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MIDTERM Flashcards

1
Q

A football player receives a blow to the side wall of chest, what complications could happen?

A

The long thoracic nerve can be caused which will put the serratus anterior out of business and cause winged scapula since serrates anterior can no longe hold shoulder

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2
Q

What structures are found in the axilla?

A

Brachial plexus
Axillary artery and vein

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3
Q

What are the branches of the Axillary artery?

A

Screw the lawyer, save the patient

Superior thoracic artery
Thoracoacromial artery
Lateral Thoracic artery
Subscapular artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery

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4
Q

Where does axillary artery become brachial artery?

A

distal border of teres major

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5
Q

What are the terminal branches of the brachial plexus?

A

Median
Radial
Ulnar
Musculocutaneous
Axillary

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6
Q

What is the function of the axillary sheath?

A

acts as a conduit from vertebral column to arm, forearm. hand

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7
Q

What is contained in the axillary sheath?

A

Axillary artery and its branches
Axillary vein
Brachial Plexus

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8
Q

______ becomes axillary artery at the lateral border of the first rib

A

Subclavian

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9
Q

What are branches of the Thoracoacromial artery?

A

Cadavers are dead people
Clavicular
Acromial
Deltoid
Pectoral

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10
Q

What does the Lateral Thoracic artery supply?

A

Serratus anterior
Lateral Breast

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11
Q

Fracture of surgical neck of humerus can cause ?

A

Damage to axillary nerve and posterior humeral circumflex artery

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12
Q

If the axillary artery is cut and ligated, blood flow will reverse in what artery?

A

Blood flow will reverse in the subscapular artery

Ligation should be performed proximal to the subscapular artery

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13
Q

BRACHIAL PLEXUS IS A NETWORK OF NERVES DERIVED FROM ______ SPINAL NERVES THAT SUPPLY THE UPPER EXTREMITY

A

C5-T1

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14
Q

If you fracture the clavicle, you must worry about damage to?

A

Axillary vessels
Brachial plexus

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15
Q

_________ and _________ cords of the brachial plexus are anterior to the axillary artery

A

Lateral and medial cords are anterior to axillary artery

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16
Q

What part of the brachial plexus is supraclavicular?

A

Roots
Trunks
Divisions

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17
Q

What part of the brachial plexus in infraclavicular?

A

Cords
Branches

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18
Q

What brachial plexus cord does the Thoracodorsal nerve (middle subscapular nerve) come from?

A

Posterior cord

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19
Q

Thoracodorsal nerve (middle subscapular nerve) innervates which muscle?

A

Latissimus dorsi

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20
Q

The big M of the brachial plexus is which cords?

A

The big M is comprised of the lateral and medial cords and their branches

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21
Q

Which terminal branches of the brachial plexus come from the lateral cord?

A

Musculocutaneous nerve
Median nerve

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22
Q

Which terminal branches of the brachial plexus come from the posterior cord?

A

Axillary nerve
Radial nerve

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23
Q

Which terminal branches of the brachial plexus come from the medial cord?

A

Median nerve
Ulnar nerve

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24
Q

What does the Musculocutaneous nerve innervate?

A

Flexor compartment of arm
Biceps brachii
Coracobrachialis
Brachialis

Musculocutaneous nerve continues as Lateral Cutaneous Nerve of forearm for sensory innervationof lateral forearm

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25
Q

Damage to musculocutaneous nerve results in?

A

Sensory loss to the lateral forearm

Great weakness of forearm and arm flexion

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26
Q

What does the axillary nerve innervate?

A

Deltoid
Teres minor
Skin over deltoid

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27
Q

What structures run through the quadrangular space?

A

Axillary nerve
Posterior humoral circumflex artery

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28
Q

Damage to axillary nerve results in?

A

Weakness in abduction, flexion, extension, and lateral rotation of arm

Sensory loss over the lateral shoulder

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29
Q

What does the radial nerve innervate?

A

Extensor compartment of arm and forearm

Triceps brachii

Skin of the posterior forearm

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30
Q

Where is the radial nerve found?

