Abdomen Clinical Supplement Flashcards
“5 F’s for abdominal protrusions:”
Fat, Feces, fetus, flatus, fluid
“What’s located at the interesection of the right semilunar line and the 9th costal cartilage?”
“Gallbladder (G)<div><br></br></div><div><img></img></div>”
What is located under the 9-11th ribs on the left side at the midaxillary line?
“Spleen (B)<div><br></br></div><div><img></img></div>”
What is located along the scapular line? left is more superior then right. Superior poles are situated at the level of the 11th ribs
“Kidneys<div><br></br></div><div><img></img></div>”
Where is the semilunar line located?
Lateral to the rectus abdominis
Superior middle section of the abdomen is also referred to as the _____________ region
Epigastric
The lateral regions of the abdomen encompassing the lateral anterior rib cage are referred to as the left and right _____________ region
Hypochondriac
Dermatome of the xiphoid process?
“T6<div><br></br></div><div><img></img></div>”
Dermatome of the umbilicus?
“T10<div><br></br></div><div><img></img></div>”
Dermatome of the inguinal ligament?
“L1<div><br></br></div><div><img></img></div>”
The cremaster reflex is elicited by stroking the medial aspect of the upper thigh (stimulation of the ______________ n)<br></br>-results in the contraction of the cremaster muscle (__________________________ n) and retraction of the testes
Ilioinguinal, genital branch of the genitofemoral
The cremaster reflex tests what spinal cord levels?
L1-L2
Abdominal Reflex<br></br>Stroke the skin of the abdominal wall at the umbilicus from lateral to medial. This should cause contraction of the ipsilateral abdominal wall muscles. This reflex tests the ___________ spinal cord levels
T5-T6
What artery is responsible for a hematoma within the rectus sheath?
“Inferior epigastric artery (comes off the external iliac artery)<div><br></br></div><div><img></img></div>”
What structures are in danger of iatrogenic injury with a vertical midline incision in the abdominal wall?
Linea alba
What structures are in danger of iatrogenic injury with a vertical paramidline incision in the abdominal wall?
Thoracoabdominal a., illiohypogastric n., illionguinal n.
What structures are in danger of iatrogenic injury with a pfannenstiel incision in the abdominal wall?
“pirimidalis muscle, rectus sheath, inferior epigastric vessels, iliohypogastric n. and ilioinguinal n.<div><br></br></div><div><img></img></div>”
When suturing together a midline abdomen incision, what layers should be sown together?
“skin, scarpa’s fascia, investing fascia, and muscle layers”
During liposuction, fat is removed from the _______________
“Subcutaneous campers fascia<div><br></br></div><div><img></img></div>”
Direct inguinal hernias are most common in _____________ (population)
Older men
“What is hesselbach’s triangle bound by?”
“Inguinal ligament, rectus abdominus, inferior epigastric vessels<div><br></br></div><div><img></img></div>”
Where do direct inguinal hernias exit the abdominal cavity?
“<b>Medial</b> to the inferior epigastric vessels through hesselbach’s triangle<div><br></br></div><div><img></img></div>”
What covers a direct inguinal hernia?
“Parietal peritoneum and transversalis fascia<div><br></br></div><div><img></img></div>”
____________ hernia<br></br><br></br>-does not traverse the entire inguinal canal<br></br>-acquires a covering of external spermatic fascia<br></br>-repair can include suturing together the inguinal ligament and conjoin tendon
“Direct inguinal<div><br></br></div><div><img></img></div>”
Most common type of abdominal hernias?
“Indirect inguinal hernia (congenital) (Inguinal hernia = above inguinal ligament)<div><br></br></div><div><img></img></div>”
____________________ hernia <br></br>- leaves the abdominal cavity <b>lateral</b> to the inferior epigastric vessels via deep inguinal ring<br></br>- traverses the entire inguinal canal and has same coverings as the spermatic cord <br></br>- commonly enters the scrotum
“Indirect inguinal<div><br></br></div><div><img></img></div>”
_____________ an inguinal hernia that includes the appendix; may mimic appendicitis
Amyands hernia
What nerves are in the triangle of pain and what are its borders?
