anatomy, abdomen Flashcards
What is a chryptorchism?
Undescended testicle - remove if can’t surgically descend or cancer.
What peritoneum is associated with inguinal hernias - mostly in males?
Parietal
Kidney malignancy Wilms tumor - which gene?
WT1
When inferior poles of kidney fuse, what halts their ascent?
Inferior mesentery artery - “horseshoe kidney”
If kidneys fail to develop, is the amniotic fluid level affected?
Yes, because of lack of urine. Oligohydramnios results
Is hypoplastic lung related to oligohydramnios? If so, it is genetic?
Yes they are related, No, it is not genetic. Pulmonary hypoplasia is incomplete development of the lungs, resulting in an abnormally low number or size of bronchopulmonary segments or alveoli. A congenital malformation, it most often occurs secondary to other fetal abnormalities that interfere with normal development of the lungs. SEE that I have two different answers re if it is genetic.
Other source says: There may be a genetic component, but more commonly pulmonary hypoplasia is secondary to an underlying abnormality such as restrictive malformation of the chest wall and decreased fetal breathing (fetal neuromuscular disease), decreased fetal lung fluid (prolonged rupture of membrane, fetal renal dysplasias
What’s an annular pancreas?
Ventral bud rotation gone astray, It should rotate dorsally and fuse with dorsal bud. An annular pancreas means it rotated ventrally, second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines.
What can failure of lateral folds in embryonic development result in?
Lateral folds are key to musculature in anterior abdominal wall - defects range from umbilical hernia (minor) to gastroschisis (major)
What is gastroschisis?
An opening forms in the baby’s abdominal wall. The baby’s bowel pushes through this hole. The bowel then develops outside of the baby’s body in the amniotic fluid.
In relation to the esophagus, how much does the proximal foregut rotate and what nerve is involved?
90 degrees counterclockwise. Vagus nerve.
Half of baby’s diaphragm is rising higher - what happened?
Eventration. One muscular hemidiaphragm fails to develop - due to lack of muscle or phrenic nerve function/development. Due to pressure, abdominal organs are pushed into thorax - pleuroperitoneal folds contribute, as does development of septum transversum (becomes central tendon)
Would esophageal atresia cause pneumonia?
No, it would end in a blind tube - and while associated with tracheoesophageal fistula, it does not open into the trachea, so pneumonia would not result.
What does the tracheoeosophageal septem separate?
The ventral wall of the forgut (esophagus) from the laryngottracheal tube. - a fistula would result in fluid from esophagus into trachea and possible pneumonia.
What does the septum transversum form?
The central tendon.
What do the pleuroperitoneal folds form?
The posterolateral part of the diaphragm.
What does the pleuropericarial fold form?
The fibrous pericardium.
What do the cervical myotomes form?
Musculature of diaphragm.
Malrotation of the midgut loop may result in what complication?
Midgut volvulus (without fixed mesentery).
Absence of an ascending colon is caused by what?
Failure of cecal bud to descend.
Does duplication of the intestine have a fixed mesentery?
Yes - no free movement.
What is congenital megacolon due to?
Failure of migration of neural crest cells into wall of colon - lack of parasympathetic postganglionic neurons.
What is Hirschsprung disease?
Congenital megacolon - neural crest migration problem.
What is rectal atresia?
Failure to adequately recanalize - both anal and rectum exist - but are not connected.
Incomplete separation of the cloaca would result in what?
Anal agenesis either with or without presence of a fistula.
What is the most common site of Meckel diverticulum?
Ileum. Outpouching is a persistence of vitelline duct and can be attached to the umbilicus.
Where is the most common site of ectopic pregnancy?
Uterine tubes -
Where is the most common site of implantation?
Fundus
What nerve carries general visceral afferent fibers from abdominal organs and can be involved in referred pain?
The greater splanchnic nerve.
Does the dorsal primary rami of intercostal nerves carry messages from abdominal organs?
Yes - pain from these fibers would be sharp and localized as opposed to dull and diffuse as occurs in referred pain.
Does the vagus nerve transmit pain?
No.
What nerve transmits pain from the pelvis?
The pelvic splanchinic nerve - parasympathetic, S2 to S4, contains visceral afferent fibers.
What is an indirect inguinal hermia?
When a loop of bowel enters the spermatic cord through the deep inguinal ring (lateral to the interior epigastric vessels).
Where does the ilioinguinal nerve run
with the spermatic cord to innervate the anterior portion of the scrotum and proximal parts of the genitals - and could be compressed during an indirect inguinal hernia
The iliohypogatric nerve - what does it innervate?
The skin of the suprapubic region.
What does the lateral femoral cutaneous nerve innervate?
The skin over the lateral thigh
What nerve innervates the band of skin superior to the iliac crest and inferior to the umbilicus?
subcostal
What innervates the musculature and skin of the perineum?
The pudendal.
What lymph drains direction from the stomach before draining into the cisterna chyli?
Celiac Lymph.
From where do the superior and inferior mesenteric lymph nodes receive drainage?
Below the stomach
Where do the lumbar lymph nodes receive drainage?
Structures inferior to the stomach.
What organ are the hepatic lymph nodes associated with
The liver
Where does the splenic artery run -
behind the stomach to the spleen from the celiac trunk.
During a laparoscopic cholecystectomy, a resident clamped the hepatoduodenal ligament instead of the cystic artery - which vessel would be occluded?
The proper hepatic artery. It lies near the foramen of Winslow. The common hepatic gives origin to the proper hepatic art. but does not run w/in the hepatoduodenal ligament.
What hernias of the intestines run through the deep inguinal ring?
Indirect.
Do direct intestinal hernias penetrate the deep inguinal ring?
No, they penetrate the abdominal wall medial to the inferior epigastric vessels through the inguinal triangle (of Hesselback)
Where do umbilical hernias exit?
The umbilicus
Where do femoral and lumbar hernias exit ?
femoral - through the fermoral ring inferior to the inguinal ligament; Lumbar can penetrate through superior (grynfeltt) or inferior (Petit) lumbar triangles
What type of germ cells does the pancreas come from?
Endoderm
start lippincott abdomen
BEGINS HERE
The kidneys are supplied by what arteries
Renal
What arteries supply the pyploric portion of the stomach?
Gastroduodenal artery.
The head of the pancreas is supplied by what arteries?
Superior and Inferior pancreaticoduodenal arteries.
The splenic flexure of the colon is supplied by what arteries?
Marginal - although I also have this answer: receives dual blood supply from the terminal branches of the superior mesenteric artery and the inferior mesenteric artery, thus making it prone to ischemic damage in cases of low blood pressure because it does not have its own primary source of blood.
Man lifting weights - what kind of hernia?
Direct - when comes through weakness in anterior abd wall. Borders are inferior epigastric artery localed laterally, semilunar line of rectus sheath medially, and inguinal ligament inferiorily.
A direct hernia exits from which ring?
Superficial inguinal ring - and does not usually descend into the scrotum - as do indirect hernias.
GI bleed - in lower left area - what artery?