A

Radial (spiral) groove of the shaft of the posterior humerus

Triangular interval

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31
Q

What structures are found in the triangular interval?

A

Radial nerve
Profunda brachii artery

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32
Q

If deep branch of radial nerve is damaged, what happens?

A

Wrist drop

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33
Q

If superficial branch of radial nerve is damaged, what happens?

A

Lose sensation over the skin of posterior forearm

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34
Q

What does median nerve innervate?

A

Muscles of anterior forearm (except for flexor carpi ulnaris and ulnar half of flexor digitorum profundus)

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35
Q

What artery does the median nerve run with?

A

Brachial artery

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36
Q

What does the ulnar nerve innervate?

A

Flexor carpi ulnaris

Ulnar half of flexor digitorum profundus in the forearm

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37
Q

Ulnar nerve runs along_____

A

medial epicondyle

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38
Q

Which compartment of the arm are the flexors found in and what nerve are they innervated by?

A

Anterior

Musculocutaneous nerve

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39
Q

Biceps brachii action

A

Flexion of forearm at elbow

Supination

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40
Q

Brachialis action

A

flexes forearm

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41
Q

Coracobrachialis action

A

flexes arm

helps biceps brachii

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42
Q

What compartment of the arm are the extensors found in and what’s it innervated by?

A

Posterior

Radial nerve

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43
Q

What does the hinge joint of elbow consist of and its action?

A

trochlea and trochlear notch

flexion/extension

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44
Q

What does the gliding joint of elbow consist of and its action?

A

Capitulum and radial head

pronation/supination

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45
Q

What are the 3 ligaments of the elbow joint?

A

Annular ligament
Medial (ulnar) collateral ligament
Lateral (radial) collateral ligament

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46
Q

What are 2 functions of the annular ligament of elbow?

A

Hold radial head in place

Allows for pronation and supination

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47
Q

What nerve does a surgeon need to be careful of when performing surgery in the axilla region?

A

Thoracodorsal nerve

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48
Q

IS the radius and ulna crossed in pronation or supination?

A

The distal radius rolls over the ulna and proximal radius turns in pronation

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49
Q

DAMAGE TO WHAT NERVE AND AT WHAT SPINAL LEVEL WILL RESULT IN WINGED SCAPULA?

A

LONG THORACIC NERVE

C5, C6, C7

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50
Q

WHAT HAPPENS TO FUNCTION IN A PATIENT WITH WINGED SCAPULA ?

A

LOSS OF LONG THORACIC NERVE WILL MAKE THE PATIENT UNABLE TO ABDUCT ARM ABOVE 90 DEGREES BECAUSE OF LOSS OF THE SERRATUS ANTERIOR

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51
Q

WHAT STRUCTURES CAN GET DAMAGED IN A FRACTURE OF SURGICAL NECK OF HUMERUS?

A

AXILLARY NERVE

POSTERIOR HUMORAL CIRCUMFLEX ARTERY

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52
Q

WHAT HAPPENS TO FUNCTION IN A PATIENT WITH AXILLARY NERVE DAMAGE?

A

WEAKNESS IN ABDUCTION, FLEXION, EXTENSION, AND LATERAL ROTATION OF ARM

SENSORY LOSS OVER THE LATERAL SHOULDER

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53
Q

HOW MAY A PATIENT PRESENT WHEN THEY HAVE AXILLARY NERVE DAMAGE?

A

FLATTENED DELTOID

INABILITY TO ABDUCT SHOULDER PAST 15 DEGREES

REDUCED OR LOSS OF SENSATION OVER DELTOID AND LATERL ARM

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54
Q

WHAT CAUSES ERB’S PALSY?

A

DAMAGE TO UPPER ROOTS (C5 AND C6) OF BRACHIAL PLEXUS

INCREASED ANGLE BETWEEN NECK AND SHOULDER

FALLING ON HEAD AND SHOULDER OR IF INFANT’S HEAD PULLED ON FORCEFULLY

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55
Q

HOW DOES ERB’S PALSY PRESENT?

