Clinical Correlates Flashcards
Peritonitis
Bacterial infection from laparotomy or traumatic penetration -> inflammation of peritoneum
Peritoneal adhesions
Damaged peritoneum -> inflamed and sticky fibrin
Ascites
Fluid accumulation in peritoneal cavity -> dissension and swelling
1. Can affect respiratory fxn
Abscess formation
Collection of purulent exudate in subphrenic recess
Internal hernia thru omental foramen
Loop in small bowel thru omental bursa
- Can be strangulated by foramen
- Rare
Temporary control of hemorrhage from cystic a.
Artery ligated and clamped -> severed during cholecystectomy
Diaphragm rupture
Inc intra-abdominal pressure -> rupture
1. Traumatic or congenital
Abdominal hernia
Structures thru wall in areas of weakness
Abdominal aortic aneurism
Localized enlargement of abdominal aorta
1. Inc mortality rate if ruptures
Gastro-esophageal reflux disorder (GERD)
Recurrent heartburn from acid regurgitation
1. Esophageal sphincter failure
Hiatal hernia
- Para-esophageal: cardia normal, fundus herniates-> no reflux
- Sliding: esophagus, cardia, and fundus herniate -> reflux
Pylorospasm
Spasms of pylorus at 2-12 weeks old, smooth muscle doesn’t relax properly -> food stuck -> discomfort and vomiting
Pyloric stenosis
Hardening and narrowing -> chyme can’t pass -> non-bilous vomiting, dehydration, and “olive” sized mass at pylorus
1. Single-bubble sign
Duodenal atresia
Congenital absence/closure at duodenojejunal flexure -> stomach distension, bilious vomiting
- Double-bubble sign
- Common w/ Down’s syndrome and pregnancies w/ xs amniotic fluid
Paraduodenal hernia
2-3 inconstant folds and fossae around duodenojejunal flexure
1. Bowel strangulation if intestinal loop stuck
Peptic ulcers
Duodenum/stomach
- H. Pylori
- Lethal hemorrhage if erode a.
Pancreatic cancer
Can obstruct IVC, bile duct, hepatopancreatic ampulla -> bile retention, inc gallbladder, and jaundice
1. Drain into lymph system -> metastasis
Cholelithiasis
Stones in gallbladder, cystic duct, or bile duct
- Usually asymptomatic
- Large -> obstruction -> ulceration -> cholecysto-enteric fistula
- Lodged ileocecal valve -> intestinal constriction -> bowel obstruction = gallstone ileus
Porcelain gallbladder
Inflammatory scarring and calcification of walls
1. Chronic gallstones (overweight females)
Subphrenic abscess
Pus in subphrenic recess
1. Usually drains to hepatomegaly recess
Cirrhosis of liver
Fatty/fibrous scar tissue accumulate -> dec circulation -> inc BP in partial system -> varices
1. Hobnail appearance
Hirschsprung’s disease (congenital megacolon)
Abnormal development of autonomic n. And enteric system in distal colon
A. Non-function -> accumulation prox to immobile section
Diverticulosis
Outpockets in colon wall between teniae coli
1. Infection = diverticulitis
Appendicitis
Blockage -> inflammation
- Nausea, vomiting, fever, dec appetite
- Pain vague peri-umbilicular and lumbar regions -> severe right lower quadrant
- Pressure at McBurney’s point -> tenderness and guarding
Intestinal ischemia
Occlusion vasa recta by emboli, thrombosis, or atherosclerotic occlusions
1. Severe -> necrosis and ileus
2. Colicky pain, abdominal distention, vomiting, fever, dehydration
3. Emboli from heart -> SMA because of acute angle from aorta
A. SM angiogram to clear obstruction
Volvulus of sigmoid
Rotation/twisting -> lumen obstruction
1. Obstipation, ischemia, necrosis if untreated
Inflammatory bowel disease (IBD)
- Ulcerative colitis: chronic inflammation and ulceration of colon
- Crohn’s disease: patchy inflammation anywhere in GI tract -> deeper layers of intestinal wall
A. Etiology = unknown
Pyloric stenosis
Pylorus musculature hypertrophy -> narrowing -> food obstructed
- Common
- Non-bilious projectile vomiting
Annular pancreas
Obstruction of duodenum by pancreas ring in dev
Mobile cecum
Mesentery doesn’t fuse post wall
- Mobile
- Possible volvulus
Omphalocele
Herniation thru enlarges umbilical ring
- Covered by amnion
- Failure of bowel to return into cavity
- Inc mortality rate
Gastroschisis
Visceral thru body wall -> amniotic cavity lateral to umbilicus
- Abnormal wall closure
- Bowel may be damaged by amniotic fluid
Meckel (ileal) diverticulum
Small portion vitelline duct persists -> outpocket ileum (40-60 cm from ileocecal valve)
1. Usually asymptomatic
Enterocystoma
Vitelline cord
- Ends -> fibrous
- Middle -> cyst
- Small intestine twist around strands -> volvulus
Umbilical fistula
Vitelline duct patent -> open between umbilicus and intestines
1. Feces at umbilicus
