Exam 3 - Clinical Notes Flashcards
What is the MC injury of the anterior abdominal wall?
Inguinal Hernias
Lower thoracic and upper lumbar subluxations may affect the function of anterior abdominal wall muscles, increasing the risk of what?
Inguinal Hernias
Subluxations of L1, L2, (Genitofemoral N) may affect ____ _______. (this is know as the Subluxation Hypothesis)
male fertility
Varicose veins within the pampiniform plexus can be mistaken for testicular cancer is referred to as what condition?
Varicocele
What functions as a heat block? Ascending veins surround the descending artery creating a transfer in heat.
Pampiniform Plexus
Accumulation of fluid within cavity of Tunica Vaginalis is know as what condition?
Hydrocele
Increased rate of infection via _____ _______ occurs in 1) immunocompromised women and 2) individuals who gave birth in unsterile conditions
uterine tubes
What condition occurs when gastric juice enters subhepatic space, then down the right paracolic gutter? (pain can mimic appendicitis)
Perforated Duodenal Ulcer
What type of ulcer enters the Submucosa and becomes a bleeding ulcer?
Submucosal Ulcers
Propulsive movement of the gut, contractile ring appears and moves distally…is known as what?
Peristalsis
What occurs during vomiting?
Reverse Peristalsis
Secretion of gastric acid (Parietal Cells) is controlled by the vagus nerve…subluxation of T5-T9 may play a role in what condition?
Gastric Ulcer
What portion of the small intestine secretes a dilute alkaline mucus which mixes with the chyme and neutralizes gastric acid? (contains “Brunner” glands)
Duodenum
Motility of the _____ ________ is controlled, in part, by the autonomic nervous system (Vagus, great/lesser splanchnic nerves). Subluxations of lower thoracics may affect motility, contributing to conditions such as Crohn’s disease.
small intestine
The _____ _______ is involved in vitamin synthesis which requires bacterial action. Most well known is Vitamin K (needed for blood clotting). If removed, Vitamin K supplementation is possibly needed.
large intestine
What condition is characterized by severe inflammation and ulceration of the rectum and lower colon. Usually restricted to the mucosa. Abdominal pain and diarrhea are symptoms. Bowel perforation may occur. Radiographically, the bowel appears constricted (tear drop deformity)
Ulcerative Colitis
Radiographically, when the bowel appears to be constricted in the case of Ulcerative Colitis, what deformity is present?
Tear drop deformity
What is the common condition involving recurrent abdominal pain and diarrhea with NO inflammation or deterioration in health? Symptoms are caused by abnormal muscular contractions of the colon. Cause is unknown, but symptoms are often brought on by stress and anxiety
Irritable Bowel Syndrome (Spastic Colon)
What condition is characterized with low BP and poor flow rate in the arteries of the gut which may cause plaques to develop. It is this “end point” of ischemic bowel disease.
Bowel Infarction
Bowel Infarctions are less common than Myocardial Infarctions due to the anastomotic property of which artery?
marginal artery (heart)
Diarrhea, constipation, and other colon problems may be related to subluxations in what vertebral areas? (3) Chronic constipation is associated with increased risk of hiatal hernia, inguinal hernia, diverticulosis, and colon cancer.
lower thoracic, upper lumbar, or sacral subluxations
All nutrients, except fats, pass through the _____ _______ to the liver. Fats are picked up by lymphatic vessels called _______ in the small intestine (fats bypass the liver).
Portal System, Lacteals
Where is the MC site for metastasis of colon cancer outside of the intestine?
Liver
What condition is characterized by destruction of hepatic cells and their replacement by fibrous tissue and fat? The liver becomes nodular and hard, and tends to constrict the portal vein at the porta hepatis, causing portal hypertension.
Cirrhosis of the Liver
What are the 4 main causes of cirrhosis of the liver?
Causes: 1) alcohol 2) Hepatitis 3) Chronic obstruction of the Bile Duct 4) CHF
What condition is characterized by…?
1) Abnormal elevation of pressure within the portal system, often due to cirrhosis of the liver
2) Portal vein constriction within the porta hepatis
3) Blood backs up into the caval system in the regions where portal-caval anastomoses occur (portal system has no valves; flow is reversed, bypassing the liver)
4) Veins in these areas become varicose (dilated, tortuous, and thin walled) and may rupture
Portal Hypertension
What can hemorrhage within the esophagus, often causing severe/fatal bleeding?
Esophageal Varices
What condition is characterized with pronounced snake like veins radiating around the umbilicus? (As a clinician…it is only present in severe or advanced cases)
Caput Medusae
What condition is not a diagnostic for portal hypertension when present alone within the rectum/anal canal?
Hemorrhoids
What condition is characterized by a yellow discoloration of the skin, sclera of the eyes, and mucous membranes? Due to the release of bilirubin into circulation, often due to liver damage.
