ABDOMIN GENERAL

Question 1

Varicocele

Answer 1

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.

Question 2

A left varicocele appearing acutely in an elderly man suggests

Answer 2

Onset of varicocele in elderly man should raise the suspicion of a

retroperitoneal mass that is compressing the testicular veins causing inadequate drainage.

Question 3

ovarian cancer helps to improve survival of patients with bulky disease how he is it approached

Answer 3

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.

Question 4

ovarian cancer is most prevalent amongst

Answer 4

ovarian cancer is most prevalent amongst women over the age of 60.

Question 5

overall survival with ovarian cancer

Answer 5

almost 80% of women diagnosed with ovarian cancer will succumb to their disease.

Question 6

For women over the age of 50 with adnexal masses suspicious for malignancy what is recommended management

Answer 6

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.

Question 7

The blood supply for the duodenum is

Answer 7

The blood supply for the duodenum:

gastroduodenal artery (from common hepatic artery)

collaterals from right gastric artery (from proper hepatic artery)

Question 8

The ileum and jejunum blood supply is from

Answer 8

superior mesenteric artery,

Question 9

colon blood supply comes from

Answer 9

both the superior mesenteric artery

AND

inferior mesenteric artery.

Question 10

The right adrenal gland receives its blood supply

Answer 10

inferior phrenic artery

middle adrenal artery from the aorta,

branches from the renal artery.

Question 11

In a number of special circumstances, the evaluation of the patient with acute abdominal pain is particularly challenging.

Answer 11

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.

Question 12

The differential diagnosis for a single enlarged kidney on intravenous pyelography includes

Answer 12

pyelonephritis,
hydronephritis,
renal mass,
renal vein thrombosis.

Question 13

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

Answer 13

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.

Question 14

Multiple myeloma is associated with what anemia findings

Answer 14

normocytic and normochromic anemia.

Question 15

Endometriosis typically presents with

Answer 15

dysmenorrhea,
dyspareunia,
infertility.

Question 16

Endometrial cancer often presents with

Answer 16

abnormal vaginal bleeding.

endometrial hyperplasia.

Question 17

Ovarian Cancer presents with

Answer 17

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.

Question 18

describe peritoneum and the organs covered by visceral peritoneum and the abdomen

Answer 18

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

Question 19

intestinal tract that is lined by visceral peritoneum

Answer 19

from stomach to distal sigmoid colon is lined by visceral peritoneum

BUT not the rectum!

The rectum is entirely extraperitoneal.

Question 20

acute abdominal pain categories

Answer 20

somatic
visceral
referred pain.

Question 21

acute abdominal Referred pain

give most common examples

Answer 21

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.