Chapter 4 Pathology Flashcards
Where is transpyloric plane and what are structures?
9th costal cartilage anteriorly to L1 posteriorly.
Transects:
- stomach pylorus
- superior part of duodenum
- duodenojejunal flexure
- gallbladder fundus
- sup. mesenteric a. origin
Cryptorchidism:
absence of one/both testes
due to: failure of testis to descend thru inguinal canal during development
What is the developmental significance of the inguinal canal?
MALES:
- Primordial testis is connected to genital swelling (future scrotum)
- at same time, vaginal process arises at inguinal canal (evagination of peritoneum)
- testis will slide thru inguinal canal into scrotum transporting ductus deferens and vessels
- vaginal process moves down into scrotum transporting muscles, etc that will become wall of scrotum
- wk 12: testes in pelvis
- wk 28: testes at deep inguinal ring
- few days in the inguinal canal
- 4 wks later, arrive at scrotum
- stalk of vaginal process closes while distal part on testis remains open as double layered sac of peritoneum called tunica vaginalis
FEMALES:
ovaries descend same way as testis except they remain in pelvic cavity
- ovarian ligament: ovaries and uterus
- round (teres) ligament: uterus and labium
Abnormal closure of vaginal process may lead to:
hydrocele of thecord
excess fluid in tunica vaginalis?
hydrocele of testis
Contents of rectus sheath:
- rectus abdominis
- pyramidalis muscle
- inf. and sup. epigastric vessels
- lymphatic vessels
- 5 lower intercostal nerves, including subcostal.
Medial and Median unbilical folds are remnants of:
Medial: fetal umbilical arteries
Median: urachal cord
Differences between direct and indirect inguinal hernias:
Direct:
- typically middle aged men
- weakness in abdominal wall
- medial to inf. epigastric vessels or inside inguinal triangle
- doesn’t pass into vaginal process
- lower risk of strangulation of structure
Indirect:
- more common
- both men and woman
- patent vaginal process
- passes thru deep inguinal ring within vaginal process
- higher risk of strangulation of structure
- commonly passes thru male scrotum or labium in females
Method of hernia repair:
cooper’s ligament repair
Zenker’s diverticulum:
outpouching of pharyngeal wall above esophagus
- affect mainly older adults
- asymptomatic or symptomatic
- if symptomatic: leads to dysphagia, regurgitation of food, coughing, halitosis
- complicated by ulceration, bleeding, inflammation
Achalasia (cardiospasm):
failure of lower esophageal sphincter to relax during swallowing due to absence of neurons in myenteric plexus
- can lead to: chagas disease
- symptoms: dysphagia, retrosternal pain, aperistalsis, LES pressure increase
tracheoesophageal fistula:
abnormal connection between esophagus and trachea
due to: failure of separation during embryogenesis
How does vomiting increase blood pH?
vomiting prevents H+ from reaching small intestines
Zollinger-Ellison syndrome:
gastrinomas secrete excess gastrin leading to hyperacidity
Dumping syndrome:
abnormally rapid emptying of stomach
caused by: vagotomy or gastric resection; anything that compromises pyloric function
Gastritis:
inflammation of gastric mucosa
- erosive or nonerosive
- acute or chronic
due to: toxicity from alcohol or bile, steroids, non-steroids like aspirin, stress
untreated will lead to: ulcer formation or stomach cancer
teritz ligament:
suspensory muscle of duodenum; used to located duodenojejunal flexure
Decreased blood supply of intestine:
occlusion of vasa recta –> ischemia –> necrosis of involved part –> paralytic
meckel’s diverticulum:
outpocketing of inestines near ileocecal valve
mimics pain of appendicitis
rule of twos or threes used to describe condition: occurs in 2% of children, 2 feet above ileocecal valve, 2 types of ectopic mucosa (gastric and pancreatic), usually occurs in 2 year old children
celiac disease (nontropical sprue)
hypersensitivity to gluten resulting in malabsorption
results in absence of villi
symptoms include diarrhea, weight loss, flatulence
gluten free diet improves condition
tropical sprue:
intestinal microbial infection epidemic and endemic in southeast asia and caribbean
symptoms: chronic diarrhea, malabsorption, weight loss
typhoid (enteric) fever:
salmonella typhi contamination in food, drink, water
spread of bacteria thru intestine to blood and other tissues
symptoms: high fever, bloody diarrhea, “ROSE SPOTS” (rashes), inflammation of peyer’s patches leading to perforation of intestine
barium enema (w. double contrast)
method used to examine large intestine
- barium sulfate pumped into large intestines thru anus
- take x-rays
- patient defecates
- air pumped thru anus
- x-ray again
anal suppository:
insert suppository in anal canal in newborns and infants = effective way to deliver proper dosage of drug in short time
immediately absorbed thru inferior rectal veins into IVC
