Gray's 4 + 5 Flashcards
Tumor in the head of the pancreas. Which structure is obstructed?
Common bile duct is located at the head of the pancreas and receives contents from cystic duct + hepatic duct
Patient has acute pain in right upper quadrant of abdomen with 24-hour history of jaundice. Which structure is obstructed by gallstone?
The common bile duct, if obstructed, allows no collateral pathway for drainage of bile from the liver or gallbladder.
Which porto-caval anastomoses leads to hemorrhoids?
Superior rectal veins (portal) and middle or inf. rectal veins (caval) can expand in portal hypertension as hemorrhoids
Upper GI bleeding + esophageal varices. Evaulation shows ascites and splenomegaly. Which surgical venous anastomoses is used to relieve these symptoms?
The splenic vein (major tributary component of the portal venous system) and the left renal vein (component of caval-systemic venous system).
Tumor in the tail of the pancreas. Which organ is most likely to have its blood supply compromised?
The splenic artery lies adjacent to the superior border of the pancreas. Blood supply to the speen can be affected in the vent of a tumor in the tail of the pancreas.
Tumor of the head of the pancreas involving the uncinate process. Which vessel is most likely to be occluded?
The SMA arises from the aorta, deep to the neck of the pancreas, then crosses the uncinate process and 3rd part of the duodenum. An uncinate tumor can cause compression of the SMA.
Tumor is causing portal hypertension. Lab studies reveal that the patient has fatty stools, malnutrition and liver hypoxia. Which location is the tumor located at?
The porta hepatis transmits the proper hepatic artery, portal vein, common hepatic duct, autonomic nerves and lymph vessels.
Which artery must be clamped to remove the gallbladder safely?
The cystic artery is the only artery that goes directly to the gallbladder. It is often a branch of the right hepatic artery.
Examination reveals ruptured spleen. A splenectomy is performed. Which peritoneal structure must be carefully manipulated to prevent intraperitoneal bleeding?
The splenorenal ligament is the attachment of the spleen to the left kidney and is the only ligament that contains the major branches of the splenic artery to the spleen and greater curvature of the stomach.
What is Murphy’s sign?
Murphy’s sign is a test designed to detect and diagnose problems in the upper right abdominal quadrant. It is classically used to diagnose diseases of the gallbladder by pressing deeply under the right costal margin and asking the patient to breathe deeply. This causes sharp pain in patients with cholecystitis.
Examination reveals a right subphrenic abscess that extends to the midline. Which structure is in a position to slow the spread of an abcess across the midline?
The falciform ligament separates the subphrenic spaces into right and left recesses and extends between the liver and the anterior abdominal wall. Because of its location and attachments, it would serve to stop the spread of an abcess from one side to the other across the midline.
Which landmark best describes the precise location of the gallbladder with respect to the body wall?
The intersection of the right linea semilunares with the 9th costal cartilage in the right upper quadrant is typically associated with the point of contact of the gallbladder fundus with the anterior abdominal wall.
Biopsy reveals ductular adenocarcinoma. Which structure will first receive metastatic cells?
The liver would be the 1st structure to receive the metastatic cells because they would flow through the portal venous system from the pancreas to the liver.
Examination shows a tumor at the neck of the pancreas. Which vessel would be most likely obstructed?
The portal vein is the most likely structure to be occluded by a large tumor at the neck of the pancreas due to its proximity.
Describe caput medusae
The snakelike appearance of veins on the body wall results from anastomoses between tiny veins that accompany the ligamentum teres hepatis (within the falciform ligament) with veins of the anterior abdominal body wall.
