CLINICAL NOTES Flashcards
Where does extravasation of Urine occur?
between scarp’s fascia and deep fascia
What happens between scarp’s fascia and deep fascia in extravasation of urine?
fluid accumulates because the spongy urethra ruptures
Where can the urine spread?
superiorly in anterior abdominal wall within the space
Where can the urine not spread?
inferiorly into thigh because firm attachment of scarpa’s fascia to fascia lata
Who is prone to extravasation of urine?
Males exclusive
Why is extravasation of urine exclusive to males?
urethra is longer, more superficial, and more horizontally orientated than females
Cause for extravasation of urine?
trauma
What is low back pain associated with?
weak abdominal muscles
What is a hernia?
abnormal protrusion of tissue through an opening
What is an inguinal hernia?
abdominal viscera (usually small intestine) protrude through inguinal region
Inguinal hernias are more common in males or females?
males
Why are inguinal hernias more common in males?
large diameter of inguinal canal and scrotum is an out pounching of anterior abdominal wall making it a large potential space for viscera to fill
What are the two types of inguinal hernias?
indirect and direct
Where does an indirect inguinal hernia happen?
passes through deep inguinal ring, inguinal canal, and superficial inguinal ring before descending to scrotum
Where does an indirect inguinal hernia pass the inferior epigastric vessel?
lateral
Where does a direct inguinal hernia pass the inferior epigastric vessel?
medial
Indirect inguinal hernia is
a) congenital
b) acquired
c) both
both congenital and acquired
Direct inguinal hernia is
a) congenital
b) acquired
c) both
acquired, due to weakness in conjoint tendon
Indirect inguinal hernia accounts for what % of inguinal hernias
75%
Direct inguinal hernias account for what % of inguinal hernias
25%
Does the Rectus abdominis play a role in preventing hernias?
no because it lies medial to inguinal canal
Where do direct inguinal hernias happen?
punches directly through posterior wall of inguinal canal, bypassing deep inguinal ring
What does a direct inguinal hernia cause
general bulging of anterior abdominal wall
Femoral Hernia passes through what
passes through femoral canal
Where does femoral hernia occur
occurs inferior to inguinal ligament
Where does inguinal hernias occur
occurs superior to inguinal ligament
Is femoral hernia more common in males or females
females
Umbilical hernia occurs when
incomplete closure of anterior abdominal wall after ligation of umbilicus at birth or due to defect in linea alba
What affects male fertility
subluxation of L1,L2 (genitofemoral nerve)
Varicocele (varicous veins) form in what plexus
pampiniform plexus of veins
Varicocele can look like what
tumor when swelled together
What is cryptorchidism
undescended testes at birth
Cryptorchidism occurs in ____% of full term infants and ____% in premature infants
3, 30
Where are undescended testes usually found
in inguinal canal and usually unilateral
Most descend after few weeks after birth but if they don’t what happens
infertility but androgen secretion is unimpaired
T/F Is undescended testes a greater risk for cancer?
true
Infections of Peritoneal cavity via uterine tubes occur in
Immunocompromised women or unsanitary conditions during birth
Is ascites a disease or a condition
condition
Ascites is what
accumulation of fluid within the peritoneal cavity
Ascites results in
imbalance between fluid production and absorption (more production)
Peritoneal cavity is used for what?
rabies vaccine, kidney dialysis
Causes of Ascites
malnutrition, congestive heart failure, liver failure, kidney failure, peritonitis
What is peritonitis
inflammation of peritoneum, usually results in infections
Causes of peritonitis
trauma, inflammatory bowel disease, vaginal infection, perforated ulcers
Where does peritonitis occur
adhesions between parietal and visceral peritoneum
What can cause these adhesions in peritonitis
surgery
In peritonitis under the diaphragm the phrenic nerve referes pain to what and causes what
pain to shoulder, hiccups
What is congenital hypertrophic pyloric stenosis?
increase in size of the pyloric spincter which reduces the size of the pyloric canal
What does congenital hypertrophic pyloric stenosis resemble?
tumor
When is congenital hypertrophic pyloric stenosis present?
at birth
Congenital hypertrophic pyloric stenosis is more common in males or females?
males
What is a symptom of congenital hypertrophic pyloric stenosis?
projectile vomitting
How is congenital hypertrophic pyloric stenosis fixed?
surgery
What is pylorospasm?
spasmodic contraction of pyloric sphincter, no change in size
Is pylorospasm present at birth?
sometimes
What is causes because of pylorospasm?
food does not pass easily from stomach to duodenum causing stomach to become overly full sometimes resulting in vomiting
Subluxations of what thoracics may play a role in pylorospasms?
