical fold
Content?
Fetal structure
Inferior epigastric vessels
110
Reveals when urethral obstruction is present
Such as in congenital urethral obstruction
prostate enlargement
Patent urachus
111
Have mesentery
| Mobile
Visceral peritoneum
112
Immobile or fixed
Retroperitoneal