A

UPPER EXTREMITY IS MEDIALLY ROTATED AND PARALYZED EXCEPT FOR FINGERS

LOSS OF SENSATION ON LATERAL ASPECT OF UPPER LIMB

WAITERS TIP POSITION

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56
Q

WHAT IS KLUMPKES PALSY CAUSED FROM?

A

DAMAGE TO LOWER ROOTS (C8 AND T1) OF BRACHIAL PLEXUS

EXCESSIVE UPWARD PULL OF UPPER LIMBS

GRABBING A TREE BRANCH TO BREAK A FALL OR PULLING ON INFANTS ARM DURING DELIVERY

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57
Q

HOW DOES KLUMPKES PALSY PRESENT?

A

SHORT INTRINSIC HAND MUSCLES ARE PARALYZED

CLAW HAND

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58
Q

WHAT CAUSES SATURDAY NIGHT PALSY?

A

DAMAGE TO RADIAL NERVE

CAN HAPPEN THROUGH EXCESSIVE PRESSURE ON AXILLA (CRUTCHES OR SLEEPING WITH ARM OVER CHAIR)

WRIST DROP

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59
Q

WHAT NERVE MAY GET DAMAGED IN BREAST SURGERY?

A

THORACODORSAL NERVE

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60
Q

A PATIENT WITH THORACODORSAL NERVE DAMAGE MAY HAVE DEFICITS IN FUNCTION IN WHAT AREAS?

A

A PATIENT WITH THORACODORSAL NERVE DAMAGE MAY HAVE WEAKNESS IN EXTENSION, MEDIAL ROTATION, AND ADDUCTION OF ARM

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61
Q

A PATIENT THAT CAN NOT WIPE THEMSELVES IS EXAMPLE OF WHAT TYPE OF DAMAGE?

A

THORACODORSAL NERVE DAMAGE

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62
Q

what does hypesthesia mean?

A

reduced sensation

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63
Q

What does the interosseous membrane that is between the radius and ulna divide?

A

Anterior (flexor) and posterior (extensor) compartments

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64
Q

What nerves are found in the flexor compartment (anterior forearm) ?

A

Median and Ulnar nerves

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65
Q

What nerves are found in the extensor compartment (posterior forearm)?

A

Radial nerve

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66
Q

Radius articulates with the ________ of the humerus and the _______ of the ulna

A

Capitulum of humerus

Radial notch of the ulna

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67
Q

What inserts on the radial tuberosity of the radius?

A

Tendon of the biceps brachii

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68
Q

What part of radius is prone to fracture?

A

Styloid process on the distal end of radius

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69
Q

What part of the ulna is prone to fracture?

A

Styloid process of the ulna on distal end

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70
Q

What can cause a fracture of the styloid process of the ulna?

A

Falling on outstretched hand

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71
Q

Why is it necessary to have collateral circulation at elbow?

A

Because when you flex the elbow, you kink brachial artery

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72
Q

What does brachial artery split into?

A

Ulnar and radial arteries

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73
Q

During supination, the radius and ulna are _______

A

parallel

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74
Q

What nerve separates the superficial and deep layers of the anterior forearm (flexor compartment)?

A

Median

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75
Q

What muscles are found in the flexor compartment (anterior forearm)

A

Any muscle starting with flexor or pronator

Palmaris longus

Brachioradialis *** located in extensor compartment but is a flexor muscle

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76
Q

All of the flexor muscles of the forearm are innervated by the Median nerve except which muscles?