Jaundice
What condition occurs in 40% of infants and is caused by stress of liver due to jumpstarting liver production after birth? (largely not an issue)
Neonatal Jaundice
Jaundice is often due to damage to the ______, allowing _______ to be released into circulation
liver, bilirubin
What is characterized by hard masses formed by the solidification of bile constituents? (mainly composed of cholesterol crystals)
Gallstones
What are the 4 main “risk factors” associated with gallstones?
1) Being Female
2) Obesity
3) Pregnancy (Or having Multiple Pregnancy)
4) High Fat Diet
________ are mainly composed of cholesterol crystals. They most commonly become impacted at the ______ end of the hepatopancreatic ampulla (at sphincter of ampulla which is the narrowest point in the biliary passages). Blockage at this location causes backup of bile through the pancreatic duct = Acute Pancreatitis
Gallstones, distal
Acute Pancreatitis can be the end result of the formation of what?
Gallstones, due to the blockage/backup of bile through the pancreatic duct
Upper abdominal diseases involving the liver, gallbladder, or stomach may refer pain what spinal cord segments?
lower thoracic spinal cord segments (T8-T12)
A gallbladder attack most commonly causes pain in the which quadrant of the abdomen? In 30% of patients, pain is also referred to what region of the back?
right upper quadrant of the abdomen, right subscapular region of the back
What often occurs when there is forceful compression of the abdomen? (as in an auto accident when a person is thrown against the steering column…the steering column acts as a hammer, the vertebral column acts as an anvil)
Rupture of the pancreas
In the case of a ruptured pancreas, the release of _______ ______ into the body cavity causes a lot of damage to _______ tissues.
digestive enzymes, adjacent
Pain from pancreas is referred to ______ thoracic segments. Pain from the head is referred to the _____ of the vertebral column. Pain from the body and tail is referred to the ____.
lower, right, left
What is the most frequently injured abdominal organ? (rupture results in severe hemorrhage and shock)
Spleen (rupture)
What region of the spleen is particularly vulnerable to blows causing it rupture?
left hypochondrium region
When the ______ is removed, Kupffer cells of the liver take over its function in phagocytosis of worn out red blood cells
spleen
Enlargement of the spleen is known as what condition?
Splenomegaly
Chiropractors must use caution adjusting patients with active __________ of the spleen.
mononucleosis
Extravasation of urine (commonly caused by trauma) is most exclusive to _____ due to longer, superficial and horizontal orientation of what structure?
males, urethra
Rupture of the ______ ______ allows accumulation of urine within the potential space between Scarpa’s fascia and deep fascia of the abdomen.
spongy urethra, superiorly, inferiorly
In the case of a rupture of the spongy urethra, urine can spread superiorly into the ________ _______ ____, but can NOT spread inferiorly into the _____…this is due to firm attachment of Scarpa’s fascia to the _____ ____.
anterior abdominal wall, thigh, fascia lata
Abdominal wall muscles are typically active in what bodily functions/activities? (6)
1) Defecation
2) Coughing (Vagus N)
3) Sneezing (Trigeminal N)
4) Vomiting
5) Micturition (mechanical emptying of the bladder)
6) Parturition (child birth)
What condition is characterized with undescended testes at birth? (3% of full term infants and 30% in premature infants)
Cryptorchidism
In the case of Cryptorchidism, the undescended testes are most commonly found in the _______ _____ and the condition is _______.
inguinal canal, unilateral
In reference to Cryptorchidism, the testes _______ within a few weeks to months after birth. If the testes do NOT descend…infertility results, but _______ ______ is unimpaired.
descend, infertility, androgen secretion
In the case of Cryptorchidism, the undescended testes are at an increased risk for what? What is a typical treatment?
Cancer, treated with administration of testosterone
The accumulation of fluid within the peritoneal cavity is know as what? It represents an imbalance between fluid production and absorption.
Ascites
In a healthy person, the _________ is highly absorbent and is used for Rabies vaccine and kidney dialysis.
peritoneum (periotoneal cavity)
What are the 5 causes of Ascites discussed in class? (Ascites = accumulation of fluid within peritoneal cavity)
1) Malnutrition (too much fluid)
2) CHF (too much fluid)
3) Liver Failure (too much fluid)
4) Kidney Failure (too much fluid)
5) Peritonitis (prevents absorption)
What condition is characterized by inflammation of the peritoneum? Is usually (not always) result of infection.
Peritonitis
What are the 4 typical causes of Peritonitis?
1) Trauma
2) Inflammatory Bowel Disease (including ruptured appendix)
3) Vaginal Infections
4) Perforated Ulcers
Peritonitis often results from ________ between parietal and visceral peritoneum possibly a complication of abdominal surgery and may lead to ______ _______ .
adhesions, bowel obstruction
In the case of peritonitis, pain may refer to the ________ via what nerve?
shoulder via the phrenic nerve
What condition is characterized by a tumor-like increase in the size of the pyloric sphincter, which reduces the size of the pyloric canal?
