CIS sessions

Question 1

carcinoma of head of pancreas

Answer 1

results in jaundice and slight palpable mass in RUQ

Question 2

where does carcinoma of pancreas spread?

Answer 2

cisternic chyle via the celiac nodes: unresectable if cancer has already spread here

Question 3

how do you resect head of pancreas?

Answer 3

cut out part of duodenum and pacreatic tumor

reattach pancreas tail and bile duct to small intestine. reattach stomach to small intestine

Question 4

why do you have to remove duodenum in taking out the head of pancreas?

Answer 4

because it will take away blood supply to the duodenum via the gastroduodenal and pancreaticoduodenal aa.

Question 5

hx: crampy periumbilical pain and nausea, vomiting without blood. Moderate distension of abdomen. tenderness on left side, palpable left inguinal hernia.

Answer 5

small bowel obstruction from incarcerated inguinal hernia

Question 6

what is herniated sac made of in deep inguinal hernia?

Answer 6

processus vaginalis (contains bowel in this case)

Question 7

anterior inguinal canal?

Answer 7

external abdominal aponeurosis

Question 8

posteiror inguinal canal

Answer 8

transversalis fascia

Question 9

where does internal oblique go?

Answer 9

forms cremaster muscle which surrounds permatic cord

Question 10

which nn. and vessels are at risk for injury with hernias?

Answer 10

inferior epigastric aa (can be cut if needed)

ilioinguinal n. genitofemoral n.

Question 11

protrusion through deep inguinal ring?

Answer 11

indirect hernia

Question 12

protrusion through hasselbach’s triangle?

Answer 12

direct hernia

Question 13

hasselbach’s traingle?

Answer 13

medial: rectus abdominis
superolaterally: inferior epigastric aa.
inferiorly: inguinal ligament

normally this is protected by conjoint tendon

Question 14

what embryo structure makes up herniated indirect sac?

Answer 14

processus vaginalis

Question 15

laparoscopic herniography

Answer 15

from inside

lateral circumflex iliac and common/external ilical aa. at risk for injury

Question 16

hx: vomitting large amounts of bright red blood, ETOH abuse, sclerul icterus, caput medusa

Answer 16

bleeding esophageal varices

caput medusa: due to round ligament opening back up, and blood anastamosing back to IVC via periumbilical vv. and superior/inferior epigastric vv.

Question 17

esophageal varices

Answer 17

portal v –> backs up into left gastric vv. –> esophageal vv –> IVC

Question 18

periumbilical varices

Answer 18

caput medusa

high pressure results in opening of round ligament –> periumbilical vv. –> superior/inferior epigastric vv. –> IVC

Question 19

hemmorrhoids

Answer 19

middle and inferior rectal vv. anastamose with superior rectal vv. blood from superior rectal vv. is shunted through these, to reach the IVC.

Question 20

hematochezia vs. hematemesis

Answer 20

hematochezia: bright red blood per rectum
hematemesis: bright red blood per vomitting

Question 21

RLQ pain, fever, began as crampy in periumbilical region, now sharp in RLQ

Answer 21

appendicitis

Question 22

course of arterial supply to appendix?

Answer 22

SMA –> ileocolic –> appendicular a.

Question 23

which structures lie adjacent to appendix in male and female?

Answer 23

male: cecum, ileum, spermatic cord, ureter, ilionginual. n. psoas sign
female: cecum, ileum, ovaries, psoas major

Question 24

which nearby structures if inflamed might mimic appendicitis?

Answer 24

psoas : psoas sign
ureter: discomfort in flank
ilioinguinal n.: pain to anterior scrotum

Question 25

hx: Left sided abdominal pain after open abdominal aortic anuerysm repair. from dull to sharp crampy pain. temperature. moderately distended abdomen, tenderness with rebound in LLQ, no organomegally, lactic acid level is twice normal .

Answer 25

abdominal aortic aneurysm resulting in ischemic colitis

Question 26

hx: frequent nosebleeds, heavy periods, clotting disorder, peteceal rash and purpuric regions

Answer 26

required splenectomy

Question 27

what splenic aa? run through the ligaments?

Answer 27

splenic a/v - runs through splenorenal a.
short gastric aa. run through gastrosplenic
tail of pancreas sits in hilum of spleen