“Femoral branch of the genitofemoral n., femoral n., Lateral femoral cutaneous n., <br></br><br></br>inguinal ligament and testicular vessels<div><br></br></div><div><img></img></div>”
What boarders make up the triangle of doom?
“Vas defrens and testicular vessels<div><br></br></div><div><img></img></div>”
“What’s in the triangle of doom?”
“External illiac vessels, deep circumflex illiac and genital branch of genitofemoral n.<div><br></br></div><div><img></img></div>”
____________ hernia is in the midline between the xiphoid and umbilicus
epigastric
____________ hernia is a herniation of the fundus of the stomach through the esophageal hiatus
esophageal (hiatal)
____________ hernia is herniation through the left vertebrocostal trigone into the pulmonary cavity which can involve gut (stomach), spleen, or retroperitoneal structures (kidney, fat)
congenital diaphragmatic aka bochdaleck
“____________ hernia is a protrusion of the gut loops through the femoral ring into femoral canal<br></br>-lateral to the pubic tubercle, lacunar ligament, anterior and lateral to the pectineal ligament and medial to the femoral vein<br></br>-mass shows up in femoral triangle <br></br>-3x more common in females<br></br>-repair can include reducing the femoral canal by suturing to pectineal ligament (Cooper’s ligament)”
femoral
____________ hernia is a femoral hernia that includes the appendix
“de garengeot’s”
____________ hernia is a hernia through a surgical wound
incisional
____________ hernia is a herniation at superior lumbar triangle (12th rib, quadrates lumborum, internal oblique)
“Grynfeltt’s<div><br></br></div><div><img></img></div>”
____________ hernia is a herniation at inferior lumbar triangle (latissimus dorsi, external oblique and iliac crest)
“petit’s<div><br></br></div><div><img></img></div>”
____________ hernia is a herniation of viscera through the obturator canal
“obturator<div><br></br></div><div><img></img></div>”
____________ hernia is a herniation through an opening in the supravesical fossa between the urachnus (median umbilical ligament) and the remnants of the umbilical artery.<br></br>-typically results in intestinal obstruction <br></br>-<b>iliohypogastric nerve</b> is at risk during repair
“supravesical<div><br></br></div><div><img></img></div>”
____________ hernia is a herniation through the umbilicas
“umbilical<div><br></br></div><div><img></img></div>”
what nerves need to be anesthetized during a vasectomy?
genital branch of the genitofemoral nerve, ilioinguinal nerve
3 fascial layers that need to be transversed to reach the ductus defrens:
(skin)<br></br>-external spermatic fascia (arising from the external oblique aponeurosis)<br></br><br></br>-cremaster fascia (which contains the cremaster muscle. arising from the internal oblique muscle and aponeurosis)<br></br><br></br>-internal spermatic fascia (arising from the transversalis fascia)
what neurovascular structures are at risk of iatrogenic damage during a vasectomy?
(<b>contents of spermatic cord</b>)<br></br>genital branch of the genitofemoral nerve, ilioinguinal nerve, panpiniform plexus, testicular artery
what usually anchors the testicle and when its injured can lead to torsion of the testicle?
“gubernaculum<div><br></br></div><div><img></img></div>”
___________ is excessive accumulation of fluid in the cavity of the tunica vaginalis; a congenital one will have direct communication with the peritoneal sac via a persistent processus vaginalis
“hydrocele (of the testis)<div><br></br></div><div><img></img></div>”
___________ is excessive accumulation of blood in the cavity of the tunica vaginalis due to trauma to testicular veins
“hematocele (of the testis)<div><br></br></div><div><img></img></div>”
enlargement of the veins of the spermatic cord (pampiniform plexus) which results due to vertical entry of the left testicular vein
“varicocele<div><br></br></div><div><img></img></div>”
S/S of L renal vein entrapment?