Congenital Hypertrophic Pyloric Stenosis
Congenital Hypertrophic Pyloric Stenosis is present at ______ and is most common in what gender?
present at birth, most common in males
What condition results in projectile vomiting and requires surgery in early infancy?
Congenital Hypertrophic Pyloric Stenosis
What condition is the spasmodic contraction of the pyloric sphincter? (sometimes present in infants)
Pylorospasm
In the case of Pylorospasms, food does not pass easily from ______ to _______ causing the ______ to become overly full…resulting in vomiting (possibly projectile). Subluxations of what specific vertebral segments may play a role?
stomach to duodenum, stomach
Subluxations of what specific vertebral segments may play a role in Pylorospasms?
T5-T9
What is characterized as a “crater-like” depressions in the mucosa of the stomach?
Gastric Ulcer
The stomach secretes alkaline mucus which is viscous, sticky, and forms a barrier between stomach acid and mucosa. Sometimes protection is inadequate, allowing gastric acid to erode the stomach mucosa which leads to the formation of what?
Gastric Ulcer
Excess acid secretion (often related to stress) and inadequate mucus barrier (usually related to presence of bacteria that erode the mucus barrier are causes of what condition?
Gastric Ulcer
Inadequate mucus barrier which can lead to gastric ulcers, is usually related to the presence of what specific type of bacteria that erode the mucus barrier? This bacteria are closely related _____-____ transmission.
Helicobacter Pylori bacteria, fecal-oral transmission
What condition occurs when the mucus is eroded to form crater-like depression and most commonly occurs in duodenal cap?
Duodenal Ulcer
What type of ulcers may perforate, allowing contents to escape into peritoneal cavity causing peritonitis?
Duodenal Ulcer
In the case of a _______ ulcer, fluid travels to the 1) sub hepatic recess, 2) right paracolic gutter, 3) right iliac fossa.
Duodenal Ulcer
In what condition are the pancreas, liver and gallbladder often damaged due to location? (Erosion of gastroduodenal artery can result in sever hemorrhage)
Duodenal Ulcer
Both gastric and duodenal ulcers have been found to be associated with subluxations in what area?
mid-thoracic subluxations
The greater splanchnic nerve supplies sympathetic innervation to the _______ and ________ above the entrance of the ______ ____ ____.
stomach and duodenum, common bile duct
What is a common malformation of the digestive tract when the remnant portion of the embryonic Vitelline Duct takes the form of a fingerlike pouch which projects from the distal ileum?
Ileal (Meckle’s) Diverticulum
What malformation contains all layers of the ileum and may contain gastric or pancreatic tissue? Diverticulum often becomes inflamed, mimicking appendicitis.
Ileal (Meckle’s) Diverticulum
What condition is an inflammatory bowel disease, which most commonly affects the distal ileum and adjacent colon, but can affect any part of the digestive tract?
Crohn’s Disease
What condition characteristically affects all layers of the intestine and results in thickening and ulceration of the affected segment? Results in pain, diarrhea, and malabsorption.
Crohn’s Disease
In the case of Crohn’s Disease, what is typically produced Radiographically and what is the belief in reference to the Etiology?
Radiographically - produces a “cobblestone” appearance
Etiology - unknown, but believed to be autoimmune
What condition is characterized by inflammation of the appendix and is the MC intra-abdominal inflammatory condition in the world?
Appendicitis
Symptoms of what condition are characterized as umbilical pain, which then localizes to the right lower abdominal quadrant? (position of the _______ is variable, and can affect where pain is felt)
Appendicitis, appendix
In reference to appendicitis, if untreated…the appendix may ______, leading to _______.
rupture, peritonitis
Appendicitis is caused by obstruction of the ______ due to: 1) lymphoid hyperplasia 2) Fecal impaction (popcorn seeds, perfect size to block)
lumen
What condition is characterized with herniations of the mucosa of the colon through the muscular layer, without inflammation?
Diverticulosis
Diverticulosis is most common in what individuals of what age and what specific location in the body?
MC in individuals over 40 years of age
MC in sigmoid colon
In reference to Diverticulosis, if the diverticuli become inflamed the condition is called what?
Diverticulitis
Diverticulosis results in _______ pain, diarrhea, and in some cases abscess. Related to low _____ diet (may be treated with laser endoscopy)
abdominal, fiber
Radiographically, diverticulosis is characterized by numerous “_________” along the colon
“outpouchings”
Gallstones most commonly become impacted at the _____ end of the hepatopancreatic ampulla (at sphincter of ampulla, narrowest point in the biliary passages). Blockage at this location causes backup of bile through the pancreatic duct and results in _____ _________.
distal, acute pancreatitis
