CIS sessions Flashcards
carcinoma of head of pancreas
results in jaundice and slight palpable mass in RUQ
where does carcinoma of pancreas spread?
cisternic chyle via the celiac nodes: unresectable if cancer has already spread here
how do you resect head of pancreas?
cut out part of duodenum and pacreatic tumor
reattach pancreas tail and bile duct to small intestine. reattach stomach to small intestine
why do you have to remove duodenum in taking out the head of pancreas?
because it will take away blood supply to the duodenum via the gastroduodenal and pancreaticoduodenal aa.
hx: crampy periumbilical pain and nausea, vomiting without blood. Moderate distension of abdomen. tenderness on left side, palpable left inguinal hernia.
small bowel obstruction from incarcerated inguinal hernia
what is herniated sac made of in deep inguinal hernia?
processus vaginalis (contains bowel in this case)
anterior inguinal canal?
external abdominal aponeurosis
posteiror inguinal canal
transversalis fascia
where does internal oblique go?
forms cremaster muscle which surrounds permatic cord
which nn. and vessels are at risk for injury with hernias?
inferior epigastric aa (can be cut if needed)
ilioinguinal n. genitofemoral n.
protrusion through deep inguinal ring?
indirect hernia
protrusion through hasselbach’s triangle?
direct hernia
hasselbach’s traingle?
medial: rectus abdominis
superolaterally: inferior epigastric aa.
inferiorly: inguinal ligament
normally this is protected by conjoint tendon
what embryo structure makes up herniated indirect sac?
processus vaginalis
laparoscopic herniography
from inside
lateral circumflex iliac and common/external ilical aa. at risk for injury
hx: vomitting large amounts of bright red blood, ETOH abuse, sclerul icterus, caput medusa
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.
esophageal varices
portal v –> backs up into left gastric vv. –> esophageal vv –> IVC
periumbilical varices
caput medusa
high pressure results in opening of round ligament –> periumbilical vv. –> superior/inferior epigastric vv. –> IVC
hemmorrhoids
middle and inferior rectal vv. anastamose with superior rectal vv. blood from superior rectal vv. is shunted through these, to reach the IVC.
hematochezia vs. hematemesis
hematochezia: bright red blood per rectum
hematemesis: bright red blood per vomitting
RLQ pain, fever, began as crampy in periumbilical region, now sharp in RLQ
appendicitis
course of arterial supply to appendix?
SMA –> ileocolic –> appendicular a.
which structures lie adjacent to appendix in male and female?
male: cecum, ileum, spermatic cord, ureter, ilionginual. n. psoas sign
female: cecum, ileum, ovaries, psoas major
which nearby structures if inflamed might mimic appendicitis?
psoas : psoas sign
ureter: discomfort in flank
ilioinguinal n.: pain to anterior scrotum
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 .
abdominal aortic aneurysm resulting in ischemic colitis
hx: frequent nosebleeds, heavy periods, clotting disorder, peteceal rash and purpuric regions
required splenectomy
what splenic aa? run through the ligaments?
splenic a/v - runs through splenorenal a.
short gastric aa. run through gastrosplenic
tail of pancreas sits in hilum of spleen