A

Flexor carpi ulnaris (Ulnar nerve)

Brachioradialis (Radial nerve)

The portion of the Flexor Digitorum Profundus that controls the medial 2 digits (Ulnar nerve)
Lateral 2 digits controlled by median nerve

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77
Q

Pronator teres action

A

pronates and flexes forearm

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78
Q

Flexor carpi radialis action

A

flexes and abducts wrist (radial deviation)

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79
Q

Palmaris longus action

A

flexes wrist

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80
Q

Flexor carpi ulnaris action

A

flexes and adducts wrist (ulnar deviation)

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81
Q

Brachioradialis action

A

flexes elbow

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82
Q

Flexor digitorum superficialis action

A

flexes wrist, PIP and MP joints of median 4 digits

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83
Q

Flexor digitorum profundus action

A

flexes wrist, DIP,PIP, and MP

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84
Q

Flexor pollicus longus action

A

flexes thumb

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85
Q

Pronator quadratus action

A

pronates forearm

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86
Q

what nerve runs through the carpal tunnel?

A

Median nerve

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87
Q

Median nerve enters forearm alongside ________ artery

A

Brachial artery

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88
Q

How does patient with median nerve injury at elbow present?

A

Hand of Benediction (Ape hand)

cannot oppose thumb

loss of pronation

sensory loss

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89
Q

What is Hand of Benediction?

A

Attempted formation of a fist results in 4th and 5th flexed (intact ulnar nerve) but first 3 fingers remain extended

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90
Q

What is ape hand

A

inability to abduct the thumb

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91
Q

What can result from median nerve injury at the wrist (in carpal tunnel)

A

Ape hand due to damage of the recurrent branch of the median nerve resulting in sensory loss, thenar eminence wasting and inability to abduct the thumb

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92
Q

Ulnar nerve runs along the medial edge of the forearm along with the _______

A

ulnar artery

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93
Q

Ulnar nerve innervates which muscles of the anterior compartment of forearm?

A

Flexor carpi ulnaris

Portion of the flexor digitorum profundus that controls medial 2 digits

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94
Q

How does patient with ulnar nerve damage at elbow present?

A

Claw hand (can’t abduct and adduct fingers)

Claw hand develops over time
Hypeextension of MP joint
Flexion of PIP joint
Static Sign unlike Hand of Benediction

can’t flex DIP joints, ring and little fingers

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95
Q

What artery runs through snuffbox?

A

Radial artery

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96
Q

The radial artery becomes the __________ arch?

A

Deep palmar arch

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97
Q

Ulnar artery becomes the ________ arch

A

superficial palmar arch

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98
Q

What is the Allen’s test?

A

Allen’s test allows testing of circulatory status of radial and ulnar arteries. Occlude both arteries by pressure and then ask patient to make a fist until palmar surface is white. Releasing pressure on either radial or ulnar artery will reveal whether the opposite artery is providing adequate circulation to hand

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99
Q

All extensor muscles of forearm are innervated by?
any muscle that starts with extensor, supinator, and the abductor pollicis longus

A

Radial nerve

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100
Q

Extensor carpi radialis longus action

A

extend abduct wrist (radial deviation)

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101
Q

Extensor carpi radialis brevis action

A

extend and abduct wrist (radial deviation)

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102
Q

Extensor digitorum action

A

partially extend all but thumb
final extension of fingers by lumbrical and interosseous muscles

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103
Q

Extensor carpi ulnaris action

A

extend and adduct wrist (ulnar deviation)

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104
Q

extensor digiti minimi action

A

extend little finger

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105
Q

Extensor indicis action

A

extend index finger (along with extensor digitorum)

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106
Q

Extensor pollicis longus action

A

extend thumb (IP joint)

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107
Q

Extensor pollicis brevis action

A

extend thumb

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108
Q

Abductor pollicis longus action

A

abduct thumb

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109
Q

Supinator

A

supinates forearm

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110
Q

which are stronger? Supinator or pronator

A

Supinators are stronger than pronators

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111
Q

The superficial branch of radial nerve innervates?

A

skin of posterior forearm and parts of dorsum of hand

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112
Q

The deep branch of the radial nerve innervates ?

A

muscles in the posterior compartment of forearm (extensors)

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113
Q

What are signs of radial nerve injury?

A

wrist drop

cannot extend elbow

loss of sensation on posterior forearm and dorsum of hand

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114
Q

What structure in dorsum of hand holds all tendons in position as they pull on insertions?