Inferior mesenteric (I don’t know if this is always right - but based on the xray-and this Q)
A remnant of the embryonic ventral mesentery is…?
the Falciform ligament.
Fractures on ribs 9 and 10 on left - what organ likely damaged?
Spleen, 1x3x5”,7lbsR9r11 mneomonic
Meckel’s diverticulitis - where will it be?
Lower ileum - a persistent remnant of embryonic vitelline duct (yolk sac). Mneumonic - rule of 2 (2” long, 2 ft proximal to ileoccecal valve, in 2% of the population
Woman with advanced polycystic kidney disease - what nerves convey visceral sensory fibers from renal capsule and cause referred pain to skin of suprapubic region?
Least splanchic - carries presynaptic symp. fibers from T12. Visceral afferent travel along refer pain to T12 dermatome. Further, the renal nerve plexus is supplied primarily from least splanchnic nerve - L1, L2.
Infant can’t hold milk after 3 weeks of normal feeding - projectile vomit - nonbilous and nonbloody - what’s best diagnosis?
Pyloric stenosis, prevents stomach contents from emptying into duodenum. usually present at 2 - 3 weeks after birth. Key is the vomit - nonbilous implies mlik not reach bile. nonbloody rules out possible GI bleed.
37 week old fetus, which fetal vessel is carrying the highest concentration of oxygen ?
Umbilical vein.
4 year old with diagnosis of aganglionic colon - deficient in which of following neural cells? - she has vomiting, constipation, and abdominal distention.
Postsynaptic parasympathetic neurons. Congential megacolon (Hirschsprung disease) is absense of enteric ganglia in colon - due to failure of neural crest cell migration. Classic symptom described in Q. Is colon not working?
to do a laparoscopic appendectomy, what artery needs to be litigated?
Superior mesenteric artery - arises from abdominal aorta at L1. The appendix is an outpocketing of embryonic midgut connected to the cecum - in lower right quadrant.
What is esophageal atresia?
congenital disorder where esophogus ends in blind pouch - detected at first feeding.
What does the celiac artery supply blood to in embryonic terms
Foregut - from approx lower esophagus to second part of duodenum.
What does the inferior mesenteric artery supply in embryonic terms?
Hindgut - from distal portion of trasnverse colon to superior aspect of rectum.
failure of differentiation of organs from embryonic foregut would cause malformation in which of following? spleen, gallbladder, asc colon, dec colon, Ileum?
Gallbladder - speen not from gut tube, asc, and ileum from midgut, dec colon from hindgut.
Spleen develops incidentally in the dorsal mesogastrium
Malformation of the central tendon in the diaphragm comes from?
Septum transversum
What vein drains the embryonic midgut?
superior mesenteric vein. The hepatic portal system collects blood from abd gut tube and spleen and directs flow to liver. Therefore, the distal duodenum, jejunum, ileum, cecum, appendix, asc colona,d prosimarl 2/3 of transverse colon drain via this route.
With a perforated ulcer in posterior wall of first part of duodenum, which artery is nearby and possibly damages?
Gastroduodenal.
With a left renal and perirenal abscess, which organ is irritated by abscess, and radiating pain to left shoulder?
Diaphragm. closely related to superior pole of left kidney. Visceral sensory fibers convey pain from kidney from t12, L 1 - leads to referred pain in lower abdomen, and thigh - visceral pain is often perceived as cutaneous pain at same spinal cord level as affected abdominal organ. Involvement of diaphragm would refer to left shoulder
Dorsal mesentery of esophagus of gut tube forms what structure of the diaphragm?
crura. The crus of diaphragm (pl. crura), refers to one of two tendinous structures that extends below the diaphragm to the vertebral column. There is a right crus and a left crus, which together form a tether for muscular contraction.
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one year post pregnancy, the medial umbilicus fold contains what structure?
Obliterated umbilical arteries.
Which blood vessels supply the embryonic foregut and its derivatives?
Celiac artery. Superior mesenteric (midgut); Interior mesenteric (hindgut); Hepatic portal - drains all three - doesn’t supply them; umbilical vein carries blood from placenta to liver and into liver bypass - does not supply gut tube.
fetus with midline anterior abd wall defect involving umbilical cord - with intestinal loops and part of liver within membraneous sac - what defect?
Omphalocele - need to finish answer here Q 21
rare familial neural defect - involving neural crest cells - which would not be affected by this disorder? pyloric sphincter, abd aorta, teniae coli, diaphragm, hepatopancratic pshyincter?
to do
In suprapubic region - using flap for mastectomy, which artery needs to be transected and later grafted?
Inferior epigastric artery
A genetically engineered virus selectively attacking cell bodies of post synaptic parasymp neurons - where would virus be most dense? celiac plexus, paravertebral ganglia, myenteric or hypogastric plexus, gray matter of sacral spinal cord segments?
myenteric plexus -
loss of weight, upper abd pain radiating to middle/upper back - sclera of eyes are icteric (yellow) reveals tumor in pancreas. Exocrine secretions is blocked from which organ?
liver
What does the left gastric artery supply?
Lesser curvature of stomach - forming anastomotic arc with right gastric artery along the lesser curve.
Peritoneum referred pain is where?
c3 - c5 dermatomes over shoulder (slides)
Projectile nonbilous vomiting one hour after feeding suggests what problem?
Pyloric stenosis - caused by hypertrophy (not error in recanalization), can often be palpitated. More common in males.
Histologically, list the four layers of the alimentary canal wall.
Mucosa, Submucosa, Muscularis Externa, Serosa
The esophagus starts and ends at what points?
C6 - T11. Upper sphincter, lower
Esophageal achalasia - what is it?
A failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter LES to remain closed.
What are the 3 esophageal constrictions and their locations?
Cervical (C5 -6), Thoracic (betw aortic art and left main bronchus), Diaphragmatic T10
What does the phrenicoesophageal ligament do?
Permits independent movement of diaphragm and esophagus during respiration and swallowing. The esophagus is attached to its hiatus by this ligament
What is a hiatal hernia?
When stomach prolapses the esophageal hiatus. Rarely life threatening
What are the two main types of hiatal hernias?
Paraesophogeal and sliding - sliding most common
What is a Bochdalek hernia?
Congenital diaphragmatic hernias -
A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant’s diaphragm, allowing normally intra-abdominal organs (particularly the stomach and intestines) to protrude into the thoracic cavity.
What side do Morgagni hernias normally occur on?
90% right - high mortality rate in infants re causes pulmonary hypoplasia - organs move up into chest.
Is there an anatomic sphinchter at the lower end of the esophogas, and what nerves control it?
No, vagus. It is called the esophogastric junction - Z line. LES
What is the cardiac orifice?
Where esophagus and stomach join - cardiac sphinter prevents regurgitation
What causes GERD?
Functional or mechanical problems of LES (lower esophogal sphincter - made of a bundle of muscles) - are most common - transient relaxation can be caused by foods, drugs, hormones (progesterone), nicotine
Are the les and z line the same?