hematuria (blood in urine), flank pain, varicocele
The testes drain their lymph to ______________ nodes; the scrotum drains lymph to ______________ nodes.
lumbar (aka para-aortic), superficial inguinal
inflammation of the testis
orchitis
which ligament tethers the splenic flexure (Left side) of the colon to the body wall, restricts the flow of ascites (accumulation of fluid) in the abdominal cavity
“phrenicocolic ligament (yellow box)<div><br></br></div><div><img></img></div>”
_____________ - inflammation of the peritoneum<br></br>-painful when it involves parietal peritoneuma.<br></br>-Can arise from infections, perforated ulcers, appendicitis, diverticulitis, cancer, cirrhosis
peritonitis
______________ - fluid can accumulate here in the supine position and can reach the R subphrenicspace (would lead to irritation of diaphragm -shoulder pain) and the lesser sac (aka omental bursa) through the epiploic foramen.
“morrison’s pouch (hepatorenal recess)<div><br></br></div><div><img></img></div>”
fusion of parietal and visceral layers; results from inflammation or trauma (surgery)
Peritoneal adhesions
pain from appendicitis, ulcers, tumor or ectopic pregnancies (i.e. acute abdominal pain) can result in ______________ = reflexive contraction of the abdominal wall musculature to protect inflamed organs
guarding
A twisting of the organ that can block flow of intestinal contents (obstruction), resulting in reduced blood flow and ischemia
Volvulus
Accumulation of serous fluid within the peritoneal sac = ___________<br></br>Usually treated by _______________
Ascites, paracentesis
Removal of fluid from the recto-uterine pouch; done by entering the peritoneal cavity via the posterior vaginal fornix
“Culdocentesis<div><br></br></div><div><img></img></div>”
What layers are traversed in paracentesis ?
Skin, campers fascia, scarpas fascia, transversalis fascia, extraparatoneal connective tissue, parietal peritoneum
where are the illiohypogastric and illioinguinal nerves located? between what layers?
internal oblique and transversus abdominus
what arteries are in danger during paracentesis?
(<b>epigastric</b>) <br></br>subcostal or intercostal
removal of fluid from the recto-uterine pouch; done by entering the peritoneal cavity via the posterior vaginal fornix
“culdocentesis<div><br></br></div><div><img></img></div>”
peritoneal cavity can be clinically used for ________ and ________
drug administration, dialysis
uses a catheter, excessive cerebrospinal fluid can be absorbed through the peritoneum… this is called _____________ shunts
“Ventriculoperitoneal<div><br></br></div><div><img></img></div>”
-gas induced into the abdominal cavity for the purpose of laparoscopic procedures<br></br>-gas can also arise from pathological causes, such as perforation of the bowel
“pneumoperitoneum<div><br></br></div><div><img></img></div>”
“Regurgitation of gastric contents, characterized by ““heartburn””, dysphagia and/or sore throat”
“Gastro-esophageal reflux (GERD)<div><br></br></div><div><img></img></div>”
What nerves provide sensory innervation for pyrosis (aka heartburn)?
GVA (from T5-T8)
4 physiological mechanisms serve to normally prevent reflux of stomach acid into the esophagus:
“lower esophageal sphincter, folds of the gastric mucosa forming a ““seal””, angle of the cardiac orifice, right crus (diaphragm)”
-replacement of the esophageal epithelium (stratified squamous) with gastric epithelium (simple columnar with glands) from chronic reflux<br></br>-this is a <b>premalignant condition</b>. patients with this disease have a significantly increased risk of developing esophageal carcinoma
“Barrett’s esophagus”
what are the first nodes that the lymph from the stomach reaches?