A

extensor retinaculum

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115
Q

What is compartment syndrome?

A

Muscles of forearm are grouped into tight fascial compartments and if there is swelling the compartment blood supply can be cut off

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116
Q

What type of fractures are scaphoid bones prone to ?

A

avascular fractures

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117
Q

Identify the bones of wrist on xray

A
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118
Q

Which bones of the wrist transmit force from the hand?

A

scaphoid and lunate

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119
Q

Where is interphalangeal joint (IP) found?

A

thumb

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120
Q

What is the function of the palmar aponeurosis?

A

Lies right under skin and protects all underneath structures from crushing injuries

Prevents long tendon from bowing out when constricted strongly

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121
Q

Carpal tunnel is formed by ______

A

flexor retinaculum

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122
Q

What nerve is found in the carpal tunnel?

A

Median nerve which breaks into branches called the recurrent nerve

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123
Q

Sensory branches of the median nerve innervate?

A

thumb second digit, third digit and half of fourth digit

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124
Q

What is carpal tunnel syndrome?

A

Inflammation of the flexor retinaculum sheath due to repeated movement in the carpal tunnel, fluid retention, fractures, infection or trauma to wrist

this results in decrease in size of tunnel and compression of the median nerve leading to tingling, lack of sensation (except for palm),

wasting of thenar muscles and lack of opposition

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125
Q

If the recurrent median branch of median nerve is affected in carpal tunnel syndrome, what happens?

A

Ape hand

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126
Q

How do you test for carpal tunnel syndrome?

A

Phalen’s maneuver

test for median nerve compression

raise arms to shoulder level and bring dorsum of hand together and hold wrist forced flexion 30-60 seconds. Positive phalens get tingling and numbness

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127
Q

What is tendonitis/synovitis?

A

sterile inflammation of the tendon or synovial sheath that is a result of overuse

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128
Q

What is Tenosynovitis

A

infection of both the digital synovial sheath and the tendon causing inflammation

usually confined to one digit

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129
Q

Which muscle is the only muscle to flex DIP joint

A

Flexor digitorum profundus

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130
Q

Flexor digitorum profundus action

A

flexes DIP, PIP, MP joint and wrist

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131
Q

What is special about how the Flexor Digitorum Superficialis attaches ?

A

Flexor Digitorum Superficialis splits and inserts on each side of the middle phalanx

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132
Q

Flexor digitorum superficialis action

A

flexes PIP, MP joint and wrist

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133
Q

What are the three long flexor tendons?

A

Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Lumbricals

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134
Q

Where do Lumbricals insert?

A

Lumbricals insert on the radial side of profundus tendon (no direct bone attachment)

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135
Q

what are vincula

A

synovial folds containing small blood vessels to long flexor tendons

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136
Q

What is the function of the lumbricals?

A

fine finger movements

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137
Q

The lateral two lumbricals are innervated by?

A

Median nerve

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138
Q

The medial two lumbricals are innervated by?

A

ulnar nerve

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139
Q

Interosseus muscles of hand (located between metacarpals) are innervated by?

A

ulnar nerve

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140
Q

What is the function of the palmar interossei muscles of hand?

A

Palmar Interossei muscles adduct 2, 4, 5 digits (toward middle finger) PAD

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141
Q

What is function of Dorsal Interossei muscles of hand?

A

Dorsal interossei muscles abduct 2, 4, 5 digits (away from middle finger) DAB

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142
Q

The intrinsic muscles (aka THENAR muscles) of the deep thumb are innervated by?

A

recurrent branch of the median nerve

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143
Q

Damage to recurrent branch of median nerve causes?

A

loss of opposition (APE HAND)

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144
Q

What are the three muscles of thumb?

A

Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollici

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145
Q

What muscle is the ONLY muscle that opposes thumb?

A

Opponens Pollicis

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146
Q

Adductor pollicus action and innervation

A

Adduct and flex the thumb
Ulnar nerve

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147
Q

Hypothenar muscles are innervated by?