One is the location of the lower esophageal sphincter (LES) or gastroesophageal junction. The second is the upper end of the squamo-columnar junction (Z line),which now (with Barrett’s) is in the esophagus (moved north).
What is Barrett’s Esophagus?
A condition where the tissue lining is replaced by a lining similar to the intestinal tract, caused by chornic esophagitis. (Columnar metaplasia). Most patients would have GRD and hiatus hernia or mid/high ulcer.
What nerves innervate the esophagus?
Sympathetic T 1 - 10, para Vagus afferants
The esophagus is innervated by the vagus nerve and the cervical and thoracic sympathetic trunk. The vagus nerve has a parasympathetic function, supplying the muscles of the esophagus and stimulating glandular contraction.
Lymphatics of esophogus?
Prox third - deep cervical nodes - thoracic duct; mid third - superior and posteria mediastinal nodes; distal third, follow left gastric artery to gastric and celiac lymph nodes
Two acids in stomach?
Pepsin (protein digesting) HCI (helps kill bacteria - hydrochloric acid). simple columnar epithelium, secretes bicarbonate buffered mucus
Nutrients from stomach not waiting to be absorbed in small intestine?
Water, electrolytes, some drugs (aspirin) , and alcohol
List order of pyloric parts starting from the duodenum.
Pylorus, pyloric sphincter, pyloric canal, pyloric atrium
Can gastric and duodenal ulcers be distinguished based upon history alone
No - although some findings are suggestive.
When is testing for H pylori infection necessary?
to determine if have peptic ulcer - rapid urease tests best choice
What is one mark of a benign stomach ulcer?
ulcer projects out beyond normal expected lesser curvature.
STARTING at Q 22 of Greys
here we go
Patient diagnosed w/ inguinal hernia. During operation loop of intestine found passing through deep inguinal ring - what kind of hernia is it?
Indirect hernia results from intestines coming through deep inguinal ring. Direct penetrate the anterior abd wall MEDIAL to inferior epigastric vessels through inguinal triangle and DO NOT penetrate deep ring.
perforating ulcer in stomach, posterior wall - where would peritonitis most likely develop initially?
Omental bursa is directly posterior to stomach. Pouch of Morison (subhepatic space) is behind liver and anterior to right kidney;
Which venous tributaries to portal system anastomoses w/ caval veins to causes varices in esophagus?
Left gastric vein carries blood from stomach to portal vein. At junction, left gastric vein (portal system) anastomoses with esophageal veins (caval system)
severe abdominal pain, cremasteric reflect notedly absent - which nerves is responsible for efferent limb of this reflex?
Genitofemoral from vental rami L1 and L2. Ilioinguinal arises from L1 and supplies skin over root of penis and upper part of scrotum. Pudendal innervates external genitalia.
exploratory lapartomy - where would incision likely be made to separate left and right rectus sheaths
Linea alba
After a tummy tuck, which layer of abdominal wall will hold the sutures?
Scarpas. Thick and tough.
Tumor in head of pancreas - which structure is likely obstructed?
Common bile duct is located at the head of the pancreas and receives contents from the cystic duct and hepatic duct. . An obstruction here backs up bile with pain and jaundice.
man admitted - excessive vomiting and dehydration - xray shows part of bowel is being compressed between abd aorta and superior mesenteric artery - which intestinal structure is most likely being compressed?
Third part of duodenum,
During surgical repair of perforated duodenal ulcer, the gastroduodenal artery is ligated - what branch of what artery will continue to supply blood to the pancreas?
Superior mesenteric artery.
alcoholic, bleeding from esophogael varices, Varices most likely a result of anastomoses between left gastric vein and which other vessels?
left gastric vein and esop veins of azygos form important link when portal vein backing up. Portal caval anastamoses.
Excruciating pain in back and left shoulder - abscess in upper part of left kidney - The shoulder pain may be caused by spread of inflammation from what structure?
Diaphragm
which anatomical features is most useful to distinguish the jejunum from the ileum?
Jejunem has less mesenteric fat.
severe diarrhea, 90% blockage of inferior mesenteric artery from aorta - which artery will provide collateral supply to desc colon?
middle colic artery. via marginal?
dull aching pain in umbilical region, and flexion of the hip causes sharp pain in lower abd quadrant - which structure is most likely inflamed?
appendix. psoas sign makes sense re iliopsoas muscle group lies directly beneath appendix.
Excruciating pain in back and left shoulder - abscess in upper part of left kidney - The shoulder pain may be caused by spread of inflammation from what structure?
Diaphragm
Dull pain, tumor at head of pancreas - abdominal pain is mediated by afferent fibers that travel initially with which of the following nerves?
Greater thoracic splanchnic nerve arising from T5 - T9
Severe antherosclerosis, low sperm count - which artery is most likely occluded?
Testicular artery.
malignancy in scrotum, which of following are the
first lymph nodes affect area?
Superficial inguinal nodes.
which component of spermatic cord is derived from internal abd oblique muscle?
cremaster muscle.
Do neural crest cells give rise to adrenal medulla or adrenal cortex?
Medulla
Does nerepinephrine or dopamine increase cardiac output?
nerepinephrine
What neurotransmitter is the most common excitatory one in the CNS?
Glutamate
Does GABA or dopamine inhibit cardiac output in the CNS?
both
What is a perinuerium?
Each bundle of nerves is surrounded by one, consisting of several layers of epithelial cells.Tight junctions exclude most macromolecules
The tight junctions provide selective barrier to chemical substances. The perineurium is a smooth, transparent tubular membrane which may be easily separated from the fibers it encloses. In contrast, the epineurium is a tough and mechanically resistant tissue which is not easily penetrated by a needle.
What does the epineruium surround?
Many fascicles, but does not exclude macromolecules - it is an external coat of nerves.
What is the layer of reticular fibers that covers each individual nerve fiber?
endoneurium - which does not exclude macromolecules.
What is the neurotransmitter for preganglionic sympathetic and pre and post ganglionic parasym synapsis?
ACh
What are Nissi bodies composed of and where do they reside?
Only in neurons, large granular basophilic bodies of RER and polysomes.
What is the axon hillock made of?
it contains microtubules arranged in bundles and permits passage neurofilaments, mitochondria, and vesicles into the axon.
Do synaptic vesicles become incorporated into the presynaptic membrane or enter the synaptic cleft?
They become incorporated - releasing neurotransmitters via exocytosis
What disease is associated with demyalinization in the CNS and retina?
MS
What disease is characterized by tremors, muscular rigidity, difficulty in movement, and what is its cause?
Parkinsons. Loss of dopaminergic neurons from the substantia nigra possibly due to poisons and envionmental factors.
What disease is associated with loss of neurons that produce the neurotransmitter GABA
Huntingtons - a fatal heredity disease becoming evident in the third or fourth decade of life.
Is viral or bacterial meningitis more serious?
bacterial. Death can occur within 24 hours.
Does depolarization trigger the opening of voltage gated K+ channels?