“celiac<div><br></br></div><div><img></img></div>”
“Virchow’s nodes are aka _________”
“supraclavicular<div><br></br></div><div><img></img></div>”
sister mary joseph nodule is aka ____________
“periumbilical<div><br></br></div><div><img></img></div>”
the Irish node is aka ____________
“anterior axillary<div><br></br></div><div><img></img></div>”
Duodenal ulcers most commonly occur along the ____________ ________ of the organ; <br></br>-complete ulceration of the wall will result in peritonitis and damage adjacent organs
posterior wall
Structures posterior to the 1st part of the duodenum: (3)
gastroduodenal artery, common bile duct, portal vein
Structures posterior to the 2nd part of the duodenum: (2)
R renal vessels, IVC
Structures posterior to the 3rd part of the duodenum: (5)
R ureter, psoas major, gonadal vessels, IVC, aorta
Structures posterior to the 4th part of the duodenum: (4)
aorta, left sympathetic trunk, left psoas major, left renal vessels
“any air in the abdominal cavity will show up on a radiograph as ““___________”””
“free subdiaphragmatic air<div><br></br></div><div><img></img></div>”
compression of the 3rd part of the duodenum between the SMA and aorta creating<br></br>an obstruction (nausea, vomiting, abdominal pain, malnutrition); due to insufficient intra-abdominal fat; more<br></br>common in young, anorexic women
“Wilkie’s (SMA) syndrome<div><br></br></div><div><img></img></div>”
“Approximately 2 feet from the ileocecal valve there exists in 2% of the population an ileal diverticulum<br></br>(Meckel’s), representing a persistent _______________<br></br>-often asymptomatic; bloody stool (hematochezia), periumbilical pain”
“vitelline duct <br></br>(long narrow tube that joins the yolk sac to the midgut lumen of the developing fetus)<div><br></br></div><div><img></img></div>”
A chronic inflammatory condition of the intestine (most often the ileum) that typically leads to fibrosis and obstructive symptoms; characterized by abdominal pain and diarrhea, and is often complicated by fistulas and obstructions
“Crohn’s disease<div><br></br></div><div><img></img></div>”
Predisposition of the appendix to infection: (3)
“-long, thin tube that can collect fecal material<br></br>-narrow lumen is easily blocked, <br></br>-has abundant collection of lymphatic tissue<div><br></br></div><div><img></img></div>”
what artery supplies the appendix? ____________<br></br>-does not form significant anastomoses - inflammation of the appendix can compress the supplying artery leading to necrosis/gangrene/perforation
“appendicular<div><br></br></div><div><img></img></div>”
in appendicitis, pain begins as a vague, dull achy pain (carried by ______ fibers) around the umbilicus (example of ___________ pain)<br></br>-afterward, irritation of the __________ ___________ results in a sharp, well-localized, somatic pain (carried by ______ fibers) in the right, lower quadrant
“GVA, referred pain, parietal peritoneum, GSA<div><br></br></div><div><img></img></div>”
indicated as the middle third of a line connecting the anterior superior iliac spine and the umbilicus; used to surgically approximate the appendix
“McBurney’s point<div><br></br></div><div><img></img></div>”
inflammation of diverticula, small pouches extending from the intestinal lumen, most common in the large intestine (especially sigmoid colon - left lower quadrant pain); <br></br>-signs/symptoms includes pain, nausea and constipation; complications can include peritonitis, bleeding, rupture
“diverticulitis<div><br></br></div><div><img></img></div>”
inflammation of the large intestine, most commonly in the rectum; chronic disease is associated with increased risk of colorectal cancer
ulcerative colitis
a telescoping of a proximal gut segment into the lumen of an adjacent segment; most common in the ileocolic region; can result in ischemia and necrosis
“Intussusception<div><br></br></div><div><img></img></div>”
hallmark findings of a PE of a pt with ____________<br></br>-mass in R hypochondrium, with emptiness in RLQ<br></br>-also presents with jelly stool
Intussusception (part of the intestine telescopes into itself)
a decreased caliber stool indicates a ____________ of the colon
“distal lesion (colorectal carcinoma)<div><br></br></div><div><img></img></div>”
if colorectal cancer spreads locally to the peritoneum, this is called ___________
mesothelioma
in disease affecting the large intestine it may be necessary to remove a segment of the colon; as the distal portion of the colon heals, the proximal portion is sutured to an opening (stoma) along the anterior abdominal wall (through the rectus abdominis) where waste products are expelled
colostomy
a protrusion of the rectal wall into the anal canal or through the anal opening; characterized by protrusion of a reddish, mucosal mass into the anal canal (most commonly related to longstanding hemorrhoids); associated with constipation, malnutrition and prior rectal trauma
“rectal prolapse<div><br></br></div><div><img></img></div>”
weakness in <b>puborectalis</b> and <b>pubovaginalis</b> muscles can result in bulging of the rectal wall into the posterior vaginal wall; associated with painful intercourse or bowel movements, constipation, a sense of fullness; can lead to rectal prolapse
“Rectocele<div><br></br></div><div><img></img></div>”
what ligament differentiates upper GI from lower GI bleed?