Rectourethral and rectovaginal fistulas
Abnormal formation cloaca and/or urorectal septum
Imperforate anus
Incomplete separate cloaca -> urogenital and anorectal parts
Non-rotation of the gut
Large intestines don’t surround small intestines
1. Off to left side
Mixed rotation and volvulus
Partial rotation -> volvulus of upper duodenum
Urethral rupture males
- Intermediate part: assoc w/ pelvic girdle fx
A. Blood an urine -> deep perineal pouch -> (move sup) thru urogenital hiatus -> around prostate and bladder
B. Spongy part: straddle injury- Urine from bulb -> scrotum or abdominal wall
C. Urine can’t pass into thigh (fascia lata) or posterior (superficial and deep perineal fascia)
- Urine from bulb -> scrotum or abdominal wall
Hemorrhoids
- Predisposing factors:
A. Pregnancy
B. Chronic constipation
C. Disorders of venous return - Anastomoses: superior, middle, and inf rectal a. Imp connection between portal and systemic venous systems
A. Inc pressure valveless portal v. -> varices - Internal (piles): prolapse anal cushions from breakdown muscularis mucosa m. Layer
A. Thru anal canal -> strangulate and ulcerate
B. Above pectinate line => visceral innervation => unconscious and not painful - External: thromboses in external rectal venous plexus
A. Inf pectinate line => somatic afferent => painful
Hypospadias
Common congenital abnormality of penis from failure urogenital folds to fuse on ventral surface
- Glandular: external urethral orifice on ventral aspect of glans
- Penile (body of penis)
- Penoscrotal/scrotal
Phimoses
Prepuce of penis fits tightly (hard to retract)
1. Smegma may accumulate -> irritation
Paraphimosis
Painful prepuce contraction over corona constricts glans inhibits blood drainage
- Ischemia, vascular engorgement, swelling, edema, penile gangrene
- Tx: circumcision
Impotence
No erection, several causes
Erectile dysfunction
CNS and endocrine related causes common
Greater vestibular gland infections
Can enlarge and partially occlude rectum
Weakness in female perineal m.
Inc risk urinary incontinence and post-partum prolapse
Hydrocele
Fluid in tunica vaginalis of testes or along spermatic cord
1. Infection or injury -> partial occlusion processes vaginalis
2. Hematocele: blood
3. Varicocele: enlargement pampiniform venous plexus or spermatic cord
A. “Bag of worms” in scrotum
Injury to pelvic floor (childbirth)
- Dec support for vagina, uterus, bladder, and rectum
- Pubococcygeus and puborectalis tear
- Urinary stress incontinence
- Pelvic organ prolapse
Cystocele
Herniation of female urinary bladder
1. Weakened muscles and CT between bladder and ant wall vagina -> vagina bulges and herniates into vaginal lumen
2. Causes
A. Pelvic floor rupture during childbirth
B. Lesion of nerves supplying m.
C. Rupture of fascial support
Uretrocele
Female urethra displaced -> dec passive compression of urethra -> “leakage” w/ inc intra-abdominal pressure
Tubal sterilization
Surgical resection uterine tubes
Deferenectomy
Male sterilization
Disposition of uterus
Disposition of normally anteverted and anteflexed uterus, which passively supports the uterus
Hysterectomy
Surgical resection uterus
Benign hypertrophy of prostate (BHP)
Enlargement
1. May project into bladder, compress urethra, obstruct internal urethral orifice
2. Lead to
A. Nocturnal
B. Dysuria
C. Urgency
3. Assoc w/ bladder infections and kidney damage
Prostate cancer
Feels hard and irregular of digital rectal exam
1. Transurethral resection of prostate (TRUP) to remove hypertrophied region
Regional analgesia/anesthesia for childbirth
- Regional analgesia: conscious of contractions and can bear down
- Regional anesthesia: complete block pain
A. Epidural: L3-L4, entire birth canal anesthetized, limbs not affected- Uterine pain (sup pelvic line) still felt => conscious uterine contraction
Spinal anesthesia
Subarachnoid space L3-L4 -> complete anesthesia inf to waist
1. Circulates subarachnoid space -> “spinal headache”
Pudendal n. Block
S2-S4 dermatologist and inf 1/4 vagina
1. Contractions felt
Ilio-inguinal n. Block
Abolish sensation from ant part perineum
Accessory ureters
Division of ureteric bud
Renal agenesis
- Unilateral: one kidney forms
- Bilateral: no kidneys
A. Potter sequence- Oligohydramnios
- Anuria
- Cardinal anomalies
- Tracheal and duodenal atresias
- Cleft lip/palate
- Brain abnormalities
- Flat face
- Clubbed feet
Malrotated kidney
Rotated wrong direction or not at all
1. Possible vasculature probs
Ectopic kidneys
Stays ant to sacrum
- Supply: aortic bifurcation or common iliac a.