Yes. Voltage-gated potassium channels are activated by depolarization, and the outward movement of potassium ions through them repolarizes the membrane potential to end action potentials, hyperpolarizes the membrane potential immediately following action potentials, and plays a key role in setting the resting membrane
Is Hirschsprung disease characterized by a dilated retina or colon?
Colon - caused by the absence of parasympathetic myenteric ganglia known as Auerback plexus.
Hirschsprung disease (HSCR) is a birth defect. This disorder is characterized by the absence of particular nerve cells (ganglions) in a segment of the bowel in an infant. The absence of ganglion cells causes the muscles in the bowels to lose their ability to move stool through the intestine (peristalsis).
Why is the arcuate line is important?
It is the site of entry of the inferior epigastric artery into the rectus sheath.
What is Hesselbach’s triangle?
Common site for direct hernias - area of potential weakness. Bound medially by linea semilunaris, laterally by inferior epigastric vessels, and interiorly by inguinal ligament
What is the Superficial Inguinal Ring
A triangular opening in the aponeurosis of the external oblique muscles that lies just lateral to the pubic tubercle.
What a aponeuroris?
A sheet of pearly white fibrous tissue that takes the place of a tendon in flat muscles having a wide area of attachment.
What is the deep inguinal Ring?
Lies in the transversalis fascia, just lateral to the inferior epigastric vessels
The two openings to the inguinal canal are known as rings. The deep (internal) ring is found above the midpoint of the inguinal ligament. which is lateral to the epigastric vessels. The ring is created by the transversalis fascia, which invaginates to form a covering of the contents of the inguinal canal.
What is the inguinal Canal?
connects deep and superficial inguinal ring - transmits spermatic cord or round ligament of uterus and genital branch of genitofemoral nerve - both of which run through the deep inguinal ring and inguinal canal.- An INDIRECT HERNIA also passes through.
Does the ilioinguinal nerve run through the inguinal canal?
Yes, but not through the deep inguinal ring.
Describe the differences between Reducible, Incarcerated and Strangulated hernias
Reducible - content can be returned; Incarcerated - trapped or stuck in groin - irreducible; Strangulated - life threatenening - tissues twisted and will turn gangrenous.
Indirect Inguinal hernia
congenital - descends into scrotom, LATERAL to inf. epig vessels - more common than Direct. - passes through deep ring, canal and superficial
Direct hernia
through weakened area of abdominal - MEDIAL to inf epig vessels - rarely descends to scrotum. Older men get them because of weakened transverse muscles. ?
What is the spermatic cord composed of?
The spermatic cord contains the ductus deferens (vas deferens), the testicular artery and the pampiniform plexus of veins. Other structures in the cord are the cremasteric artery, the artery to the vas, nerve to the cremaster, sympathetic nerves and the lymphatics of the testis and epididymis.
What is the Processus Vaginalis Testis?
fetal structure -
The processus vaginalis (or vaginal process) is an embryonic developmental outpouching of the peritoneum. It is present from around the 12th week of gestation, and commences as a peritoneal outpouching. n males, it precedes the testis in their descent down within the gubernaculum, and closes.
What happens if around birth the processus vaginalis testis fails to close?
can lead to congenital indirect inguinal hernia, may cause fluid accumulation (hydrocele processus vaginalis) if occluded
What is the inntermost layer of the scrotum?
Tunica Vaginalis
What are the peritoneal reflections?
Omentum (Lesser, Greater), Mesenteries (Proper - small intestine; Transverse mesocolon; Sigmoid mesocolon; Mesoappendix); other Peritoneal Ligaments - (5) and Peritoneal Folds ( 3)
What is Peritonitis?
Inflammation/infection of pertitoneum - commonly caused by burst appendix, a perforating ulcer, or poor sterile techniques during abd surgery - NEEDLE insert - McBurney’s Point - avoiding epigastric vessels.
Is the peritoneal cavity sealed?
Only in males - hence females can get infections through… vagina and uterine tubes. Is there something more here?
What is the Pouch of Douglass - and do only males have it?
Only females:
The rectouterine pouch, also known as the rectovaginal pouch, cul-de-sac or pouch of Douglas, is an extension of peritoneum between the posterior wall of uterus and the rectum in females. It is the most dependent part of the peritoneal cavity and is analogous to the rectovesical pouch in males.
What is Morrison’s Pouch?
An area between your liver and your right kidney. It’s also called the hepatorenal recess or right subhepatic space. Morison’s pouch is a potential space that can open up when fluid or blood enters the area
What is the Lesser Sac and where is it?
“Omental Bursa” - a space behind liver, lesser omentum, stomach, and upper greater omentum - CLOSED sac except communication with Greater Sac through epiploic (omental) foramen.
How many recesses does the Lesser Sac have?
three - superior, inferior, and splenic
what is the Greater Sac?
Extends across abdomen - with many recesses into which pus can live - Subphrenic (between diap and anterior/superior liver - separated into two by Falciform Ligament; Subhepatic (Morrison’s pouch) - betwe liver and kidney and suprarenal gland - communicates with Lesser Sac via epiploic foramen and right paracolic gutter - thus the pelvic cavity, Paracolic (Gutters) - lateral to ascending colon (right recess) and lateral to descending (left)
What is the epiploic or Omental (Winslow’s) Foramen?
natural opening between lesser and greater sacs - DAVE - Duct, Artery, Vein, Epiploic foramen -
anterior: the free border of the lesser omentum, known as the hepatoduodenal ligament. This has two layers and within these layers are the common bile duct, hepatic artery, and hepatic portal vein.
What do peritoneal reflections do?
support the viscera and provide pathways for associated neurovascular structures. - include omentum (lesser, greater), 4 mesenteries, and 5 Ligaments and 3 folds
What is a Pott’s fracture?
Fibula and tibia - damage to their distal ends.
What is a Colles fracture?
Radius near wrist.
Three sources of new bones when healing?
Periosteum (majority), endosteum, bone marrow (will need to take time to differentiate) - especially the pluripotent stem cells.
What are diathroses vs. synarthroses joints?
Diathroses - a lot of movement (knee, elbow)
What is Pannus?
In rheumatoid arthritis, where synovial membrane lining thickens and is changed to a villae-type inflammatory connective tissue.
What is the cause of rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disorder -
Peptide antigen presented to T cells (DC4+) releasing Interfeuron 15 activating synovial macrophages that secrete proinflammatory cytokines, which then release collagenase and matrix metalloproteases - Neutrophils contribute prostaglandins, proteases and reactive oxygen species tarted to the destruction of the articular cartilage and subjacent bone tissues.
What is an ascites?
Abnormal buildup of fluid in the abdomen.
What is Morrison’s pouch?
Morison’s pouch is an area between your liver and your right kidney. It’s also called the hepatorenal recess or right subhepatic space. Morison’s pouch is a potential space that can open up when fluid or blood enters the area.
What is the Pouch of Douglass?
The rectouterine pouch, also known as the rectovaginal pouch, cul-de-sac or pouch of Douglas, is an extension of peritoneum between the posterior wall of uterus and the rectum in females. It is the most dependent part of the peritoneal cavity and is analogous to the rectovesical pouch in males.
