Clinical Notes Flashcards
Infection in the ___ or ___ ___ moves into the Psoas Fascia
Lumbar or Thoracic Vertebrae
Psoas Abscess
- Infection within the Psoas Fascia
- Fascia thickens due to accumulating pus and creates tube-like structure running the length of the muscle
Symptoms of Psoas Abscess
- Back pain
- Leg and hip pain triggered by movement
- Fever
- Inguinal mass
- Limp
Positive Psoas Sign
- Positive when patient has Psoas Abscess
- Positive test occurs when patients lower abdominal pain is exacerbated by extending the thigh
Pringle Maneuver
Clamping of the Hepatoduodenal Ligament to stop hemorrhaging of the liver during surgery
Peritonitis
Infection and inflammation of the peritoneum due to injury, surgery, or bacterial infection/bursting of an organ (ex. appendix)
Symptoms of Peritonitis
- Release of pus and other excretions into the cavity
- Pain in the overlying skin
- Fever
- N/V
Ascites
- Condition that can occur due to peritonitis, cancer and liver disease
- Excess fluid released from the abdominal organ (ascitic fluid) builds up within the cavity
- Fluid follows the flow created within the abdominal cavity towards the pelvic cavity
Inguinal Hernias
- Most common type of hernia
- Occur mostly in men due to passage of spermatic cord through the area
- Occurs when the abdominal viscera and peritoneum protrude through weak areas in the abdomen
Direct Hernia
- Occurs due to weakness in the abdominal wall near the medial inguinal fossa (inguinal triangle: inguinal ligament, lateral border rectus abdominis, lateral umbilical ligament)
- Pushes through the abdominal wall and can push through the superficial inguinal ring (impacts sensory innervation in the region by pressing on the nerves in the area such as the ilioinguinal n)
Indirect Hernia
- Located lateral to the inferior epigastric vessels
- Follows the path of the contents of the spermatic cord or round ligament outside of the body via the deep inguinal ring
- May result in the viscera and associated fascia entering the scrotum or labia majora
During a sliding hiatal hernia, what portion of the stomach moves through the esophageal hiatus?
Cardia of the Stomach
In a Para-Esophageal Hiatal Hernia, what portion of the stomach moves through the esophageal hiatus?
Fundus of the Stomach
Hiatal Hernia
- Occurs when part of the stomach moves superiorly through the esophageal hiatus of the thoracic diaphragm and enters the mediastinum
- Two types: Paraesophageal, Sliding Hiatal
Sliding Hiatal Hernia
- Common type of hiatal hernia
- Esophagus, Cardiac region, and Fundus of the stomach move superiorly through the esophageal hiatus
- Regurgitation of food can occur
- Amount of stomach displacement can change based on body positioning
Ileal Diverticulum (Meckel Diverticulum)
- Outpouching or bulge of the middle to the distal part of the small intestine, containing all layers of the intestinal wall
- Most common abdominal congenital condition (present at birth)
- Occurs in 2% of the population, 2” long, within 2” of the ileocecal valve, and presents before 2 years of age
Cause of Ileal Diverticulum (Meckel Diverticulum)
- Incomplete obliteration of the Omphalomesenteric duct (vitelline duct –> connecting the yolk sac to the small intestine)
- Because of this the diverticulum can be attached to the umbilicus
Appendicitis
Inflammation of the Vermiform Appendix causing abdominal pain
Appendicitis: Cause
Blockage of the lumen of the appendix either by lymphatic follicles or feces — blocks drainage of appendix
Appendicitis: Symptoms
Palpitation at McBurney Point (1/3 distance btwn ASIS and umbilicus) results in tenderness once the parietal peritoneum becomes irritated (visceral peritoneum causes pain near the umbilicus)
If the appendix bursts, it can cause ____
Peritonitis
Renal Calculi (Kidney Stone)
- Accumulations of salts and other inorganic or organic material
- Can block the flow of urine if it becomes lodged, especially at sites of constriction (ureteropelvic junction, pelvic brim, ureterovesical junction)
Locations of Renal Calculi
- Kidney (calyxes and pelvis)
- Ureters (Ureteric Calculi)
- Urinary Bladder
If the calculus is larger than the structure it is trying to pass through, it may cause:
- Severe intermittent pain as the calculus moves through the system
- Blockage of the flow of urine (if becomes lodged)
Gallstones (Cholelithiasis)
Created by the concretion of material within the gallbladder
Gallstones: Symptoms
Often asymptomatic until they block the biliary ducts and start causing pain and jaundice
If the gallbladder becomes dilated due to Gallstones, it may create a ____ between itself and the GI Tract, and the gallstone may enter the ___ ___
- Fistula
- GI Tract
Calot’s Triangle
- Cystic Duct
- Cystic Artery
- Common Hepatic Duct
- Lund’s Node
Hydrocele
- Occurs when peritoneal fluid accumulates within the Tunica Vaginalis and causes swelling with the scrotum
- More common in babies than adults
If light does not pass through the scrotum, ___ or ___ might be causing the scrotal mass
- Blood (Hematocele)
- Tumor
If light does pass through the scrotum, ___ ___ is likely causing the scrotal mass and physicians must check to make sure the ___ ___ is closed
- Peritoneal Fluid
- Processus Vaginalis
Varicocele
- Occurs when the veins that create the Pampiniform Plexus become dilated and tortuous
- Gives scrotum a “bag of worms” appearance
Varicocele: Causes
- Venous Valve Failure
- Kidney issues
Varicoceles are more common on the right or left side? Why?
Left because the left testicular vein empties into the left renal vein
Varicoceles can be asymptomatic, but can impact ____, which may require surgical intervention.
Fertility
Renal Vein Entrapment Syndrome
- Left Renal Vein normally passes between the Superior Mesenteric A and the Abdominal Aorta before reaching the IVC
- This syndrome occurs when the superior mesenteric artery moves inferiorly and puts pressure on the renal vein
- Sometimes called Nutcracker Syndrome
Renal Vein Entrapment Syndrome: Symptoms
- Hematuria (blood in urine)
- Proteinuria (protein in urine)
- Left abdominal pain
- Nausea
- Vomiting (can contain bile b/c SMA can apply pressure to the horizontal part of the duodenum)
- Left testicular pain (L gonadal vein empties into L renal vein)
Referred Pain: Visceral Pain
- Pain arises from an organ
- Pain can be mild to severe, and is often difficult to localize due to the way the autonomic innervation is supplied to the spinal cord and brain
- Pain is brought to the spinal cord at the same level as a dermatome – means that the pain associated with the skin and dermatomes are not necessarily associated with the organ leading to it (referred pain)
- Ex. Stomach is supplied by Greater Splanchnic N that is from T5-T9; stomach pain can be associated above the level of the stomach and even into the upper back
Somatic Pain
- Pain is felt at the location of injury due to the somatic (more direct) innervation of that part, and is not considered referred
- Pain is more localized and can be more acute
- Ex. if liver becomes inflamed and rubs on the diaphragm, the pain is felt over that area of the liver b/c of the more direct innervation pathway
