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Anatomy Exam 1 > Interval 3 > Flashcards

Interval 3 Flashcards

1
Q

What causes varicose superficial epigastric varicosities?

A

-obstruction of either the IVC or hepatic portal vein

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2
Q

Obstruction of the IVC or hepatic portal vein can cause what?

A

-varicosities in superficial epigastric veins

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3
Q

Ascites

A

-accumulation of fluid in the peritoneal cavity and may be caused by peritonitis or result from congestion of venous drainage of abdomen

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4
Q

What nerves innervate the skin, fascia, and muscles of the anterolateral abdominal wall?

A
  • Lower intercostal nerves (T7-T11)
  • Subcostal nerve (T12)
  • Iliohypogastric nerve (L1)
  • Ilioinguinal nerve (L1)
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5
Q

Cremasteric reflex utilizes sensory and motor fibers in the ___________. Describe the reflex and nerves involved.

A
  • Ventral rami of L1 spinal nerve
  • Stroking of skin of superior and medial thigh stimulates sensory fibers of the ilioinguinal nerve
  • Motor fibers from genital branch of genitofemoral nerve cause the cremaster muscle to contract
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6
Q

Torsion

A

-results in a sudden onset of testicular pain and loss of cremasteric reflex

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7
Q

4 types of abnormal cysts in spermatic cord

A
  • Hydrocele
  • Hematocele
  • Spermatocele
  • Varicocele
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8
Q

Hydrocele

A

-accumulation of serous fluid in tunia vaginalis or in a persistent part of process vaginalis in the cord

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9
Q

Hematocele

A

-accumulation of blood in tunica vaginalis and results form rupture of testicular blood vessels after traumu to spermatic cord or testis.

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10
Q

Pain associated with trauma to the testis may be referred over the ___________ dermatome

A

T11-L1

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11
Q

Spematocele

A

-Cyst containing sperm that develops in epididymis just above testis

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12
Q

Varicocele

A

-results from dilations of tributaties of the testicular vein in the pampiniform plexus

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13
Q

When are varicosities of pampiniform plexus seen and not able to be seen?

A

-Observed when patient is standing and disappear when lying down

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14
Q

A varicocele may be caused by ______.

A

defective valves in pampiniform plexus or by compression of testicular vein (more often the left) in abdomen

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15
Q

A malignant neoplasm of the testis (most commonly a seminoma) metastasizes directly to the __________ distinguishing it from a malignancy of the scrotum which metastasizes initially to _______>

A
  • Lumbar nodes

- Superficial inguinal nodes

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16
Q

What is the most common cause of a painless testicular mass?

A

-malignancy

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17
Q

Carcinoma of the fundus of the uterus may metastasize to ___________ along lymphatic vessels that course with the round ligament.

A

-Superficial inguinal nodes

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18
Q

Inguinal hernia categories

A

-direct or indirect

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19
Q

Which type of inguinal hernia may emerge through the superficial inguinal ring and pass superficial to inguinal ligament?

A

-both direct and indirect

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20
Q

Most common type of inguinal hernia

A

-indirect

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21
Q

Mechanism of formation of indirect inguinal hernia

A
  • protrude through the anterior abdominal wall lateral to the inferior epigastric artery and vein, enter the deep inguinal ring, and appear at the superficial ring after traversing the length of the inguinal canal
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22
Q

Indirect inguinal hernias may follow a persistent _________ through the inguinal canal, are covered by _____________ and may descend into the __________. Where can females develop indirect hernias?

A
  • Processus vaginalis
  • Peritoneum and 3 fascial layers of spermatic cord
  • Scrotum

-Canal of nuck

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23
Q

Direct hernia formation mechanism

A

-protrude through posterior wall of the inguinal canal medial to the inferior epigastric artery and vein

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24
Q

Which hernias are more likely to tear through transversalis fascia and lie adjacent to contents of spermatic cord? What is this hernia usually covered by then?

A
  • Direct inguinal hernia
  • external spermatic fascia and lie adjacent to contents of spermatic cord and obliterates processus vaginalis at superficial inguinal ring
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25
Q

Which location of hernias are more common in males? females?

A
  • Males get inguinal hernias more often

- Females get femoral hernias more often

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26
Q

Femoral hernia mechanism of formation

A
  • enter anterior thigh after passing through the femoral ring deep to the inguinal ligament
  • have highest rate of bowel incarceration of any type of hernia
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27
Q

Where is the femoral ring?

A
  • Medial to the femoral vein

- Lateral to lacunar ligament, an extension of inguinal ligament

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28
Q

After passing deep to the inguinal ligament, femoral hernias may protrude ___________.