What is osteopetronis?
Stone bone - failure of OClasts or hormones associated w/, lack of ruffled border - very thick bones, fills in medulary cavity - then lack of marrow, and lack of RBC/WBC production.
Cleidocranial dysplasia - what is it?
Affects development of bones and teeth - Lack of or mutation in RUNx2, hypoplastic clavicles, delayed ossif of sutures - cartilagous skeletons in mice. Some have extra pieces of bone called Wormian bones within the sutures.
What is osteogenesis imperfecta?
Many kinds - Collagen Type 1 deficiency - gene mutation - , Brittle Bone - blue sclera, hearing loss, seizures, OSx deficiency, ectopic cartilage formation under bone collar. Affects Collagen Type I mutation
What are rickets vs. Osteomalacia?
Vitamin D and calcium deficiency - rickets in children, growth place wides - soft osteoid, bones bow and bend
Scurvy is caused by what vitamin deficiency and what does it do?
C - Disrupts growth plate - vitamin C needed for collagen. Early symptoms of deficiency include weakness, feeling tired and sore arms and legs. Without treatment, decreased red blood cells, gum disease, changes to hair, and bleeding from the skin may occur.
What is achondroplasia?
Problem in chondrocytes - poorly formed growth plates - limbs short and stunted.
What is osteofibrosa?
CA up - Excessive fibrous tissue w/ many Oclasts - bone transparent in xrays. Loss of calcium in bones - makes them fragile.
Osteitis fibrosa cystica is the result of unchecked hyperparathyroidism, or the overactivity of the parathyroid glands, which results in an overproduction of parathyroid hormone (PTH). PTH causes the release of calcium from the bones into the blood, and the reabsorption of calcium in the kidney.
What is osteoporosis?
bone quality goes down - two types - menopausal women (lack of estrogen) and elderly - lack of zinc.
What is Acromegaly?
bones grow thick due to excess human growth hormone in pituitary- GH - causes excess IGH - large hands, feet and face.
What are malignant bone tumors called, who gets them and where are they located?
osteosarcoma - young adults, femur, humerus
Jansen’s Disease- 20 cases in the world, what is it?
PTH mutation - rare autosomal dominant disorder characterized by short-limbed dwarfism and severe, agonist-independent hypercalcemia. Four different mutations in the gene encoding the PTH/PTHrP receptor (PTHR1) were identified in several unrelated JMC patients
How does hyperparathyroidism effect bones?
Excessive bone resorption. Overactivity of the thyroid gland, resulting in a rapid heartbeat and an increased rate of metabolism.
What does excess of Human Growth Factor bode?
Gigantism, or dwarfism if insufficient. HGH calls out IGFs, IGFs promote cell division in growth plate.
What is the different between osteoarthritis and rheumatoid arthritis?
Rheumatoid - immune system attacks the synovium - changing membrane to villae-type. A chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles. Osteroarthritis comes from USE over time.
What is mneumonic for growth plate process?
Real People Have Career Options
Resting zone, Proliferative zone, Hypertrophic cartilage zone, Calcified cartilage zone, Ossification zone.
Describe the four layers of the alimentary canal - from esophagus to anal canal -
MSMS - Mucosa, Submucosa, Muscularis Externa, Serosa
What is McBurney’s Point?
Marks BASE of appendix.Site of maximum pain and tenderness in acute appendicitis. Junction of the outer 1/3 and middle 1/3 of an imaginary line between the umbilicus and anterior superior iliac spine
What is Addison’s plane?
The transpyloric plane, also known as Addison’s plane, is an imaginary axial plane located midway between the jugular notch and superior border of pubic symphysis, at approximately the level of L1 vertebral body.
What are esophageal varices?
Enlarged veins in the esophagus. They’re often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas and spleen to the liver.
What is caput madusea?
Caused by portal hypertension - recanalized ligament of teres (in females) - and travels to superfilicial periumbilical veins. Sx of portal hypertension.
What causes anal rectal hemorrhoids?
Portal hypertension- blood backflows through superior rectal vein -
What are the three main places one finds sinusoid capillaries (the most permeable)?
The liver, spleen and red blood marrow. Traps old RBC (120 days).
In liver, what’s the percentage of hepatic portal vein blood to hepatic artery blood?
75/25
What is Annular Pancreas?
A rare condition in which the second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines.
What is the difference between interstitial and appositional growth in bone?
Interstitial increases length, Appositional increases in width.
What is the difference between intramembranous and endochondral ossification?
In intramembranous ossification, bone develops directly from sheets of mesenchymal connective tissue. In endochondral ossification, bone develops by replacing hyaline cartilage. … Appositional growth allows bones to grow in diameter.
What is endochondral ossification?
The process by which growing cartilage is systematically replaced by bone to form the growing skeleton.
What are the six steps of endochondral ossification?
Step 1
Cartilage enlarges; Chondrocytes die
Step 2
blood vessels grow into perichondrium; cells convert to osteoblasts; shaft becomes covered with superficial bone
Step 3
more blood supply and osteoblasts; produces spongy bone; formation spreads on shaft
Step 4
Osteoclasts create medullary cavity; appositional growth
Step 5
epiphysis centers calcify; blood and osteoblasts move in; secondary ossification centers
Step 6
Epiphysis filled with spongy bone; cartilage remains at joints; epiphyseal plate in metaphysis
What is GFAP?
A type III intermediate filament protein that is expressed by numerous cell types of the central nervous system (CNS), including astrocytes and ependymal cells during development.
Effects of IGF-1 on bones:
Ups Oblast and Oclast activity, thus increasing endochondral ossification. Increases collagen type 1 and proteoglycans. - It also increases interstitial bone growth by acting on cartilage to proliferate, increas size and differentiation of chondroblasts.
How does appositional bone growth occur?
Osteoblasts in the periosteum deposit new bone matrix layers onto already-formed layers of the outer surface of bone. … This results in a greater concentration of bone being built than being destroyed, which produces thicker and stronger bones.
What does GH do in the liver to promote bone growth?
Facilitates creation of IGF-1. This is where IGF-1 is created.
What does FAST stand for in the ER room re trauma?
Focused assessment with sonography for trauma (FAST) is a rapid assessment type of ultrasonography which includes evaluations of: The hepatorenal recess (Morison pouch) The perisplenic area The subxiphoid pericardial space Suprapubic area (Douglas pouch)
Why is the arcuate line important and where is it?
It is roughly positioned half way between the umbilicus and the pubic crest. Clinically, the arcuate line is important as the site of entry of the inferior epigastric artery into the rectus sheath.
The inferior one-quarter (below the arcuate line) of the rectus sheath is supported posteriorly only by the transversalis fascia, extraperitoneal fat, and the peritoneum
what is the rectus sheath?
The rectus sheath, also called the rectus fascia, is formed by the aponeuroses of the transverse abdominal and the internal and external oblique muscles. It contains the rectus abdominis and pyramidalis muscles. It can be divided into anterior and posterior laminae.