A

Ulnar nerve

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148
Q

IF THE UPPER LIMB HAS SUSTAINED TRAUMA, HOW DO TEST FOR SENSATION OF THE
MEDIAN NERVE
ULNAR NERVE
RADIAL NERVE

A

MEDIAN NERVE-PALMAR SURFACE OF INDEX FINGER

ULNAR NERVE-DORSAL SURFACE OF PINKY

RADIAL NERVE-DORSUM OVER THE FIRST INTEROSSEOUS

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149
Q

CUTANEOUS INNERVATIONS OF THE HAND

A
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150
Q

Claw hand is caused by what type of nerve damage?

A

Ulnar nerve damage

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151
Q

Benediction hand is from what type of nerve damage

A

median nerve damage at elbow

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152
Q

Ape hand caused by what type of nerve damage?

A

median nerve damage at wrist

thenar muscle paralysis

can be due to carpal tunnel

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153
Q

The superficial palmar arch (ulnar) and the deep palmar arch (radial) anastomose and provide collateral circulation. Allen’s test can be performed by occluding both radial and ulnar nerves. What constitutes a positive Allens test?

A

Positive Allen’s test-color of hand doesn’t return to normal within 5 seconds

Negative Allens test-color of hand returns to normal after 5 seconds

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154
Q

What is a Colles’ fracture?

A

Fracture of the ulnar styloid process and distal radius (DINNER FORK DEFORMITY)

common in women aged 50+

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155
Q

What can cause a scaphoid fracture?

A

Common in young adults usually with a fall onto an abducted and outstretched hand

Degeneration of bone may occur due to cut off blood supply from branch of radial artery

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156
Q

What ligaments are involved in shoulder separation?

A

acromioclavicular ligament
coracoclavicular ligament

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157
Q

muscles of the rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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158
Q

What is the sequence of muscle activation in abduction of the arm at the shoulder?

A

Supraspinatus initiates abduction
Deltoid brings arm to 90 degrees
Serratus anterior and Trapezius brings arm over 90 degrees

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159
Q

What type of action can cause shoulder dislocation?

A

Forced abduction and lateral rotation

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160
Q

What direction do shoulder dislocations most often occur?

A

Anterior dislocation

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161
Q

What is the function of the annular ligament in the elbow?

A

allows for pronation/supination as radius rotates in ligament

Holds the head of radius against ulna

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162
Q

Describe elbow dislocation

A

Head of radius slips out of the annular ligament (subluxation)

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163
Q

What type of nerve damage may occur with olecranon fracture?

A

Ulnar nerve damaged

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164
Q

Winged scapula and difficulty abducting arm above 90 degrees and pushing

No sensory loss

What nerve damaged?

A

Long thoracic nerve
Serratus anterior

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165
Q

Patient undergoes breast surgery and afterwards shows weakness in extension, medial rotation, and arm adduction

no sensory loss

What nerve damaged?

A

Thoracodorsal nerve

Latissimus dorsi

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166
Q

A patient presents with weakness in abduction of arm, weakness in flexion, extension, and lateral rotation of arm plus sensory loss over lateral shoulder

What nerve damage?

A

Axillary nerve

deltoid, teres minor, and skin over deltoid (lateral shoulder)

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167
Q

Axillary nerve comes from ________ cord and runs through _____________

A

Axillary nerve comes from posterior cord and runs through quadrangular space (surgical neck)

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168
Q

A patient presents with weakness in the flexion of the forearm, weakness in the flexion of arm and loss of sensation over the lateral forearm

What nerve damaged?

A

Musculocutaneous nerve

flexor muscles of the arm and skin of lateral forearm

Biceps brachii
Coracobrachialis
Brachialis

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169
Q

Musculocutaneous nerve comes from ______ cord and runs through __________

A

Musculocutaneous nerve comes from lateral cord and runs through coracobrachialis

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170
Q

If a patient present with:

cannot flex the distal IP joint of the ring and little fingers

cannot abduct and adduct fingers

cannot adduct thumb and has CLAW HAND

What nerve damaged?