A

-anteriorly through the saphenous hiatus, a fault in the fascia lata that transmits saphenous vein

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29
Q

Referred pain of GI tract

A

-stimulation of visceral pain fibers that innervate a GI structure results in a dull, aching, poorly localized pain that is referred over the T5-L1 dermatomes

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30
Q

Where do the sites of referred pain generally correspond to?

A

-Spinal cord segments that provide the sympathetic innervation to the affected GI structure

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31
Q

A colicky type is pain is a _______________. pain symptomatic of what?

A
  • rhythmic, recurring pain

- Symptomatic of ileus, an obstruction of a GI structure

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32
Q

What causes colicky pain?

A

-results from recurrent smooth muscle contractions against the obstruction

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33
Q

Colic

A

-severe form of colicky pain

34
Q

What does biliary or renal colic result from?

A

-recurring smooth muscle contractions against a gall stone lodged in the biliary system or a calculus lodged in ureter

35
Q

Parietal peritoneum innervation

A
  • sensitive to pain
  • innervated by lower intercostal nerves (T7-T11), subcostal nerve (T12), iliohypogastric and ilioinguinal nerves (L1) and branches of phrenic nerve (C3-C5)
36
Q

Patients with inflamed parietal peritoneum may exhibit _______ and ________ over the site of inflammation.

A
  • Rebound tenderness: pain that is elicited after the pressure of palpation over affected area is removed
  • Guarding: reflex spasms of abdominal muscles in response to palpation which may be ecident over region of inflamed peritoneum
37
Q

Cause of gastroesophageal reflux, or heartburn,

A
  • May result from incompetent lower esophageal sphincter

- patients may complain of substernal burning that is worse when lying down

38
Q

Achalasia of esophagus

A
  • smooth muscle sphincter of esophagus gfails to relax
  • Patients have difficulty swallowing liquids and solids
  • dilated esophagus and experience abnormal contractions of smooth muscle of esophagus proximal to affected segment
39
Q

How is achalasia similar to Hirshsprung’s disease?

A

-Both may be caused by absence of terminal parasympathetic ganglia

40
Q

Epiphrenic diverticulum

A
  • may develop just superior to lower esophageal sphincter

- false diverticula/pulsion diverticula that do not consist of all of the layers of the esophagus

41
Q

False diverticula are most common ________.

A

In sigmoid colon

42
Q

Surgical access to omental bursa may be obtained by?

A

-Incising the lesser omentum, the gastrocolic ligament, or gastrosplenic ligament

43
Q

What would have to be avoided in surgicial access to omental bursa via the 3 mechanisms mentioned.

A
  • Lesser omentum: right and left gastric arteries
  • Gastrocolic ligament: middle colic artery
  • Gastrosplenic ligament: short gastric arteries and left gastro-omental artery
44
Q

Carcinomas of the stomach commonly develop in the _______ part and metastasize to the ________ and through the _________ to the __________.

A
  • pyloric part
  • cisterna chylia
  • thoracic duct
  • left brachiocephalic vein
45
Q

What is a sentinel node for gastric carcinoma?

A

-Left supraclavicular node of Virchow

46
Q

In an occlusion of the celiac artery at its origin from the abdominal aorta, collateral circulation may develop in the ______ of the pancreas by way of anastomoses between the ________________.

A

-pancreaticduodenal branches of both the SMA and GDA

47
Q

What are the 3 branches of celiac circulation that may be subject to erosion if an ulcer penetrates the posterior wall of the stomach or duodenum

A
  • Splenic artery if posterior wall of stomach
  • Left gastric if ulcer of lesser curvature
  • GDA is posterior wall of 1st part of duodenum
48
Q

Why do some patients have pain referred to the shoulder?

A

-Air escapes through the ulcer and stimulates peritoneum covering inferior aspect of diaphragm

49
Q

Contents of a penetrating ulcer of posterior wall of stomach or duodenum may enter the _______. If they leak out via the epiploic forament, they will spill into the _________

A
  • omental bursa

- subhepatic recess (Morison’s pouch)

50
Q

Which rib fractures may puncture the spleen?

A

-9-11th rib on the left

51
Q

Primary carcinomas originating in the abdominopelvic structures below the diaphragm commonly spread to the _______.

A

-Liver

52
Q

Cystohepatic triangle of Calot

A

-cystic artery, cystic duct, and common hepatic duct

53
Q

The _________ is a common site of an impacted gallstone.

A

-hepatopancreatic ampulla

54
Q

Stone blocking the cystic duct may cause enlargement of the gallbladder. Patients may exhibit biliary colic that begins in the epigastric region but moves to a point where the _________.

A

-9th costal cartilage intersects the lateral border of the rectus sheath

55
Q

Inflamed gallbladder may adhere to the duodenum and develop a ________.

A
  • Fistula

- Allows gallstone to pass into the duodenum

56
Q

Gallstone may become lodged at the ileocecal junction, forming a ________.