What is the inguinal canal, and how is it formed?
The inguinal canal is formed in relation to the relocation of the testis during fetal development.
The inguinal canal in adults is an oblique passage approximately 4 cm long directed inferomedially through the inferior part of the anterolateral abdominal wall.
Where are the inguinal rings located?
Superficial inguinal ring
A triangular-shaped defect in the aponeurosis of the external abdominal oblique and lies immediately above and medial to the pubic tubercle
Deep inguinal ring
An oval opening in transverse fascia and lies approximately 1.5cm above midpoint of inguinal ligament lateral to inferior epigastric vessels
What structures run through the inguinal canal?
In males
Spermatic cord
Ilioinguinal nerve
In females
Round ligament of uterus
Ilioinguinal nerve
What does the The ilioinguinal nerve innervate?
The anterior surface of the scrotum or labia majora, root of the penis or mons pubis, and a small portion of the upper antero-medial thigh. It also innervates the internal oblique and transversus abdominis muscles.
What nerve innervates the penis?
The pudendal nerves supply somatic motor and sensory innervation to the penis. The cavernous nerves are a combination of parasympathetic and visceral afferent fibers and provide the nerve supply to the erectile tissue.
What are the three layers of the spermatic cord?
Covered by three concentric layers of fasciae
External spermatic fascia: It is derived from the external oblique muscle. It attaches to the margins of superficial inguinal ring.
Cremasteric fascia: It is derived from the internal oblique muscle. It covers the cremaster muscle.
Internal spermatic fascia: It is derived from the fascia transversalis (fascia covering the transversus abdominis muscle). It is attached to the margins of the deep inguinal ring.
What is the spermatic cord?
The spermatic cord is the cord-like structure in males formed by the vas deferens (ductus deferens) and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an extension of the peritoneum that passes through the transversalis fascia.
What are the contents of the spermatic cord?
Contents
Vas deferens (Ductus deferens):
Thick walled muscular duct.
Transports spermatozoa from epididymis to urethra.
Testicular artery:
A branch of abdominal aorta arising at the level of second lumbar vertebra.
Supplies blood to testis and epididymis.
Testicular veins (Pampiniform plexus):
From the Pampiniform plexus (testis).
Becomes reduced in size as it ascends.
At the deep inguinal ring, only a single vein is left (testicular vein).
Drains into the left renal vein on the left side and into the inferior vena cava on the right side.
Testicular lymph vessels:
Ascend through the inguinal canal and pass up over the posterior abdominal wall to reach the lumbar (para-aortic) lymph nodes.
What nerve supplies the creamaster muscle?
Genital branch of genitofemoral nerve.
What is the Processus vaginalis?
An embryonic developmental outpouching of the peritoneum. The remains of it are present within the spermatic cord.
What nerves innervate the testis?
The somatic supply to the testes and scrotum originates from the L1–L2 and S2–4 nerve roots through the iliohypogastric, ilioinguinal, genitofemoral, and pudendal nerves The iliohypogastric nerve provides sensory innervation to skin above the pubis.
What’s the most common cause of scrotal enlargement?
Hydrocele - fluid accumulation in the tunica vaginalis (potential space).
What is varicocele of the scrotom?
An abnormal dilation and tortuosity in the pampinafour venous plexus - can be seen when patient standing. Usually on left because vein drains to left renal vein rather than right’s drainage to larger IVC.
What are the most common types of hernias?
Approximately 75% of all hernias are inguinal; of these, 50% are indirect (male-to-female ratio, 7:1), with a right-side predominance, and 25% are direct
Where do indirect (congenital) hernias occur?
Lateral to inferior epigastric vessels - passing through deep inguinal ring and as a protrusion along the spermatic cord.
Where do direct hernias occur?
Occurs medial to the inferior epigastric vessels, passes directly through the posterior wall of the inguinal canal, and is separate from the spermatic cord and its coverings derived from the abdominal wall
Where is referred pain on the DPH?
C3 -5 dermatomes over the shoulder -
Is visceral peritoneum sensitive to anything?
YES, to stretch and chemicals. Pain often referred to midline - poorly located.
What are the structures of the female that lead into the peritoneal cavity?
The uterine tubes, the uterus, and the vagina
What are the primary retroperitoneal organs (never had a mesentery)?
Kidney, Adrenals, Ureters, Aorta, IVC, Rectum, Anal Canal.
What organs lost a mesentery during development?
Duodenem (2 and 3); Head, neck and body of pancreas; Asc and Desc Colon, Upper rectum
What are the Major Intraperitonial Organs (suspended by mesentery)?
Stomach, Liver and gallbladder, spleen, duodenum (1st part), tail of pancreas, Jejunum, ileum, appendix, transverse colon, sigmoid colon
What structures does the Lessor Omentum create?
2 Structures - hepatogastric ligament (from porta hepatis to lesser curvature of stomach; Hepatoduodenal ligament - from porta hepatis to superior duodenum, - CONTAINS common bile duct, proper hepatic a and hepatic portal vein.
Where and what is the omental foramen?
behind right border of hepatoduodenal ligament.. Also called foramen of Winslow and is the passage of communication between the greater sac (general cavity (of the abdomen)), and the lesser sac.
What is the difference between the lesser sac and the lesser omentum?
The lesser sac (omental bursa) is behind the lesser omentum and stomach. It allows the stomach to move freely against the structures posterior and inferior to it. The omental bursa is connected with the greater sac through an opening in the omental bursa - the epiploic foramen (of Winslow).
What is peritonitis?
An inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein - numerous causes.
What is the greater sac?
Also known as the general cavity (of the abdomen) or peritoneum of the peritoneal cavity proper, is the cavity in the abdomen that is inside the peritoneum but outside the lesser sac.
What is mesentery?
Folds of peritoneum that support and stabilize the intraperitoneal GI tract organs. Blood vessels, lymph vessels, and nerves are sandwiched between the two folds and supply the digestive organs.
There are several different types of mesenteries:
Omenta
Ligaments
Mesentery Proper
Mesocolons
What does the small intestine mesentery do?
It has a 4 to 6 meter periphery, which covers the entire length of the jejunum and ileum and attaches to the posterior abd wall. (looks like an octopus - in a fan shape - really embracing above sections of small intestine - anchoring them.
What are the various mesenteries other than the small intestine?
Triangular (ileum to appendix), transverse mesocolon, sigmoid mesocolon; Liver ligaments - falciform, coronary, left and right triangular , round (remnant of fetal umbilical vein), hepatoduodenal (portion of lesser omentum enveloping the portal triad)..
What’s the portal triad and where is it?
The hepatic artery proper, thehepatic portal veinand thecommon bile duct in the hepatoduodental lilament (portion of lesser omentum).
What does the falciform ligament divide?
Anterior right and left lobes of liver.
What are the four ligaments of the spleen?
Gastrosplenic ligament
A double layer of peritoneum that connects the fundus of stomach to hilum of spleen.
In this double layer of peritoneum are the short gastric and left gastroepiploic vessels
Splenorenal ligament
Extends between the hilum of spleen and anterior aspect of left kidney.
