Clinical Correlations Interval 4

Question 1

Mitral Valve Stenosis

Answer 1

Narrowing of the mitral valve causing pulmonary hypertension

Symptoms:

1. Enlarged right atrium and right ventricle
2. Diastolic murmur
3. Thrombosis from the left atrium
4. Pulmonary edema due to pulmonary congestion

Blood from the left ventricle leaks into the left atrium increasing pulmonary resistance. Thus, the right side of the heart has to work harder to push against that resistance causing hypertrophy

Question 2

Sigmoid Volvulus

Answer 2

the sigmoid colon twists around the sigmoid mesocolon and may become obstructed

Question 3

What organ would be affected due to a deep wound inferior and medial to the tip of the 12th rib?

Answer 3

The right kidney (which is lower than the left kidney due to the liver)

Question 4

What are renal calculi?

Answer 4

Kidney stones

Question 5

What structures would have to be cut and ligated to remove the kidney?

Answer 5

Renal artery, renal vein, ureter and any accessory arteries you find

Question 6

Which occlusions of the IVC are most dangerous?

Answer 6

Those at L1 or above because they would interfere with the venous return from the kidney, resulting in renal failure

Question 7

What is the anatomic location and blood supply of thymomas?

Answer 7

Thymomas would occur in the superior mediastinum and the blood supply would be the Inferior thyroid artery and internal thoracic artery

Question 8

Why is the esophagus predisposed to suture line or anastomotic leak?

Answer 8

The esophagus has no serous membrane (serosa) and therefore holds sutures poorly and the mucosa tends to retract when the esophagus is divided

Question 9

What is the clinical significance of a positive psoas sign?

Answer 9

A positive psaos sign is when a patient feels pain when they passively extend their hip, stretching the iliopsoas muscle

This pain is due to irritation of the psoas mucle by inflammation or abscess (as in appendicitis or psoas abscess)

Question 10

Why would an enlarged esophageal hiatus cause the stomach to migrate into the chest?

Answer 10

Negative intrathoracic pressure gradually draws the stomach and sometimes tranverse colon into the posterior mediastinum through enlarge hiatus which can often admit to a surgeon’s entire hand

Question 11

What is the cause of arcuate ligament syndrome

Answer 11

The arcuate ligament of the diaphragm sits on top of the celiac artery (and sometimes the celiac ganglia) and can compress it, causing abdominal pain

Question 12

What is the best site on the abdomen to locate the ureters

Answer 12

Overlying the bifurcation of the common iliac arteries

Question 13

Why are right adrenalectomies technically more challenging than left?

Answer 13

The right adrenal vein is short and empties directly into the IVC making clipping or ligation problamatic

Question 14

What anatomic structure is involved in the formation of a chylothorax?

Answer 14

Lymph accumulates in the pleural cavity due to an injury to the thoracic duct

Question 15

What is Horner’s syndrome and why is it a potential complication of thoracic sympathectomy?

Answer 15

Horner’s syndrome is when you knick the stellate ganglion by accident, usually when doing a T2-T4 ganglia removal.

Symptoms:
Miosis, ptosis, enopthalmos, anhydrosis

Question 16

What is the anatomic reason the left renal vein can be safely divided if needed to repair a high or large abdominal aortic aneurysm?

Answer 16

Since gonadal, left adrenal, left 2nd lumbar veins are branches of the LRV, it can be safely divided to the right of the entrance of these branches to facilitate high exposure of the aorta up to the SMA. Left kidney venous outflow will be drained by those 3 branches

Question 17

Coarctation

Answer 17

This is a narrowing of the aorta near the ligamentum arteriosum, just distal to the last branch of the aortic arch

Symptoms:

1. Causes low pressure in limbs, and high pressure in upper body
2. Collateral circulation bypasses the blockage by going in the retrograde direction through the internal thoracic arteries which flow to the anterior intercostals which flow to the posterior intercostals which are connected to the aorta
3. This causes rib notching because the large arteries erode the surface of the rib under which they sit