Abdominal: Clinical App Flashcards
Describe what a hydrocele is.
Decribe the symptoms.
Hydroceles are fluid filled collections within the Tunica Vaginalis of the scrotum or along the Spermatic Cord.
They may represent;
- Persistent developmental connections along the spermatic cord
- An imbalance of fluid production vs absorbption
Symptoms:
- Enlarged scrotum
- Transillumination of the scrotum using a light, due to fluid accumulation
Describe the basis of Hydrocele development relative to testicular decent into the scrotum
The peritoneal sleeve accompanying the testis during decent failes to obliterate, resulting in a connection between the peritoneal cavity & Tunica Vaginalis. Hydroceles can occur along this connection.
What are the types of Inguinal Hernias?
Where do they occur?
Direct Hernia: Occurs at the Inguinal (Hassebachs) Triangle (Medial inguinal fossa), between the medial and lateral umbilical folds
Indirect Hernia: Occurs at the Lateral Inguinal fossa, just lateral to the lateral umbilical fold.
Describe what occurs with an indirect Inguinal Hernia
Indirect Inguinal Hernia’s are the most common external abdominal wall hernias, affecting both men and women.
A loop of the bowel herniates from the peritoneal cavity into the Inguinal canal, and into the scotum.
Describe direct hernias
Direct hernias are more prominent in males (uncommon in females) and protrudes out laterally.
Direct Hernias are acquired and associated with a weakness of the posterior wall of the inguinal canal (Transversalis Fascia)
Identify which colors represent pain associated with the following:
- Diaphragm, Pericardium & Heart
- Heart
- Digestive Tract
- Liver & Gall bladder
- Kidney & Ureter
- Pelvic Organs
- Diaphragm, Pericardium & Heart = Yellow
- Heart = Red
- Digestive Tract = Blue/purple
- Liver & Gall bladder = Orange
- Kidney & Ureter = Green
- Pelvic Organs = Black
What is the difference between a Sliding Hiatal Hernia & a ParaEsophageal Hiatal Hernia?
In a Sliding Hiatal Hernia, the Esophagous-Stomach junction (LES) plus some of the stomach protrudes through the esophageal hiatus and above the diaphragm.
In a Paraesophageal Hiatal Hernia, the Esophagus-Stomach junction remains normal (below diaphragm), while a portion of the stomach protrudes through the esophageal hiatus and above the diaphragm.
Describe Gastric Ulcers and their cause.
How do they compare to Duodenal Ulcers?
Gastric ulcers usually form in the pyloric antrum and have been linked to the chronic use of aspririn & other NSAIDs and to cigarette smoke.
Helicobacter pylori is responsible for both Gastric Ulcers & Chronic Gastritis.
Gastric Ulcers occur and perforate less frequently than Duodenal Ulcers, however they have a higher mortality rate.
How does carcinoma of the liver commonly occur?
Primary carcinomas originating in abdominopelvic structures commonly metastasize to the liver.
What is the blood supply to the liver?
How can bleeding from the liver occur?
If it continues, what structure might be damaged?
All blood passing to the liver enters through either;
Hepatic a. (fresh oxygenated blood from aorta)
Portal v. (from intestinal bed)
Both structures bass through the free edge of the lesser omentum (hepatoduodenal lig.)
Bleeding from the liver can be stemmed by compressing the free edge of the lesser omentum.
- If bleeding continues, it’s likely that the IVC is damaged.
Describe what occurs with an obstruction of the cystic duct.
Gallstones & Pancreatic adenocarcinomas can obstruct the cystic duct or the hepatopancreatic ampulla, resulting in cholecystitis, obstructive juandice, and possibly pancreatitis.
Obstruction of the cystic duct results in acute cholecystitis, initially presenting as epigastric pain but may be referred to T5-9 dermatomes of the back at the inferior scapular angle.
-Inflammation may involve the body wall, with localized pain in the right upper quadrant.
Obstruction of the hepatopancreatic ampulla may cause some patients to develop pancreatitis.
Chronic obstruction will result in obstructive jaundice and an enlarged & tender liver that can be palpated below the costal margin.