The splenic vessels lies within this ligament, as well as the tail of pancreas
Phrenicosplenic ligament
A double fold of peritoneum (mesentery) extending between the diaphragm and spleen; this is a portion of the greater omentum
Splenocolic ligament
Connection between thesplenic capsuleand thetransverse colon
What are the ligaments of the stomach?
Hepatogastric ligament
The part of the lesser omentum that extends between the liver and lesser curvature of the stomach
Gastrosplenic ligament (See Spleen)
Gastrophrenic ligament
The portion of the greater omentum that extends from the greater curvature of the stomach to the inferior surface of the diaphragm
Gastrocolic ligament
From the greater curvature of the stomach to the transverse colon (anterior wall of lessor sac)
Are there various peritoneal subdivisions?
Yes, including the Pouch of Morrison behind the right kidney - Right infrahepatic recesses = hepatorenal recess = Pouch of Morison!
What do the transverse colon and transverse mesocolon divide?
The greater sac into supracolic and infracolic compartments.
What is the difference between the Left and Right suprahepatic recesses?
The left suprahepatic recesees include the
left anterior and posterior suprahepatic spaces
Right suprahepatic recesses included the
right anterior and
right posterior suprahepatic spaces and the
bare area of liver (extraperitoneal space)
What are other peritoneal subdivisions?
Infrahepatic, Right (Pouch of Morrison) Left infrahepatic, and the Infracolic compartments - right and left paracolic sulcus (gutters), and the right and left mesenteric sinus
What is paracentesis?
Use a needle - Liquid that accumulates in the abdomen is called ascites. Ascites seeps out of organs for several reasons related either to disease in the organ or fluid pressures that are changing
There are two reasons to take fluid out of the abdomen
To analyze it for diagnostic purposes
To relieve pressure.
What is the route of somatic abdominal pain?
Central part of the diaphragm: Phrenic nerve (C3, 4, and 5)
Peripheral part of the diaphragm: Intercostal nerves (T7 to 11)
Anterior abdominal wall: Thoracic nerves (T7 to 12) and the 1st lumbar nerve
Pelvic wall: Obturator nerve (L2, 3, and 4)
What are the three types of abdominal pain?
Somatic from skin, fascia, muscle and parietal - can be severe and precisely localized - when origin is on one side of midline, pain is also lateral.
Visceral from organs, viscera and mesentery - cause can be stretching, distention ischemia and chemical pain (ie gastric juices) - is dull and poorly localized
Visceral is referred to midline - colic is a form - often because of lumen occlusion - ie gallstone, intestinal obstruction, etc
Referred pain - for both somatic and visceral
Where is referred pain for heart?
left chest cavity, down left arm.
Referred pain for lungs and DPH?
neck and collar area - shoulders and clavicles -
Referred pain of spleen
Left shoulder
Referred pain of ovaries?
both sides of umbilicus and down a bit.
Referred pain for kidneys?
from waste down like a skirt, into inner and outer thighs.
Referred pain for ureters
Lower than bladder - pelvic girdle
What is Meckel’s diverticulum?
An outpouching or bulge in the lower part of the small intestine ( the ILEUM). The bulge is congenital (present at birth) and is a leftover of the umbilical cord. Meckel’s diverticulum is the most common congenital defect of the gastrointestinal tract.
Meckel’s diverticula, vitelline cysts, or vitelline fistulas are most commonly found in association with with organ?
The Ileum.
During development of the gut, are the smooth muscle in the wall of the esophagus is derived from somatic or splanchnic mesoderm?
Splanchnic.
Lateral plate mesoderm gives rise to what?
The body cavity. On either side of the intermediate mesoderm resides the lateral plate mesoderm. Each plate splits horizontally into the dorsal somatic (parietal) mesoderm, which underlies the ectoderm, and the ventral splanchnic (visceral) mesoderm, which overlies the endoderm.
Paraxial mesoderm – which forms somitomeres and somites
Intermediate mesoderm – which contributes to the urogenital system
Lateral plate mesoderm – which is involved in forming the body cavity
Where is the coronary ligament?
Liver.
Ruptured spleen - surgery needed, what peritoneal structure must be carefully manipulated to avoid intraperitoneal bleeding?
Splenorenal ligament.
Kidney stone obstructing right ureter - severe pain radiating from lower back toward pubic symphysis - at which point is the calculus most likely to lodge?
Pelvic brim.
Lower portion of descending colon needs to be removed - which vessels and nerves will be cut during operation?
Pelvic splanchnic nerves and left colic artery supply desc colon.
two weeks after appendectormy, male complains of numbness of skin over pubic region and anterior portion of genitals, which nerves were most likely injured?
ilioinguinal nerve is a terminal branch of spinal nerve L1. Innervates skin overlying iliac crest and upper inner thigh (not the cremaster nerve FYI - that is genitofemoral). Can be injured with extension of appendectomy incision.
5 year old, projective vomiting, severe dysphagia - two days later aspiration pneumonia - webs and strictures in distal third of thoracic esop - ?
Esophogal stenosis results from failure or recanalization in 8th week, which may also cause esophageal atresia. webs and strictures in esop are found w/ stenosis, but not in atresia.
vomitus of 5 day old infant contains stomach contents and bile - 4th part of duodenum has stenosis, child cries all the time, not gaining weight?
duodenal stenosis caused by incomplete recanalization of duodenum. other options above this would not create bile, i.e. hypertrophied pyloric sphincter, patent bile duct, atrophied gastric antrum.
4 day old, vomiting, no bile - distressed, sucking movements w/ lips, failing to thrive - ?
hypertrophy of pyloric sphincter - projectile vomited with stomach contents but no bile. Duodental atresia, like stenosis, causes vomiting of stomach but vomiting begins soon after birth in atresia - stenosis does not begin and can occur days after delivery.
5 day old, vomit stomach contents and bile - 2 days of vomiting, xray - stenosis in third part of duodenum - ?
Incomplete recanalization of duod caused either by duod stenosis or partial occlusion of lumen of duod and usually occurs in distral third portion of duod.
2 hour old diagnosed in-utero with polyhydramnios - now vomiting w/ bile - and xray shows double bubble, constantly hungry, losing weight?
Duodenal atresia is the result of a failed reformation of lumen of duod - with vomiting within first few days of birth. Polyhyd present. double bubble is a sign because of distended gas filled stomach. Duod stenosis is caused by incomplete recanalization of duod
4 year old, severe vomiting, xray reveals annular pancreas - what is the typical explanation?
caused duod obstruction due to thick band of pancreatic tissue that surrounds and constricts second part of duod. Both buds have to be involved - any answer with only one of the buds - dorsal or ventral - is wrong - needs both.
during emergency appendectomy, surgeon notes 5cm long fingerlike pouch on anterior border of ileum near ileocecal junction - this pouch is remnant of what?
Omphaloenteric duct, vitalline. It is NOT a remnant of the umbilical cord.
