GI (plus more MSK...oops) Flashcards
types of pain fibers associated w. abd organs (3)
visceral
somatoparietal
referred
colicky pain that is intense and then lets up
cramping, burning, gnawing
visceral pain
what causes visceral pain
distension of hollow organ
why is visceral pain dull and poorly localized to midline
both sides of spinal cord stimulated by afferent impulses
does visceral pain correspond to dermatomes
roughly
is visceral pain referred
+/-
can visceral pain be elicited on PE
nope!
intense pain that is precisely located
somatoparietal
cause of somatoparietal pain
noxious stimuli of parietal peritoneum
example of somatoparietal pain
McBurney’s point in appendicitis
somatoparietal pain is aggravated by
moving/coughing
impulses in somatosensory spinal nerves obviously travel w. __ spinal nerves,
but NOT with __
somatosensory
ANS fibers
does somatoparietal pain correspond to dermatomes
yep!
why does somatoparietal pain localize
only one side of parietal peritoneum is innervated by somatosensory fibers at any given location
can somatoparietal pain be elicited on PE
yep!
remote pain from a diseased organ
referred
in referred pain, __
and __ from different anatomic regions
converge on __
in the __ at the same level
visceral afferents
somatic afferents
second order neurons
spinal cord
is referred pain well localized
yep!
sure is!
ex of referred pain
subphrenic abscess → pain interpreted in brain as coming from shoulder
where is cholecystitis pain felt
initial: subphrenic
later: RUQ
where is diverticulitis pain felt
initial: lower abd
later: LLQ
heart pain is referred to
T1-T5
t/f: the distal great saphenous vein is deep
F!
it is superficial
t/f: DVT can occur in great sahenous vein
T!
proximal great saphenous is considered deep bc it feeds into the femoral
deep veins of the thigh/pelvis
tibialis → a/p
popliteal
femoral
deep femoral
common femoral
pelvic
proximal greater saph
where can arteries to the foot be palpated (2)
dorsalis pedis
posterior tibial
dorsalis pedis pulse is between the __
and __ muscles
extensor hallicus longus
extensor digitorum longus
where is the posterior tibialis pulse located
postero-inferior to medial malleolus
what ankle injury is caused by plantarflexion and inversion
atfl
cfl
ptfl
what ankle injury is caused by eversion
deltoid
pttl
attl
tcl
tibionavicular
what ankle injury is caused by external rotation and dorsiflexion
syndemosis/high →
anterior-inferior tibiofibular
posterior-inferior tibiofibular
transverse tibiofibular
interosseous membrane/ligament
inferior transverse ligament
what do you think when you see widening of the tibiofibular space suggesting an injury to the tibiofibular syndemosis
proximal fibular fx →
maisonneuve fx complex
85% of all ankle sprains are
lateral ligament
mc injured lateral ligament
atfl
CN nerves involved in swallowing
V
VII
IX
X
XI
XII
chewing and sensation CN
V
taste on anterior ⅔ of tongue is mediated by CN __
via the __ m
VII
chorda tympani m
taste AND sensation on posterior ⅓ of tongue
sensation in oropharynx and upper pharynx
IX
sensation from throat/esophagus/abd viscera
taste from epiglottis
motor of soft palate/throat/abd viscera
airway protection
CN X
swallowing fxn
CN XI
motor nerves to tongue
XII
9 causes of dysphagia
age → weakening of sphincters
esophageal diverticuli
shatzki’s ring
hiatus hernia
GER/GERD
achalasia
barrett’s
esophageal carcinoma
esophageal varices
3 types of diverticlum that cause dysphagia
zenker’s
traction
epiphrenic
bird’s beak on barium swallow
achalasia
upper esophageal carcinoma is caused by
etoh
cigs
lower esophageal ca is caused by
GERD/Barrett’s
arteries to:
foregut
midgut
hindgut
foregut: celiac
midgut: superior mesenteric
hindgut: inferior mesenteric
foregut extends from __
to __
esophagus
proximal duodenum
midgut extends from __
to __
distal duodenum
proximal ⅔ of transverse colon
hindgut extends from __
to __
distal ⅓ of transverse colon
superior part of rectum
3 dependent areas of peritoneal cavity
hepatorenal space (morrison’s)
rectouterine (douglas)
rectovesical
6 types of hernias of lower anterior abd wall
inguinal
umbilical
femoral
para-umbilical
incisional
spigellian
2 types of inguinal hernia
direct
indirect
hernia that goes thru the superficial inguinal ring
indirect
hernia that goes thru the wall of the inguinal canal
direct inguinal
bulge under the inguinal ligament
femoral hernia
the vitelline duct is a remnant of the __
that is in the area of the __
and attached to the __
yolk sac
umbilicus
small bowel
the vitelline duct is a connection btw the __
and the __
yolk sac
midgut
what can happen if the vitelline duct persists
meckel’s diverticulum
complications of meckel’s diverticulum
inflammation
hemorrhage
intusussception
obstruction
ulceration
pathway of pain in appendicitis
visceral afferent PLUS sympathetic → enter spinal cord together at T10 level → pain referred to T10 dermatome (umbilical region)
diaphragmatic pain is referred to
C3-5
phrenic n → 3,4,5 keeps you alive
stomach pain is referred to
T5-T7
appendix pain is referred to
T10
appendicitis pain begins as __ pain,
and after 6-10 hr localized to __, which is same-same
__,
and becomes __
periumbilical colicky (visceral)
RLQ
McBurney’s point
somatoparietal
ureter pain is referred to
T12 - L2
location of ischiorectal fossa
lateral to anal canal
inferior to pelvic diaphragm
roof of ischiorectal fossa
levator ani
floor of ischiorectal fossa
perineal fascia
medial border of ischiorectal fossa
external and internal anal sphincters/anal canal
clinical significance of ischiorectal fossa
abscesses can form here from anal/genital area
difficult to treat dt poor blood supply