A

Ulnar nerve

flexor carpi ulnaris

1/2 of flexor digitorum profundus

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171
Q

Ulnar nerve comes from_______ cord and runs behind _______

A

Ulnar nerve comes from medial cord and runs behind medial epicondyle of humerus

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172
Q

The deep branch of the ulnar nerve innervates?

A

hypothenar muscles
adductor pollicis
ulnar (medial) two lumbricals
all interosseous muscles

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173
Q

The superficial branch of ulnar nerve innervates?

A

skin

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174
Q

The median nerve innervates?

A

flexors of forearm
pronators of forearm
palmaris longus
thenar muscles
radial (lateral) two lumbricals
skin

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175
Q

what are the thenar muscles?

A

flexor polllicis brevis
abductor pollicis brevis
opponens pollici

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176
Q

How does the median nerve reach the thenar muscles?

A

through carpal tunnel

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177
Q

Median nerve comes from____ cord

A

Median nerve comes from medial and lateral cords

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178
Q

What happens if the recurrent branch of the median nerve is damaged?

A

cannot oppose thumb (APE hand)

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179
Q

What happens if median nerve is damaged in carpal tunnel?

A

Patient cannot oppose thumb and has median nerve sensory changes

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180
Q

What happens if median nerve damaged higher up than the recurrent median nerve and the carpal tunnel?

A

Ape hand

cannot pronate

cannot flex distal IP joints of index and middle fingers

weak flexion of the thumb and wrist

Hand of Benediction

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181
Q

If radial nerve is damaged up high, what signs?

A

cannot extend forearm (triceps)

loss of sensation over posterior arm and forearm (I THINK DORSUM OF HAND BUT CHECK

wrist drop

loss of extension of thumb and MP joints

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182
Q

Radial nerve comes from _______ cord and travel in _______

A

Radial nerve comes from posterior cord and runs in the radial groove along shaft of humerus

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183
Q

Superficial branch of the radial nerve runs through ________ and supplies

A

snuff box

sensation to hand

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184
Q

Deep branch of the radial nerve runs through _________ to innervate_________

A

Deep branch of the radial nerve runs through supinator to innervate extensor muscles of forearm

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185
Q

Damage to the deep branch of the radial nerve results in ?

A

wrist drop
unable extend thumb
unable extend MP joints

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186
Q

Umbilicus part of _______ dermatome

A

T10 dermatome

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187
Q

What vertebral level is the iliac crest found?

A

L4

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188
Q

HOW DOES APPENDICITIS PRESENT

A

PERIUMBILICAL/EPIGASTRIC PAIN WHICH GRADUALLY MIGRATES TO RLQ (TO MCBURNEY’S POINT WHERE THE APPENDIX IS FOUND)

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189
Q

Name the layers of oblique abdominal wall

A

skin
Camper fascia
Scarpa fascia
external oblique
internal oblique
transversus abdominis
transversals fascia
exztraperitoneal fat
parietal peritoneum

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190
Q

What is the largest and most superficial muscle of abdominal cavity?

A

External oblique muscle

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191
Q

External Oblique muscle is innervated by?

A

T7-T12

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192
Q

Muscle fibres of the external oblique muscle run in what direction?

A

hands in pocket

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193
Q

External oblique muscle becomes __________ at iliac crest

A

External oblique muscle becomes inguinal ligament at iliac crest

194
Q

A hernia above inguinal ligament is termed ________ and a hernia below inguinal ligament is _______

A

Hernia above inguinal ligament-inguinal hernia

Hernia below inguinal ligament-femoral hernia

195
Q

Rectus sheath is a combination of aponeurotic fibers of what muscles?

A

external oblique
internal oblique
transversus abdomonis (POSTERIOR LAYER)

196
Q

Internal Oblique innervated?

197
Q

What muscle originates from the internal oblique muscle?

A

Cremaster muscle

198
Q

external oblique and internal oblique function ?

A

flex, rotate, compress

199
Q

Innervation of Transversus Abdomens?