- Can be confused as tumor
- Damaged during childbirth
Horseshoe kidney
Inf poles fuse before ascension
1. Ureter obstruction possible
Cystic kidney disease
Numerous cysts 1. Autosomal recessive A. Progressive B. Renal failure infancy/childhood 2. Autosomal dominant A. More common B. Less progressive C. Renal failure adulthood
Urachal fistula
Urine from umbilicus
Urachal cyst
Local area allantois persists -> cystic dilation
Urachal sinus
Lumen in upper part of allantois persists
- May open to bladder
- Asymptomatic unless infected
Exstrophy of bladder
Mucosa exposed in ventral body wall
Exstrophy of cloaca
More severe version of bladder exstrophy
- Dev. Urorectal septum altered -> anal canal malformations and imperforate anus
- External genitalia defects
Hypostadias
Incomplete fusion of urethral folds in males
- Glandular: urethra on ventral surface of glans
- Shaft
- Scrotal
Epispadias
Urethral opening on dorsal side of penis
1. Assoc w/ exstrophy of bladder
Duplications of uterus
Lack of paramesonephric duct fusion
- Uterus didelphys: entirely double
- Uterus arcuatus: slight indentation in middle
- Uterus bicornis: 2 horns entering one vagina
Double vagina
Sinovaginal bulbs don’t fuse
Vaginal atresia
Sinovaginal bulbs don’t develop
1. Vaginal pouch surrounds cervix
Micropenis
Low androgen
- Primarily hypogonadism
- Hypothalamic/pituitary dysfunction
- 2.5 SD below mean length
Bifid/double penis
Genital tubercle splits
Ambiguous genitalia
Large clitoris or small penis
1. Hermaphrodites
Ovotesties
Ovarian and testicular tissue
Androgen insensitivity syndrome (AIS)
Lack androgen receptors => no male parts
1. No female internal genitalia
Gonadal dysgenesis
No oocytes
- Ovaries appear as streak gonads
- Female phenotype
Measuring obstetric conjugate
- Measure diagonal conjugate
- Subtract 1.5-2.0 cm
- Normal > or = 10 cm
Bituberous measurement
Pelvic outlet measurement
1. Measure distance between ischiotuberosities (find w/ thumbs from outside)
McDonald’s rule
OB
20-32 wks
Cm=week number
Ankle sprains
Torn ligament
- Mostly inversion injury: weak lateral tendons
- Can -> tibia/fibula fx
Pott’s fx
Eversion ankle sprain
- Torn deltoid and posterior tibiofibular ligaments
- Distal fibula fx
Maisonneuve fx
Eversion ankle sprain
- Torn anterior tibiofibular, deltoid lig, and interosseous membrane
- Posterior medial malleolus fx
- Spiral fx proximal fibula
Genu varum
Bow-legged
1. Small Q-angle
Genu valgum
Knock-kneed
1. Large Q-angle
Abnormal Q-angle
Leads to arthritis and menisci degeneration
Unhappy triad
Torn:
- MCL
- ACL
- Medial meniscus
Baker’s cyst
Abnormal fluid-filled sac in popliteal region
1. Usually between semimembranosus tendon and medial head gastrocnemius
Fabellar syndrome
Sesamoid bone irritates lateral aspect popliteal fossa
1. Lateral head gastrocnemius
Hallux valgus
Lateral deviation of hallux
- From tight shoes or degenerative joint disease
- Can -> corns or bunions at MTP joint of hallux
Hammer toe
Proximal phalanx permanently dorsiflexed at MTP jt
- Middle phalanx plantarflexed PIP joint
- DIP hyperextended
- Usually 2nd digit
- Weak lumbrical or interosseous membrane
Claw toe
- Hyperextension MTP
- Flexion DIP
- Usually lateral 4 digits
- Can -> callouses or corns
Pens planus
Flat feet
1. Flexible: normal when not wt bearing
2. Rigid: always flat
A. Congenital: bone fusion
B. Acquired
1. Dysfunction dynamic arch support
2. Trauma
3. Degeneration
4. DenervationEpidural hematoma
Blood between dura and calvaria
Subdural hematoma
Between dura and arachnoid
Subarachnoid hematoma
Between arachnoid and pia
Intraparenchymal hematoma
Within brain tissue
Le Fort fx I, II, III
Facial fx along thinning areas and suture lines
1. Common