“ligament of Treitz<div><br></br></div><div><img></img></div>”
common signs are vomiting blood (hematemesis) or black, tarry stool (melena)<br></br>common causes are stomach cancer, ulcers, gastritis, esophageal varices
Upper GI bleed
common sign is red or maroon colored stool (hematochezia; fresh blood); common causes are diverticular disease, polyps, hemorrhoids, anal fissures, cancer, inflammatory bowel disease
Lower GI bleed
inflammation of the colon as a result of poor blood flow
“ischemic colitis<div><br></br></div><div><img></img></div>”
Splenic flexure is aka __________ <br></br>-middle colic(transverse) –> left colic(descending)
“Griffith’s point<div><br></br></div><div><img></img></div>”
the last sigmoidal to superior rectal junction point is aka ___________ (recto-sigmoidal junction)
“sudeck’s point<div><br></br></div><div><img></img></div>”
what ribs is the spleen in contact with?
left 9-11
What organs are most at risk of injury with ligation of the splenic artery?
“Pancreas (due to pancreatic branches of splenic a.) <br></br>Stomach(left gastroepiploic (gastroomental artery) and the short gastric artery)<div><br></br></div><div><img></img></div>”
shoulder pain due to irritation of the diaphragm/peritoneum <b>due to ruptured spleen</b> is known as ___________
“kehr’s sign<div><br></br></div><div><img></img></div>”
the spleen may be enlarged in numerous inflammatory or degenerative conditions; the<br></br>enlarged spleen may be palpable below the left costal margin and displace the splenic flexure of the<br></br>colon<br></br>-this enlarged spleen condition is known ________________
“splenomegaly<div><br></br></div><div><img></img></div>”
most of the hepatic lymph drains to hepatic nodes which drain to _______ nodes
“celiac<div><br></br></div><div><img></img></div>”
lymph from the bare area of the liver drains to the phrenic nodes then to the ____________ nodes
posterior mediastinal
lymph from the falciform ligament of the liver drains to the _____________ nodes
parasternal
lymph from the round ligament of the liver drains to the ____________ nodes
umbilical
This pyramidal frame is bound by: the cystic duct, the common hepatic duct and the base of the liver; typically contains the cystic artery, veins, lymph nodes, autonomic nerve fibers and any anomalous ducts
“calot’s triangle<div><br></br></div><div><img></img></div>”
clamping vessels of the portal triad (at the free edge of the lesser omentum, the hepatoduodenal ligament) to control bleeding during hepatic procedures
“Pringle’s maneuver<div><br></br></div><div><img></img></div>”
pre hepatic jaundice occurs as a result of __________
excessive breakdown of red blood cells
hepatic jaundice occurs as a result of __________
disruption of liver function (e.g. cirrhosis)
if bile cannot escape the gallbladder or biliary tree (because of gall stones), it enters the blood and causes _________
“jaundice (yellow staining of skin and conjunctiva)<div><br></br></div><div><img></img></div>”
______________ = hepatocytes are replaced by fatty and/or fibrous connective tissue which obstructs blood flow through the liver; results in hepatomegaly, ascites, edema, jaundice, splenomegaly and portal hypertension
“cirrhosis<div><br></br></div><div><img></img></div>”