A

Gallstone ileus

57
Q

Adenocarcinomas of the pancreas commonly develop in the ______________ and may result in what?

A
  • Head of pancreas

- compression of bile duct and main pancreatic duct

58
Q

What can cause duodenal compression and what do patients experience?

A
  • Superior mesenteric vessels may compress the horizontal part of the duodeunum
  • Patients experience epigastric or umbilical pain, nausea after a meal, and bilious vomiting
59
Q

Hematemesis

A
  • vomiting of blood, commonly results from bleeding into the lumen of esophagus, sotmach, or duodenum proximal to ligament of Treitz
  • commonly causes by duodenal ulcer, gastric ulcer, or esophageal varices
60
Q

Hematochezia

A
  • blood in stool

- usually due to bleeding into lumen of jejunum, ileum, colon, or rectum distal to ligament of Treitz

61
Q

Melena

A

-refers to black, tarry stools that contain blood altered by gastric secretions

62
Q

Melanemesis

A

-coffe-ground appearance of vomit

63
Q

Ileal/Meckel’s Diverticulum

A
  • remnant of fetal vitelline duct which persists in postnatal life as outpocketing of ileum
  • true diverticulum
64
Q

Define diverticulum

A

-Outpocketing of a tubular or saccular organ such as GI tract or bladder

65
Q

True vs. False/pulsion diverticula

A
  • True:protrusions that include all of the layers of the affected structure
  • False/pulsion: protrusions do not contain all tissue layers
66
Q

Appendicitis pain localization

A
  • Stimulate visceral pain fibers which course pack in lower splanchnic nerves and result in colicky pain referred over umbilical region
  • Irritation of parietal peritoneum may result in pain localized over base of appendix (McBurney’s point)
67
Q

Psoas sign and Obturator sign with appendicitis

A
  • Psoas sign: where pain from the irritated parietal peritoneum is accentuated when the right thigh is extended at the hip against resistance
  • Obturator sign: pain from irritated parietal peritoneum is accentuated when the right thigh is flexed and then internally rotated
68
Q

Why is there a risk for direct hernia with appendectomy?

A
  • Iliohypogastric nerve may be lesioned

- Weakening of anterior abdominal wall and direct inguinal hernia may result

69
Q

Sigmoid volvulus

A
  • sigmoid colon twists around the sigmoid mesocolon and may become obstructed
  • Left side colicky pain, abdominal distension, and hematochezia
70
Q

Sigmoid colon is common site of multiple _________.

A
  • Pulsion diverticula

- mucosa and submucosa herniate through smooth muscle of sigmoid colon

71
Q

Diverticulosis vs. Diverticulitis

A

1) diverticula that are not inflamed

2) diverticula that are inflamed

72
Q

“Left-Sided” appendicitis is likely what issue?

A

-Sigmoid colon diverticulitis rupture

73
Q

2 common sites of ischemic bowel infarction

A
  1. transverse colon

2. rectum

74
Q

3 sites of portacaval anastomoses

A
  1. in wall of esophagus at junction of capillary beds draining into left gastric (coronary) vein (portal system) and esophageal tributaries of the azygos vein (caval system)
  2. wall of rectum at junction of internal rectal plexus which drains into the superior rectal vein (portal system) and external rectal plexus which drains into the middle of inferior rectal veins (caval)
  3. Anterior abdominal wall at junction of paraumbilical veins, which course in falciform ligament (postal system) and tributaties of superficial epigastric veins which train into anteral abdominal wall (caval system)
75
Q

Caput medusa

A

-pattern of varicose superficial epigastric veins that radiate away from umbilic

76
Q

Interlobular artery occlusion

A
  • these are end arteries

- occlusion may result in avascular necrosis, leaving a shallow scar in renal cortex

77
Q

Proximal part of ureter may be compressed by an _________

A
  • Aberrant renal artery which commonly arises inferior to renal artery and passes anterior to origin of ureter.
  • Can cause hydronephrosis of renal pelvis
78
Q

A male patient may have varicocele (more commonly on left) due to what?

A

-Compression of left renal vein by an aneurysm of SMA near origin of artery from abdominal aorta

79
Q

Kidney transplants

A
  • only upper part of ureter which is supplied by renal artery is transplanted with renal vessels and kidney
  • usually place kidney in pelvis where upper part of ureter is attached to the bladder and renal artery is joined to external iliac artery
80
Q

3 narrow points of ureter

A
    1. origin of ureter form renal pelvis
      1. where ureter crosses pelvic brim
      2. point at which ureter enters bladder
81
Q

Aortic Aneurysm

A
  • common site is proximal to bifurcation at level of L4

- Pulsating painless mass in midline

82
Q

Krukenberg tumors

A

-carcinomas of stomach that that spread to ovaries

Anatomy Exam 1 (2 decks)

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