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Surgery Finals 2nd Sem > Abdominal Wall Part 2 > Flashcards

Abdominal Wall Part 2 Flashcards

1
Q

Messentery

In the region of the stomach, the dorsal mesentery becomes the _____________ whereas in the region of the jejunum and ileum the dorsal mesentery becomes the __________

A

greater omentum,

mesentery proper

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2
Q

In the region of the colon, the dorsal mesentery is known as the

A

Mesocolon

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3
Q

During embryonic development, after the 270-degree counterclockwise rotation of the herniated midgut, the reduced mesentery achieves its ______

A

final fixation state

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4
Q

Segments that are fixed to retroperitoneum

A

duodenum, ascending colon, and descending colon

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5
Q

Messentery

Remain mobile

A

small intestinal mesentery,
transverse colon mesentery, and to a variable extent,
the sigmoid colon mesentery

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6
Q

The root of the small intestinal mesentery wall normally courses in an oblique direction, from the __________

A

left upper quadrant at the ligament of Treitz to the right lower quadrant at the ileocecal valve and the fixed cecum

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7
Q

Sclerosing mesenteritis

Sclerosing mesenteritis, also referred to as

A

mesenteric panniculitis or mesenteric lipodystrophy

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8
Q

SM

There is no gender or race predominance, but sclerosing mesenteritis is most commonly diagnosed in individuals

A

older than 50 years of age

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9
Q

SM

The etiology of this process is unknown, but its cardinal features are a ___________________ on histologic examination

A

nonneoplastic mesenteric mass
fibrosis and
chronic inflammation

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10
Q

SM

The mass may be up to

A

40 cm in diameter

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11
Q

SM

____________is the most frequent presenting symptom, followed by the presence of a ___________

A

Abdominal pain

nonpainful mass or intestinal obstruction

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12
Q

SM

CT cannot distinguish sclerosing mesenteritis from a

A

SM

primary or secondary mesenteric tumor

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13
Q

SM

Surgical intervention is usually necessary, if only to establish a

A

diagnosis and rule out malignancy

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14
Q

SM

The extent of the disease process dictates the aggressiveness of the intervention, which may range from

A

simple biopsy,
to bowel and mesentery resection,
to colostomy (in the cases of colonic obstruction

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15
Q

(1) Complete occlusion or stenois of mesenteric arteries by embolism, thrombosis or obliterative disease

A

Mesenteric Vascular Disease

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16
Q

MVD

A

Thrombosis of mesenteric veins

(3) Extraluminal obstruction of mesenteric arteries . (
4) Aneurysms of the splanchnic arteries
(5) Traumatic injury to visceral vessels

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17
Q

MVD

acute and complete (

A

resulting from emboli or thrombosis

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18
Q

MVD

gradual and partial (

A

resulting from obliterative arterial disease

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19
Q

MVD

Collateral vessels permit gradual occlusion of either the

A

celiac or the mesenteric artery to be tolerated

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20
Q

MVD

Acute occlusion of the celiac or inferior mesenteric artery generally is a asymptomatic in an otherwise normal person; Acute occlusion of the superior mesenteric artery if untreated, results in

A

intestinal infarction and death

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21
Q

MVD

The _____________________or close to the takeoff of its middle colic branch is the usual site of acute and chronic mesenteric arterial occlusion

A

superior mesenteric artery at its origin

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22
Q

MVD

Complete occlusion of the interior mesenteric artery produces symptoms only if there is compromise

A

of collateral blood flow from the superior mesenteric or internal iliac (hypogastric) artery

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23
Q

MVD

Clinically apparent venous occlusions are sudden and complete and invariably a consequence of

A

thrombosis

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24
Q

MVD

Partial mesenteric venous occlusion usually is the result of _____________ and is asymptomatic

A

external compression

25
Q

MVD

The relative incidence of mesenteric arterial as opposed to venous occlusions is

A

unknown

26
Q

MVD

15 to 20% of all significant mesenteric vascular accidents are a result of primary ____________ and that approximately 50% are a result of ____________

A

venous thrombosis

primary arterial occlusion

27
Q

MVD

In the remaining 30 to 35% of cases intestinal infarction occurs in the absence of

A

major arterial or venous occlusion

28
Q

Acute occlusive visceral ischemia

Acute occlusion of the superior mesenteric artery may be the result of __________________ with the incidence of each being approximately equal

A

cardio arterial embolus or in situ thrombosis,

29
Q

AOVI

most likely target among the visceral vessels to receive embolic material from the heart

A

Superior messenteric artery

30
Q

AOVI

Thrombotic occlusion of the superior mesenteric artery typically occurs at the

A

vessel origin

31
Q

AOVI

The atherosclerotic plaque generally arises in the

A

visceral vessels

32
Q

AOVI

The atherosclerosis of the visceral arteries is localized to the

A

vessel origin

33
Q

AOVI

Less common causes of stenosis and occlusion of the visceral arteries include

A

Takayasu’s arteritis,
periarteritis nodosa, and
thromboangiitis obliterans

34
Q

AOVI

Extrinsic compression of the ___________________ (medium arcuate ligament syndrome) may produce a chronic visceral pain syndrome