3 sites of portal - caval anastomoses:
(portal) left gastric veins (caval-esophageal veins) <br></br>(portal) superior rectal veins (caval-middle and inferior rectal veins) <br></br>(portal) paraumbilical veins (caval-epigastric veins)
portal hypertension will lead to what presentation at each of these anastomoses sites?<br></br>left gastric veins - esophageal veins = _____(1)_______<br></br>superior rectal veins - middle and inferior rectal veins = ______(2)______<br></br>paraumbilical veins - epigastric veins = _____(3)_______
(1)esophageal varices<br></br>(2)hemorrhoids<br></br>(3)caput medusa
most of the blood from the stomach and spleen goes towards the ___________ lobes of the liver (relevant for cancer metastasis)
“left, caudate, quadrate<div><br></br></div><div><img></img></div>”
most of the blood from the intestines (midgut) goes towards the ___________ lobe(s) of the liver (relevant for cancer metastasis)
“right<div><br></br></div><div><img></img></div>”
“crystalized hepatic secretions; most common with 3 F’s: ““fat””, fertile, females (multiparous (women having bore more then one child))”
gallstones
gallstones are usually lodged where? (3)
“fundus (of gallbladder)(@Hartman’s Pouch-mucosal neck of gallbladder)<br></br>bile duct (blocking hepatic secretions)<br></br>hepatopancreatic ampulla (blocking hepatic and pancreatic secretions)<div><br></br></div><div><img></img></div>”
surgical removal of the gallbladder; during this procedure it is essential that the surgeon be aware of variations in arterial supply and biliary tree
cholecystectomy
What vessels and ducts need to be ligated in a cholecystectomy?
“cystic duct, cystic artery, cystic veins<div><br></br></div><div><img></img></div>”
inflammation of the gallbladder; may be due to blockage of the cystic duct by a gallstone.<br></br>-pain in the epigastric region<br></br>-pain may also be present in the right shoulder due to irritation of the diaphragm (referred pain)
cholecystitis
inflammation of the pancreas<br></br>-may be due to gallstones causing retrograde flow of bile into the pancreatic duct
pancreatitis
the pancreas drains to ___________ nodes
celiac and superior mesenteric
pancreatic cancer will often spread to ___________ nodes
para-aortic (lumbar)
______________<br></br>will often cause obstruction of the bile and pancreatic ducts, results in weight loss, abdominal/back pain, obstructive jaundice (retention of bile pigments), painless and palpable gallbladder (enlargement)<br></br>-may also obstruct portal vein or IVC<br></br>-may spread to local nodes and <b>liver</b><br></br><br></br>-all of these symptoms together are called _____________
pancreatic cancer, courvoisier sign
where is the pancreas located? lesser sac, greater sac, none of the above?
none of the above (it is a retroperitoneal organ)
significant trauma to the pancreas, an endocrine organ, will result in significant hemorrhaging which will accumulate blood in between the the spaces (greater and lesser omental sacs) and the ____________
“body wall<div><br></br></div><div><img></img></div>”
which part of which organ is in danger in a splenectomy?