T5-T9
What is a gastic ulcer look like?
crater like depression in mucosa of stomach
What does the stomach secrete to protect from gastric ulcers?
alkaline mucus which is viscous (sticky) and forms a barrier between stomach acid and mucosa
Gastric ulcer occurs when
alkaline mucus is inadequate in spots and gastric acid erodes stomach mucosa forming an ulcer
What are some factors of gastric ulcers?
excess acid secretion (related to stress) and inadequate mucus barrier (related to presence of bacteria - Heliobacter Pylori which erodes mucosa)
What controls the secretion of gastric acid?
vagus nerve
What can happen with a duodenal ulcer?
erosion of the gastroduodenal artery by a perforated duodenal ulcer can result in severe hemorrhage
What is a duodenal ulcer?
mucosa in the duodenum is eroded to form a crater like depression
Where is a duodenal ulcer commonly located?
duodenal cap
What is a perforated duodenal ulcer
allows contents to escape into peritoneal cavity causing peritonitis
Duodenal Ulcer flow of fluid
fluid travels from subhepatic recess to the right paracolic gutter to the right iliac fossa
What does a perforated duodenal ulcer commonly damage
liver, pancreas, and gall bladder because of its proximity
What thoracic level is associated with gastric and duodenal ulcers? and why?
mid thoracic because of greater splanchic nerve supplies sympathetic innervation to stomach and duodenum
What is Ileal (meckel’s) diverticulum
common malformation of the digestive tract
What is the Ileal diverticulum a remnant of?
embryonic vitelline duct
What does a Ileal diverticulum look like
finger-like pouch which projects from distal ileum
What layers does the Ileal diverticulum contain
contains all layers of the ileum and may contain gastric or pancreatic tissue
What does Ileal diverticulum resemble if the diverticulum becomes inflamed?
appendicitis
What is Crohn’s disease
inflammatory bowel disease which most commonly affects distal ileum and adjacent colon, but can affect any part of digestive tract
What Crohn’s affects?
all layers of intestine and results in thickening and ulceration of the affected segment
What does Crohn’s result in?
pain, diarrhea, and malabsorption
What is the etiology for Crohn’s
unknown, produces a cobble stone radiographic appearance
What segments of the thoracic when subluxations present are associated with Crohn’s
lower thoracics (affect motility which is controlled by vagus, greater and lesser splanchnic nerves)
What is appendicitis
inflammation of the appendix
What is the most common intra-abdominal inflammatory condition in the world?
appendicitis
What are the symptoms of appendicitis
begin as umbilical pain which then localizes to right lower quadrant
What happens if appendicitis is untreated
appendix may rupture, leading to peritonitis
What causes appendicitis?
obstruction of lumen due to lymphoid hyperplasia and fecal impaction
What is diverticulosis
herniation of the mucosa of the colon throughout the muscular layer
Is diverticulosis associated with inflammation?
no inflammation
Diverticulosis is most common with people?
over the age of 40
What location does diverticulosis most commonly occur?
sigmoid colon
What happens if the diverticuli become inflammed?
it is called diverticulitis
What does diverticulosis result in?
abdominal pain, diarrhea, and some cases abscess
Characteristics of Diverticulosis?
radiographically it looks like numerous outpouchings along the colon
Diverticulosis is treated with what?
laser endoscopy
What kind of diet is diverticulosis related to?
low fiber diet
What is ulcerative colitis
severe inflammation and ulceration of the rectum and lower colon
Where does ulcerative colitis occur?
mucosa
What are the symptoms of ulcerative colitis
abdominal pain and diarrhea
What could occur with ulcerative colitis
bowel perforation
How does ulcerative colitis look radiographically?