A

celiac artery by diaphragmatic fibers

35
Q

AOVI

The initial effect of proximal occlusion of the superior mesenteric artery is to cause

A

intense spasm of its distal branches

36
Q

AOVI

Acute occlusion of the origin of the superior mesenteric artery produces ischemia of the small intestine from the level of the

A

ligament of Treitz
ileocecal vaive and of the ascending colon
and proximal 2/3 of the transverse colon

37
Q

AOVI

Patency of the celiac artery can result in viability of the proximal 10 to 12 cm of jejunum owing to anastomoses between the

A

superior pantreaticoduodenal artery (celiac-based)

inferior pancreaticoduodenal artery (first branch of the superior mesenteric artery

38
Q

AOVI

Acute occlusion of distal branch vessels, such as the ___________________ results in segmental intestinal ischemia that might infarct depending on the status of the collateral circulation

A

middle colic, right colic, and ileocolic arteries

39
Q

AOVI

The mucosa is the layer of the intestinal wall most sensitive to ___________________, are early pathophysiologic events that may be recognized endoscopically

A

ischemia,
mucosal sloughing
and ulceration, often manifest as
gastrointestinal bleeding

40
Q

As the ischemia process progress to infarction, over a period of approximately 6 h in the setting of profound complete ischemia, the bowel wall becomes

A

dusky,
then cyanotic, and
ultimately frankly gangrenous and perforated

41
Q

AOVI

Abdominal pain is acute in onset, intense and diffuse, may be accompanied by vomiting, and is unresponsive to

A

narcotic administration

42
Q

AOVI

Early abdominal examination is remarkable for a ______________s. Localization of abdominal pain and development of peritoneal signs mark the onset of _____________

A

paucity or absence of finding

intestinal necrosis

43
Q

AOVI

history of ________________ should raise suspicion of embolic occlusion of the superior mesenteric artery

A

atrial fibrillation or of a previous cardioarterial embolic event

44
Q

AOVI

Laboratory investigation is too non-specific to rule out the diagnosis of acute intestinal ischemia; the diagnosis must be made on clinical grounds and requires a high index of suspicion. The leukocyte count often increases to greater than

A

20,000/mm3

45
Q

AOVI

A notable exception is that of ___________because of submucosal edema, which is indicative of intestinal ischemia

A

thumbprinting of the bowel wall

Hemoconcentration, manifest as a high hematocrit, secondary to fluid accumulation in the extravascular compartment and vomiting. Metabolic acidosis is related to the extent and duration of the intestinal ischemic process. Plain film findings occur late, and cannot be relied on for diagnosis

46
Q

AOVI

, remains the single most important diagnostic maneuver in evaluation of the patient with suspected acute mesenteric ischemia

A

Contrast arteriography, including lateral aortography and selective injection of the superior mesenteric artery

47
Q

AOVI

Once the diagnosis of acute mesenteric ischemia has been established at arteriography, continuous infusion of a vasodilator, such as _______________, may be begun directly into the superior mesenteric artery if the origin of this vessel is patent and can be cannulated

A

papaverine or nitroglycerine

48
Q

AOVI

At operation, through a____________initial decision regarding treatment is based on the extent and severity of intestinal ischemia

A

long midline incision,

49
Q

AOVI

Methods of ____________ will be vastly different depending on the cause of the ischemic insult

A

surgical revascularization

50
Q

AOVI

Embolic or atherosclerotic occlusion, only intestine that is _____________ should be resected initially, followed by an attempt at revascularization

A

frankly necrotic

51
Q

AOVI

Only a short segment of intestine appears ischemic from an embolus to a distal branch of the ileocolic artery, ______________________ may be sufficient

A

resection of the affected intestine with primary anastomosis and anticoagulation

52
Q

AOVI

Revascularization of the ischemic intestine by

A

Embolectomy

53
Q

AOVI

After anticoagulation with heparin and control of the superior mesenteric artery with a traumatic vascular clamps or doubly looped vessel tapes, a transverse arteriotomy is made and a _________________ is passed proximally

A

small Fogarty balloon embolectomy catheter

54
Q

AOVI

At the laparotomy after successful mesenteric revascularization, it is often found that bowel that appeared to be of questionable viability initially is now clearly viable look” laparotomy after successful mesenteric revascularization, it is often found that bowel that appeared to be of questionable viability initially is now clearly viable

A

At the “second look”

55
Q

AOVI

This avoids the consequences of massive intestinal resection, such as _____________ and lifelong parenteral nutrition is frequently an important adjunct in the postoperative period

A

short-guy syndrome

56
Q

AOVI

The mortality rate after sudden onset of mesenteric ischemia is as high as

A

85%

57
Q

AOVI

Mortality is higher after acute occlusion bythrombosis compared with

A

Embolism

58
Q

Yung ibang skit hindi na hinintay

A

Ilagay mo kapag finals review. Nandito sa ipad yung powerpoint

59
Q

Messentery

The mesentery develops from mesenchyme that attaches the _____________________ to the posterior abdominal wall

A

foregut,
midgut, and
hindgut

Surgery Finals 2nd Sem (5 decks)

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