“tail of pancreas (damage would cause a release of digestive organs into the abdominal cavity)<div><br></br></div><div><img></img></div>”
“__________<br></br>congenital or acquired dilation of the wall of the abdominal aorta (most often ““infra-renal””) which can be palpated left of the midline<br></br>-highly fatal<br></br>-Signs and symptoms are often related to expansion of the defect (compression of adjacent structures) and dislodging emboli into distal arterial branches<br></br>-Classic findings are: pulsatile, non-tender mass <b>below the umbilicus</b><br></br>-Often inferior to the origin of the renal arteries<br></br>-results due to an aortic dissection which is a tear in the intimal (inner) layer of the aorta and hemorrhage between the layers of the vessel<br></br>-associated with acute onset of back/chest pain, lower extremity ischemia and neuropathy and pulse deficits in lower extremities”
“abdominal aortic aneurysm<div><br></br></div><div><img></img></div>”
Gradual build-up of plaque in the abdominal aorta (at the bifurcation; aka __________________) can result in leg pain (claudication) and impotence. The gradual nature of this condition permits significant collateral circulation to develop. Aorta to aorta anastomoses
“Leriche Syndrome<div><br></br></div><div><img></img></div>”
Three sets of tributaries permit venous return from the lower extremity in the instance an IVC obstruction(these are caval-caval anastomoses: IVC to SVC)<br></br>______->______, ______->______, _______->________
“inferior epigastric -> superior epigastric<br></br> <br></br>superficial epigastric -> lateral thoracic<br></br> <br></br>vertebral/lumbar veins & batson’s plexus -> azygos system<div><br></br></div><div><img></img></div>”
IVC obstruction can result due to plaque buildup on an _________
“IVC filter<div><br></br></div><div><img></img></div>”
what are the attachments of the psoas major?
Transverse process of T1-T4 (proximally), lesser trochanter (distally)
Infections (tuberculosis) may spread from the vertebrae through the investing fascia of the psoas major muscle (psoas sheath). The infection can spread underneaththissheath, deep to the inguinal ligament (and be mistaken for a _____________)<br></br>-this is known as a ______________
“femoral hernia, psoas abscess<div><br></br></div><div><img></img></div>”
“___________ (test) <br></br>The psoas major muscle is closely related to a number of abdominal viscera, inflammation of which can affect function of the iliopsoas muscle. For example, an inflamed retrocecal appendix can impact function of the right psoas major.<br></br>-test is performed by <b>passively extending</b> the patient’s hip <b>or</b> asking pt to <b>actively flex</b> the thigh at the hip.<br></br>-Abdominal pain indicates a positive test”
“psoas test (/sign)<div><br></br></div><div><img></img></div>”
A test used to diagnosis dysfunction/contracture of the psoas major muscle. <br></br>-Pt lays on their back, and examiner flexes the unaffected hip(towards the chest while the affected hip remains flat on the table). <br></br>-Dysfunction of the psoas major muscle is indicated when the test reveals flexion of the contralateral hip (without knee extension)
“Thomas Test<div><br></br></div><div><img></img></div>”
What muscle is dysfunctional if on a Thompson test, on the contralateral side there is hip flexion and knee extension?
“rectus femoris (attaches at the hip at AIIS and inserts on the patellar tendon via quadrates tendon)<div><br></br></div><div><img></img></div>”
_____________ nerve<br></br>most commonly injured nerve during inguinal hernia surgery, hysterectomy, appendectomy, abdominal muscle tears, during pregnancy
“illiohypogastric<div><br></br></div><div><img></img></div>”
_____________ nerve<br></br>most commonly injured during inguinal hernia or other abdominal surgery, pregnancy, placement of femoral catheter
“illioinguinal<div><br></br></div><div><img></img></div>”
_____________ nerve<br></br>most commonly injured during hernia repair, appendectomy, retroperitoneal hematoma
“genitofemoral<div><br></br></div><div><img></img></div>”
_____________ nerve<br></br>often passes through the inguinal ligament or sartorius muscle and is often entrapped in these locations
“lateral femoral cutaneous<div><br></br></div><div><img></img></div>”
___________________ = entrapment of the lateral femoral cutaneous nerve; caused by heavy tool belts, hip-hugger jeans, obesity
“meralgia paresthetica<div><br></br></div><div><img></img></div>”
large, fluid-filled cysts on the kidney are common in older individuals; multiple cysts may lead to renal failure.<br></br>this is known as
“polycystic kidney disease<div><br></br></div><div><img></img></div>”
stenosis of the renal artery or supra-renal aorta will result in hypotension @ the kidney, resulting in a humoral response in an effort to normalize blood pressure but results in ____________
“hypertension (renal hypertension)<div><br></br></div><div><img></img></div>”
Renal vein entrapment (aka ____________________)<br></br>S/S: blood or protein in urine, flank pain, L testicular pain (varicocele), nausea and vomiting
“Nut Cracker Syndrome<div><br></br></div><div><img></img></div>”
why is the left kidney more likely to be used in transplantation?