3 month old admitted with abnormal mass of tissue protruding from abdomen. xray shows it contains some greater omentum and small intestine - mass proturdes when infant cries, strains and coughts - what is based explanation?
Umbilical hernia - a defect in the linea alba. Differs from omphalocele - as there is a failure of intestine to return to abd cavity - without a covering of hernia of the skin. In umbilical hernia - structures are covered by skin. Gastroschisis is an imcomplete closure of the lateral foldes - resulting in an epigastrric hernia where organs protrude into the amniotic cavity - surrounded by amniotic fluid. An indirect inguinal hernia si when the communcation betwe the tunica vaginalis and peritoneal cavity do not close, and a loop pof intestine or portion of other oragn herniates through the deep inguinal ring into the inguinal canal with possible further descent thru the superficial inguinal ring into scrotum or lambium majus.
fetal defect - on right side, lateral to median plane, viscera protrude into amniotic cavity - What explains this?
Gastroschisis, an incomplete closure of the lateral folds during the 4th week.
What does nonrotation of the midgut result in?
the lower portion of the loop returning to the abdomen first, the small intestine passing to the right side of the abdomen and the large intestine lying entirely on the left.
When the cloacal membrane ruptures during the 8th week, what happens?
A communication between the anal canal and amniotic cavity.
2 hour infant vomits stomach content and bile - abdominal distention, unable to pass meconium - what is the most common cause?
obstruction in fetal bowel - midgut volvulus results in twisting of intestine and bowel obstruction, small or large intestine.
what is the most common cause of Mecke’s diverticulum?
Remnant of oomphaloenteric duct.
newborn has no passage of first meconium stool for 48 hours after birth - . Exam reveals anal agenesis w/ perineal fistula - what is most common explanation?
Incomplete separation of cloaca by urorectal septum. Failure of anal membrane to perforate results in inperforate anus.Abnormal recanalization of colon results in rectal atresia where there is NO connection between rectum and anal canal.
anal stenosis diagnosis, after infant lacking stool for ten days - what is most likely cause?
Dorsal deviation of urorectal septum results in anal stenosis.
2 month old infant presents with fecal discharge from umbilicus - best explanation?
failure of ureteric bud to form results in renal agenesis and oligohydramnios.
5 day old infant diagnosed with anorectal agenesis - ultrasound reveals rectourethral fistula - what is most likely embryoligic cause?
Anorectal agenesis - due to abnormal partitioning of cloaca, often associated with recto-type fistulas.
12 year old massive rectal bleeding - free of pain, reveals meckle diverticulum, what is the underlying embryoligcal cause?
Remnant of yolk stalk.
pregnant woman, ultrasound - unilateral renal agenesis and oligohydramnios - what condition is most likely?
Failure or ureteric bud to form. Ureteric duplication occurs due to premature division of ureteric bud and can also result in a double kidney. Wilms tumor is a malignancy of the kidney more common in children.
15 year old female with bilateral inguinal masses. No period yet but normal breast development - external genitalia feminine - shall vagina, no uterus - sec chromatin pattern was negative - what is best diagnosis? -
Androgen insensitivity syndrome involves the development of testes and female external genitalia with a blind ending vagina and absence of uterus and uterine tubes. Male and female pseudohermaphroditism have different presentation and result from 46 xy and 46 xx genotypes.
female gymnast with pelvic pain - history of primary amenorrhea and imperforate hymen - best explanation?
The vaginal plate which arises from sinovaginal bulbs, undergoes canalization during embryonic development. Failure of canalization results in persistent
vaginal plate and thus imperforate hymen.
What are the two parts of the lesser omentum?
Hepatogastric (clear) and hepatoduodenum (with portal triad).
What is the omental bursa - or lesser sac?
A hollow space that is formed by the greater and lesser omentum and its adjacent organs. It communicates with the greater sac via the epiploic foramen of winslow, which is known as the general cavity of the abdomen that sits within the peritoneum, but outside the lesser sac. It is tricky because it is behind the hepaduodenal ligametn - door takes you to other space.
Where is the transpyloric plane?
midway between jugular notch and pubic - near L1
How does the neural plate divide? Does dorsal somatic (parietal) mesoderm lie under or over the ectoderm?
Each plate splits horizontally into the dorsal somatic (parietal) mesoderm, which underlies the ectoderm, and the ventral splanchnic (visceral) mesoderm, which overlies the endoderm.
What arteries lie within the gastrosplenic ligament?
short gastric and left gastroepiploic vessels.
What arteries lie within splenorenal ligament - “high yield”?
Splenic vessels as well as the tail of the pancreas
Is the phrenicosplenic ligament part of the greater omentum and where does it lie?
Yes, and between DPH and spleen
Is the greater sac divided into two portions?
Yes, the supracolic and suprahepatic - divided by transverse colon and transverse mesocolon.
What is a route of infection between pelvic cavity and upper abdominal region?
Right paracolic sulcus (gutter). Lateral to ascending colon. Communicates between hepatorenal recess and pelvic cavity.
Where does greater omentum come from embryonically?
Dorsal mesentery hanging down from stomach once stomach has turned 90 degrees and the Ventral mesentery becomes the lesser omentum.
In lesser omentum between liver and stomach, where are the left and right gastric arteries found?
Hepatogastric ligament. Hepatoduodenal has the portal triad.
In a surgery involving the liver - where would surgeon clamp to stop blood from flowing into liver?
Hepatoduodenal ligament - portal triad.
Where do you access the lesser sac from the greater sac?
The free margin of the hepatoduodenal ligament. The epiploic foramen or Foramen of Winslow.
Is the lesser sac the lesser bursa or the lesser omentum?
The Lesser Sac is the Lesser Bursa.
What is the ligament of teres?
The round ligament of the liver (or ligamentum teres, or ligamentum teres hepatis) is the remnant of the umbilical vein that exists in the free edge of the falciform ligament of the liver. The round ligament divides the left part of the liver into medial and lateral sections… and runs all the way down to the umbilicus
??
What is the gastrocolic ligament and what arteries does it contain?
The apron of the abdomen (Greater Omentum) - a four layer structure (because of flopping and folding) dorsal to stomach - with stomach and transverse colon attached. The gastroepiplatic vessels are found here - which feed the greater omentum and stomach
Where is the gastrosplenic ligament?
in the Greater Omentum - from stomach to spleen.
Does the splenorenal ligament have a part of the pancreas?
Yes, the tail, as well as the splenic artery and vein.
Where is the juncture between the foregut and midgut?
In the duodenum, just below the major duodenal papilla. Originally where liver bud sprouted, where bile duct comes into duodenum. The second part, or descending part, of the duodenum begins at the superior duodenal flexure. … The second part of the duodenum also contains the minor duodenal papilla, the entrance for the accessory pancreatic duct.
Where is the vitelline duct located?
Communication between the intestinal loop and yolk sac.
What is the blood supply to the midgut?
Superior Mesentery Artery.
How many degrees does the midgut rotate - and where are the rotations done?
270 degrees - 90 degrees out side of body, 180 degrees when back in body.
