ABDOMIN GENERAL Flashcards
Varicocele
Varicocele is a result of dilation of veins that drain into the internal spermatic veins in the testes that ultimately drains into the left and right testicular and renal veins.
A left varicocele appearing acutely in an elderly man suggests
Onset of varicocele in elderly man should raise the suspicion of a
retroperitoneal mass that is compressing the testicular veins causing inadequate drainage.
ovarian cancer helps to improve survival of patients with bulky disease how he is it approached
ovarian cancer helps to improve survival of patients with bulky disease
Debulking, or cytoreduction, of by improving the response to adjuvant therapy.
This operation incudes:
total hysterectomy,
bilateral salpingo-oophorectomy as well as omentectomy
resection of any gross disease.
ovarian cancer is most prevalent amongst
ovarian cancer is most prevalent amongst women over the age of 60.
overall survival with ovarian cancer
almost 80% of women diagnosed with ovarian cancer will succumb to their disease.
For women over the age of 50 with adnexal masses suspicious for malignancy what is recommended management
For women over the age of 50 with adnexal masses suspicious for malignancy,
laparotomy
CT-guided biopsy and ultrasound-guided biopsy risk of tumor spillage, tumor rupture, and subsequent tumor spread with percutaneous biopsies.
Operative exploration should be to evaluate the extent of the disease, then the goal should be for either complete resection or tumor dubulking consisting of hysterectomy, bilateral salpingo-oophorectomy, and omentectomy.
The blood supply for the duodenum is
The blood supply for the duodenum:
gastroduodenal artery (from common hepatic artery)
collaterals from right gastric artery (from proper hepatic artery)
The ileum and jejunum blood supply is from
superior mesenteric artery,
colon blood supply comes from
both the superior mesenteric artery
AND
inferior mesenteric artery.
The right adrenal gland receives its blood supply
inferior phrenic artery
middle adrenal artery from the aorta,
branches from the renal artery.
In a number of special circumstances, the evaluation of the patient with acute abdominal pain is particularly challenging.
Acute abdominal pain in immunosuppressed patients (e.g., organ transplantation, immunosuppressive therapy, chemotherapy, acquired immunodeficiency syndrome)
The physical findings may be absent despite the presence of serious intra-abdominal pathology.
The differential diagnosis for a single enlarged kidney on intravenous pyelography includes
pyelonephritis,
hydronephritis,
renal mass,
renal vein thrombosis.
A 63-year-old woman with microcytic hypochromic anemia, occult blood in the stool, and a weight loss of 10 pounds, is found to have bilateral ovarian enlargement on initial physical examination. The most likely diagnosis is
Krukenberg tumor is METASTATIC adenocarcinoma to the ovary / ovaries
Stomach is the MOST common primary site accounting for 70% of cases.
Colon, appendix, and breast are the SECOND most common primary sites.
Retrograde lymphatic spread is the most likely route of metastasis.
Krukenberg tumors are bilateral in more than 80% of the reported cases.
Multiple myeloma is associated with what anemia findings
normocytic and normochromic anemia.
Endometriosis typically presents with
dysmenorrhea,
dyspareunia,
infertility.
Endometrial cancer often presents with
abnormal vaginal bleeding.
endometrial hyperplasia.
Ovarian Cancer presents with
vague abdominal pain or pressure, nausea, early satiety, constipation, abdominal swelling, weight loss, urinary frequency,
and occasionally abnormal vaginal bleeding.
Spread of disease is usually transperitoneal leading to compression of the colon rather than invasion of the mucosa.
describe peritoneum and the organs covered by visceral peritoneum and the abdomen
continuous visceral and parietal layer.
liver, spleen, and gallbladder are almost entirely covered by visceral peritoneum.
NOT pancreas and duodenum - largely located within a retroperitoneum
intestinal tract that is lined by visceral peritoneum
from stomach to distal sigmoid colon is lined by visceral peritoneum
BUT not the rectum!
The rectum is entirely extraperitoneal.
acute abdominal pain categories
somatic
visceral
referred pain.
acute abdominal Referred pain
give most common examples
perceived as at a site removed from the anatomic location of the pathology but in a region that shares a common embryonic origin.
The most common example is radiation of biliary pain origin to the right subscapular region.
Pain caused by ureteral stones commonly radiates to the groin or genitalia.
pain of kidney origin or pathology associated with the iliac artery may also radiate to the genitalia.
Uterine and rectal pain typically radiate posteriorly to the coccyx.