Diaphragm

Question 1

hiccups

Answer 1

involuntary, spasmodic contractions of the diaphragm causing sudden inhalations that are rapidly interrupted by spasmodic closure of the glottis

Question 2

cause of hiccups

Answer 2

irritation of afferent/efferent nerve endings to respiratory muscles, which may be from:

• indigestion
• diaphragm irritation
• alcoholism
• cerebral lesions
• thoracic and abdominal lesions

Question 3

section of a phrenic nerve

Answer 3

results in complete paralysis and eventual atrophy of the muscular part of the corresponding half of the diaphragm

Question 4

paralysis of a hemidiaphragm - recognition radiographically

Answer 4

permanent elevation and paradoxical movement

Question 5

referred pain from diaphragm

Answer 5

two different places b/c of difference in sensory nerve supply:

1. irritation of diaphragmatic pleura/peritoneum -> shoulder region (C3-C5)
2. irritation of peripheral regions of diaphragm -> skin over the costal margins of the anterolateral abdominal wall

Question 6

what can cause rupture of the diaphragm and herniation of viscera?

Answer 6

sudden large increase in either intra-thoracic or intra-abdominal pressure
-most often due to severe trauma to thorax/abdomen during motor vehicle accident

Question 7

what side are most diaphragmatic ruptures on and why?

Answer 7

left side - liver provides a physical barrier on the right

Question 8

lumbocostal triangle

Answer 8

b/w the costal and lumbar parts of the diaphragm - site of traumatic diaphragmatic hernia

Question 9

traumatic diaphragmatic hernia

Answer 9

herniation of the stomach, small intestine and mesentery, transverse colon, and spleen into the thorax

Question 10

hiatal hernia

Answer 10

protrusion of part of the stomach into the thorax through the esophageal hiatus

Question 11

congenital diaphragmatic hernia (CDH)

Answer 11

herniation of part of stomach and intestine through a large posterolateral trigone of the diaphragm - almost always on left

Question 12

only relatively common congenital anomaly of diaphragm

Answer 12

posterolateral defect of the diaphragm

Question 13

what does CDH cause?

Answer 13

limited space for lung to expand -> pulmonary hypoplasia

-high mortality rate

Question 14

psoas abscess

Answer 14

TB abscess in lumbar region that has spread from vertebrae into the psoas fascia -> thick tube of fascia -> pus that surfaces in the superior part of the thigh

Question 15

iliacosubfascial fossa

Answer 15

fossa formed if superior part of iliac fascia is loose and forms a pocket - cecum/appendix on right or sigmoid colon on left may become trapped here

Question 16

iliopsoas test

Answer 16

used when intra-abdominal inflammmation is suspected - person lies on unaffected side and extends thigh on affected side against resistance of examiner’s hand:
-if get pain = positive psoas sign

Question 17

what may cause spasm of the iliopsoas?

Answer 17

disease of the intervertebral and sacro-iliac joints

Question 18

why does advanced adenocarcinoma of the pancreas cause severe pain in posterior wall?

Answer 18

invasion of muscles and nerves of posterior abdominal wall

Question 19

partial lumber sympathectomy

Answer 19

surgical removal of two or more lumbar sympathetic ganglia by division of their rami communicantes - treatment for patients w/ arterial disease in lower limbs

Question 20

surgical access to the sympathetic trunks

Answer 20

through a lateral extraperitoneal approach b/c trunks are retroperitoneal

Question 21

abdominal aortic aneurysm

Answer 21

localized enlargement of the aorta

Question 22

palpation of abdominal aortic aneurysm

Answer 22

pulsations felt to left of midline and pulsatile mass may be moved easily from side to side

Question 23

acute rupture of an abdominal aortic aneurysm

Answer 23

• associated w/ severe pain in abdomen or back

- high mortality rate if not recognized b/c heavy blood loss

Question 24

collateral routes for abdominopelvic venous blood (3)

Answer 24

1. involving superior and inferior epigastric veins
2. involving the thoraco-epigastric vein
3. involves epidural venous plexus inside vertebral column, which communicates w/ lumbar veins of inferior caval system and the tributaries of the azygos system, which is part of superior caval system

Question 25

where do IVC anomalies usually occur?

Answer 25

inferior to the renal veins

Question 26

persistent left IVC

Answer 26

persistence of embryonic veins on left side - left IVC may cross to the right side at the level of the kidneys