Positional plagiocephaly “flat head syndrome”
Malformation from repetitive positioning in early development
1. Often oblique slant sagittal plane
Craniosynostosis
Premature suture fusion
Scaphocephaly
Premature fusion sagittal suture (40-60%)
Brachycephaly
Premature fusion coronal suture (20-30%)
Plagiocephaly
Premature fusion one side either coronal or lamboidal sutures or both (<4%)
Trigonocephaly
Premature fusion metopic suture (<10%)
Kleeblattschadel (clover leaf)
Premature fusion coronal, lamboid, and sagittal sutures
1. Extremely rare
Microcephaly
Premature fusion of all sutures and fontanelles
1. Severe cognitive dysfxn
Hydrocephaly
Inability to absorb CSF -> inc pressure -> inc calvaria growth
1. Usually fixed w/ shunt to venous system
Cauliflower ear
Fibrous build-up external ear from repeated trauma and auricular hematoma
Otitis externa
“Swimmer’s ear”
1. Infection external auditory meatus
Ear wax compaction
Most common ear problem
Otitis media
Infected middle ear
1. Often associated w/ upper respiratory infections
Infection of mastoid air cells
Similar to sinus infection
1. Usually diagnosed when spreads -> middle ear
Vertigo/Ménière’s disease
Membranous labyrinth bursts
Tinnitus
Ringing in ears
1. Usually associated w/ decreased hearing from prolonged exposure to loud noises
Meningitis (leptomeningitis)
Inflammation leptomeminges from microorganisms
1. Entry: subarachnoid space via blood or compound cranial fracture
Subarachnoid hemorrhage
- Causes
A. Rupture saccular aneurysm (cerebral a.)
B. Trauma
Meningiomas
Tumors from arachnoid cells 1. Compress brain tissue 2. Most common: A. parasagittal regions cerebral hemisphere B. Olfactory groove C. Sphenoid wings
Septic thrombosis cavernous sinus
Usually from infections in orbit, paranasal sinuses, or face
- May affect CN VI as traverses cavernous sinus
- Nerves embedded in sinus (CN III, IV, V1 and V2)
Cerebrovascular accidents (strokes)
No blood flow to brain -> cell death 1. Most common in adults in US 2. Neurological symptoms 3. Types A. Ischemic B. Hemorrhagic
Cerebral herniation
Lesions -> brain shift between compartments 1. Most common A. Subfalcine B. Tentorial C. Tonsillitis
Concussion
Mild TBI: temporary loss of brain fxn (lasts months 15% pts)
- +/- unconsciousness
- Transient confusion
- Memory impairment
- Incoordination
- Headache
- Fatigue
- Irritability
- Dizziness
- Nausea
- Blurred vision
Cerebral contusion
Brain bruising from head trauma
- Initial unconsciousness
- Edema -> fluctuating consciousness
- Seizures
- Focal neuronal signs
- Contusions = permanent
- Damaged tissue phagocytosed -> astrocyte prolfieration -> scarring
- Pts monitored closely
Hydrocephalus
Ventricular system dilation from collection of CSF
- Non-communicating
- Communicating
Non-communicating (obstructive) hydrocephalus
CSF obstructed in ventricular system
- Common: cerebral aqueduct and interventricular foramen
- Uncommon: ventricular system -> subarachnoid space
- Dilation above obstruction
Communicating hydrocephalus
Flow CSF blocked outside ventricular system
- Usually dec CSF reabsorption in arachnoid granulations
- Obstruction in subarachnoid space
- XS CSF production
Leakage of CSF
Fx of middle cranial fossa -> leakage from external acoustic meatus if meninges sup middle ear torn and tympanic membrane rupture
- If fx anterior to cranial fossa involve cribiform plate -> CSF thru nose
- Pts inc risk meningitis
Pharyngeal arch syndrome
Arch derivative dev patterns fail
1. Congenital abnormalities eyes, ears, mandible, and palate
Treacher-Collins syndrome
Underdeveloped zygomatic bones -> abnormalities external, middle, and inner ear
Pierre Robin sequence
Underdeveloped mandible, cleft palate, defects of eye and ear