“left renal vein<div><br></br></div><div><img></img></div>”
what artery is anastomosed with the transplanted kidney after it is placed along the iliac fossa?
“internal iliac artery<div><br></br></div><div><img></img></div>”
inferior displacement of the kidney due to insufficient peri-renal adipose tissue; may be associated with flank or groin pain and hematauria
“nephroptosis<div><br></br></div><div><img></img></div>”
what are the 3 places that the ureter can be constricted?
“junction of the renal pelvis and ureter,<br></br>crossing the pelvic inlet,<br></br>passage through the bladder wall, <br></br>(stones may also become lodged where the testicular/ovarian vessels cross the ureter)<div><br></br></div><div><img></img></div>”
Urinary obstructions can lead to ______________ -enlargement of the ureter, renal pelvis and/or calyces, can cause renal failure<br></br>-can be caused by kidney stones (nephrolithiasis), tumors, or prostatic hypertrophy
“hydronephrosis<div><br></br></div><div><img></img></div>”
Arterial supply to the abdominal ureter is from the ________ side; arterial supply to the pelvic ureter is from the _________ side -this should be considered in retraction of the ureter during surgery.
“medial, laterals<div><br></br></div><div><img></img></div>”
sympathetic abdominal organ innervation - _______ pseudounipolar cell bodies are in the posterior root ganglion at the same spinal cord segments as the preganglionic ____
GVA, GVE
PARASYMPATHETIC abdominal organ innervation - GVA pseudounipolar cell bodies for the vagus nerve are located in the ________________; <br></br><br></br>those accompanying sacral parasympathetics are found in the ______________________ at the same spinal cord segments as the preganglionic GVE
“inferior ganglion of the vagus, posterior root ganglion<div><br></br></div><div><img></img></div>”
all sympathetic preganglionic cell bodies are in the ______
“IML<div><br></br></div><div><img></img></div>”
sympathetic CNS levels for Lower esophagus
T5-T8 <br></br>(Postganglionic sym. chain)
sympathetic CNS levels for Stomach/duodenum
T5-T9 <br></br>(Postganglionic celiac ganglion)
sympathetic CNS levels for Liver/gallbladder
T6-T9R <br></br>(Postganglionic celiac ganglion)
sympathetic CNS levels for Spleen
T7-T9L <br></br>(Postganglionic celiac ganglion)
sympathetic CNS levels for Pancreas
T7-T9 L <br></br>(Postganglionic celiac ganglion)
sympathetic CNS levels for Midgut
T9-L1 <br></br>(Postganglionic superior mesenteric ganglion)
sympathetic CNS levels for Kidneys
T10-L1 <br></br>(Postganglionic aorticorenal)
sympathetic CNS levels for Ureter (sup to inf)
T10-L2 <br></br>(Postganglionic renal, aortic + hypogastric)
sympathetic CNS levels for Testes/Ovary
T10-T11 <br></br>(Postganglionic prevertebral)
sympathetic CNS levels for Hindgut
L1-2 <br></br>(Postganglionic inferior mesenteric ganglion)
sympathetic CNS levels for Adrenal medulla
T8-L2 <br></br>(Postganglionic *none -derived from neural crest)
parasympathetic CNS levels for Foregut & midgut & Kidneys/ureter
medulla <br></br>(preganglionic - dorsal vagal nucleus)<br></br>(Postganglionic - intramural)
parasympathetic CNS levels for Hindgut
S2-S4 <br></br>(Preganglionic - sacral para column)<br></br>(Postganglionic -hypogastric/intramural)
