Diaphragm Flashcards
hiccups
involuntary, spasmodic contractions of the diaphragm causing sudden inhalations that are rapidly interrupted by spasmodic closure of the glottis
cause of hiccups
irritation of afferent/efferent nerve endings to respiratory muscles, which may be from:
- indigestion
- diaphragm irritation
- alcoholism
- cerebral lesions
- thoracic and abdominal lesions
section of a phrenic nerve
results in complete paralysis and eventual atrophy of the muscular part of the corresponding half of the diaphragm
paralysis of a hemidiaphragm - recognition radiographically
permanent elevation and paradoxical movement
referred pain from diaphragm
two different places b/c of difference in sensory nerve supply:
- irritation of diaphragmatic pleura/peritoneum -> shoulder region (C3-C5)
- irritation of peripheral regions of diaphragm -> skin over the costal margins of the anterolateral abdominal wall
what can cause rupture of the diaphragm and herniation of viscera?
sudden large increase in either intra-thoracic or intra-abdominal pressure
-most often due to severe trauma to thorax/abdomen during motor vehicle accident
what side are most diaphragmatic ruptures on and why?
left side - liver provides a physical barrier on the right
lumbocostal triangle
b/w the costal and lumbar parts of the diaphragm - site of traumatic diaphragmatic hernia
traumatic diaphragmatic hernia
herniation of the stomach, small intestine and mesentery, transverse colon, and spleen into the thorax
hiatal hernia
protrusion of part of the stomach into the thorax through the esophageal hiatus
congenital diaphragmatic hernia (CDH)
herniation of part of stomach and intestine through a large posterolateral trigone of the diaphragm - almost always on left
only relatively common congenital anomaly of diaphragm
posterolateral defect of the diaphragm
what does CDH cause?
limited space for lung to expand -> pulmonary hypoplasia
-high mortality rate
psoas abscess
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
iliacosubfascial fossa
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
iliopsoas test
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
what may cause spasm of the iliopsoas?
disease of the intervertebral and sacro-iliac joints
why does advanced adenocarcinoma of the pancreas cause severe pain in posterior wall?
invasion of muscles and nerves of posterior abdominal wall
partial lumber sympathectomy
surgical removal of two or more lumbar sympathetic ganglia by division of their rami communicantes - treatment for patients w/ arterial disease in lower limbs
surgical access to the sympathetic trunks
through a lateral extraperitoneal approach b/c trunks are retroperitoneal
abdominal aortic aneurysm
localized enlargement of the aorta
palpation of abdominal aortic aneurysm
pulsations felt to left of midline and pulsatile mass may be moved easily from side to side
acute rupture of an abdominal aortic aneurysm
- associated w/ severe pain in abdomen or back
- high mortality rate if not recognized b/c heavy blood loss
collateral routes for abdominopelvic venous blood (3)
- involving superior and inferior epigastric veins
- involving the thoraco-epigastric vein
- 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
where do IVC anomalies usually occur?
inferior to the renal veins
persistent left IVC
persistence of embryonic veins on left side - left IVC may cross to the right side at the level of the kidneys