constricted, tear drop deformity
What is irritable bowel syndrome
common condition involving recurrent abdominal pain and diarrhea with no inflammation or deterioration in health
What happens with irritable bowel syndrome
abnormal muscular contractions of the colon
What causes irritable bowel syndrome?
unknown but it is linked to stress and anxiety
Ischemic bowel disease is what?
blood clot in bowel
What can ischemic bowel disease lead to?
bowel infarction, mortality rate is 95%
What is chronic constipation an increase risk for?
increased risk of hiatal hernia, inguinal hernia, diverticulosis, and colon cancer
Diarrhea, constipation, and other colon problems are associated with what vertebral segments?
lower thoracic, upper lumbar, sacral subluxations
What is the most common organ for metastasis of colon cancer?
liver
What is cirrhosis of the liver?
condition characterized by destruction of hepatic cells and their replaced by fibrous tissue and fat
What occurs to liver in cirrhosis of liver?
becomes nodular and hard, tends to constrict portal vein at the porta hepatis causing hypertension
What causes cirrhosis of liver?
alcoholism, hepatitis, chronic obstruction of bile duct, and congestive heart failure
What is portal hypertension
abnormal elevation of pressure within the portal system often due to cirrhosis of liver
What happens in portal hypertension
portal vein (no valves) is constricted within portal hepatis and blood flow is reversed causing blood to bypass the liver
Where does the blood then accumulate in portal hypertension
back up into caval system in the region where portal-caval anastomoses occurs
Portal hypertension does what to the veins?
varicose veins (dilated, twisted, thin) may rupture
Portal-Caval anastomoses has 3 sites
distal esophagus, around umbilicus, rectum/anal canal
Portal-Caval anastomoses = Distal esophagus are associated with what caval vein and what portal vein
caval - esophageal; portal - left gastric
Portal-Caval anastomoses = around umbilicus are associated with what caval vein and what portal vein
caval - superficial veins of anterior abdominal wall; portal - paraumbilical
Portal-Caval anastomoses = rectum/anal canal are assocatied with what caval vein and what portal vein
caval - middle and inferior rectal; portal - superior rectal
In Portal-Caval anastomoses in the distal esophagus can result in what
esophageal varices causing hemorrahge = fatal bleeding
In Portal-Caval anastomoses in around umbilicus can result in what
caput medusae (only in severe cases) snake like veins radiating around umbilicus
In Portal-Caval anastomoses in rectum/ anal canal can result in what
hemorrhoids
Numonic to remember Portal-Caval anastomoses
Gut (esophageal varices), butt (hemorrhoids), caput (caput medusae)
What is jaundice
yellow discoloration of the skin, sclera of the eye, and mucous membranes
What causes jaundice
due to release of bilerubin into circulation due to liver damage
What are gallstones
hard masses formed by solidification of bile constituents
What are gallstones composed of?
cholesterol crystals
Where are gallstones commonly located
distal end of the hepatopancreatic ampulla (spincter of ampulla) because it is narrowest part in biliary passages
Blockage of gallstones at this location result in what
back up of bile throughout pancreatic duct, acute pancreatitis results
Upper abdominal diseases involving liver, gall bladder, or stomach refer pain to what lower thoracic levels?
T8-T12
Gall bladder attacks cause pain where?
right upper quadrant of abdomen (30% of patients pain referred to right subscapular region of back)
Risk factors for gallstones?
females, obesity, pregnancy, high fat diet
Rupture of Pancreas occurs?
when there is forceful compression of the abdomen, as in auto accident (pancreas is smashed)
Rupture of pancreas causes
release of digestive enzymes into body cavity causing alot of damage to adjacent tissues
Where is pain from the pancreas referred to?
lower thoracic segments
Where is pain referred to from the head of the pancreas
right vertebral column
Where is pain referred to from the body and tail of the pancreas
left vertebral column
Rupture of spleen occurs?
vulnerable to blows to left hypochondrium region
What is the most common injured abdominal organ?
spleen
What does a ruptured spleen cause
severe hemorrhage and shock
Spleens become more fragile in
mononucleosis, malaria, sickle-cell anemia, septicemia
When the spleen is removed what takes over its function
kupffer cells of the liver (phagocytize- worn out red blood cells)