-If persistent, a cholecystectomy may be necessary.
Describe the cause and symptoms of pancreatitis
Pancreatitis can be caused by;
- Blockage of the common bile duct via cancer of the pancreatic head
- Obstruction of the hepatopancreatic ampulla
Causes an accumulation of inflammatory fluid in the lesser sac.
Symptoms:
- Pain in the back.
Describe the location at which the spleen is susceptible to traumatic injury.
What potential repercussions could result?
What are the symptoms?
The spleen is susceptible to trauma to the left rib cage (ribs 9-11) which could result in a ruptured spleen.
Because of it’s profuse blood supply, a ruptured spleen could prove to be fatal.
under what conditions would splenomegaly occur?
How could it be detected?
Splenomegaly may occur if hematological conditions or liver disease is present.
It can be palpated below the left subcostal margin.
Describe the abdominal pouches and how they are clinically significant.
What could occur when patients are laying in the supine position?
(2) abdominal pouches:
- Hepatorenal Pouch
- Rectovesical Pouch
These pouches can be sites of inflammatory fluid accumulation, particularly around the Diaphragm*. With patients lying in the supine position, the hepatorenal pouch is the lowest point (nadir) of the peritoneal cavity.
*Formation of an abscess in the subphrenic recess can erode through the diaphragm and into the pleural cavity, compromising the respiratory system.
Describe the Abdominal gutters and what purpose they serve clinically.
How does the Left side differ from the right?
The (4) Abdominal gutters serve as channels through which pathologic material can move into the pelvic portion of the peritoneal cavity.
- Left of the Root of the Mesentery
- Right of the Root of the Mesentery
- Left paracolic
- Right Paracolic
Movement on the right side is unrestricted, from the subphrenic recess to the pelvic cavity, while on the left, the phrenicocolic lig. restricts movement betweent he stomach and descending colon.
How do abdominal adhesions occur and what are the potential repercussions?
Peritoneal adhesions may occur if the peritoneum is damaged by a stab wound or infected, resulting in peritonitis (inflammation of the peritoneum) and subsequent increase in fibrin.
As healing occurs, Fibrin may be replaced with fibrous tissue, thereby forming abnormal attachements between;
- The visceral peritoneum of adjacent viscera
- The visceral peritoneum of an organ and the parietal peritoneum of the adjacent abdominal wall
These adhesions may limit the normal movements of the viscera, resulting in chronic pain or emergency complications, such as intestinal obstruction (volvulus).
Adhesiotomy may be necessary to surgically separate the adhesions if complications persist.
Describe how abdominal paracentesis can be used in the case of generalized peritonitis.
Describe where the needle/trocar & cannula must be inserted.
Abdominal Paracentesis can be used to remove ascitic fluid and administer large doses of antibiotics.
Additionally, it can be used to remove localized fluid for analysis.
The needle/trocar & cannula are inserted through the anterolateral abdominal wall (through the linea alba) and into the peritoneal cavity, superior to the empty urinary bladder and in a location that avoids the inferior epigastric a.
What are Peyer’s Patches?
What are their clinical significance?
Peyer’s patches are lymphoid tissue embedded in the wall of the small intestine which, under certain conditions (i.e. lymphoma’s), may enlarge and cause intestinal obstruction.
Image: Section of stained small intestined tissue (CD20-immunoperoxidase), showing infiltration of Peyers patches by Mantle cell lymphoma cells.
What are Carcinoid tumors?
Typically tumors of the Si are rare, however neuroendocrine cells within the epithelium may undergo neoplastic changes, resulting in an overproduction of pressor amines (causing an increase in BP).
This may present as episodes of;
- Increased bowel movements
- Intestinal obstruction
- Diarrhea
- HTN
- Other CV effects
What is the cause of Diverticulosis/Diverticulitis?
Diverticulosis is caused by repeated straining at stool (possibly due to a diet lacking fiber), may cause small out-pouchings of the colonic lumen through weak spots in the muscular coat of the colon.
If they become inflamed due to infection, Diverticulitis occurs, with episodes of abdominal pain.