200
Q

Transversus abdominis function

A

compress and support trunk

201
Q

Innervation of Rectus Abdominis

A

you can find 6 packs at 7/11

T7-T11

202
Q

What is rectus diastasis?

A

linea alba becomes stretched causing a weak point and intestines begin to bulge anteriorly

can happen during pregnancy or to infants

203
Q

Pyramidalis innervation?

A

T12 (subcostal nerve)

204
Q

Pyramidalis function?

A

tenses linea alba

205
Q

What structures travel upwards and pierce the rectus sheath at the arcuate line?

A

Inferior epigastric vessels travel upwards and pierce the rectus sheath at the arcuate line

206
Q

What vessels supply the rectus abdominis?

A

Superior and inferior epigastric artery/vein supply rectus abdominis

207
Q

Superior epigastric artery branches from ___________ artery

A

Superior epigastric artery branches from internal thoracic artery

208
Q

Inferior epigastric artery branches from __________artery

A

Inferior epigastric artery branches from external iliac artery

209
Q

A hernia which is found INSIDE Hesselbach’s triangle?

A

Direct inguinal hernia

210
Q

What veins are involved in Caput Medusae?

A

paraumbilical veins

211
Q

How do you treat Caput Medusae?

A

paracentesis

212
Q

What are signs of Portal Hypertension?

A

Caput Medusae
Hemorrhoids
Esophageal varices
Splenomegaly
Intra-abdominal bleed
Retropancreatic rupture

213
Q

Iliohypogastric and Ilioinguinal nerves are found vertebral level?

214
Q

Iliohypogastric and Ilioinguinal nerves traverse between which muscles?

A

Internal oblique
Transversus abdominis

215
Q

What is patent urachus?

A

open connection from bladder to umbilicus which urine can be eliminated from after birth

216
Q

The urachus becomes ? after birth

A

Median umbilical ligament

217
Q

Where is the inguinal canal found?

A

The inguinal canal lies JUST ABOVE INGUINAL LIGAMENT

(inguinal ligament does not go through inguinal canal)

218
Q

What is function of the inguinal canal?

A

Transmit spermatic cord

Transmit round ligament of uterus

219
Q

What structures are found in the spermatic cord?

A

Testicular arteries and veins
Cremasteric artery
Artery of Ductus Deferens
Genital branch of genitofemoral nerve
Pampiniform plexus (veins that act as cooling device)
Ductus (vas) deferens to/from testes

220
Q

What artery lies medial to the deep inguinal ring?

A

Inferior epigastric artery lies medial to the deep inguinal ring

221
Q

Inguinal ligament is formed by?

A

External oblique aponeurosis

222
Q

What is lacunar ligament?

A

part of external oblique aponeurosis that connects inguinal ligament to pectineal ligament and together attach to pubic tubercle

223
Q

What is function of ductus (vas) deferens?

A

transmits sperm from epididymis

225
Q

What structure is cut in vasectomy?

A

Vas deferens

226
Q

What is function of cremaster muscle and where located?

A

elevates testes reflexively and for thermoregulation

promotes pubescent descent of testicles

Derived from internal oblique

Cremaster muscles surround the spermatic cord all the way to testes

227
Q

WHAT IS CREMASTER REFLEX AND WHY USED?

A

CREMASTER REFLEX CAN MEASURE LUMBAR NERVE CONDUCTION IN INJURY

WHEN INNER THIGH IS STROKED, SENSORY

FIBERS ALONG FEMORAL BRANCH OF GENITOFEMORAL NERVE (NERVE ROOTS L1/L2)

AND ILIOINGUINAL NERVE (T12/L1) ARE STIMULATED

THESE SYNAPSE IN SPINAL CORD TO ACTIVATE MOTOR FIBERS OF GENITAL BRANCH (L1/L2) OF GENITOFEMORAL NERVE

CREMASTER THEN CONTRACTS AND ELEVATES THE TESTES

228
Q

_________artery»»>________artery»»»anterior scrotal arteries

A

Common femoral artery»>deep external pudendal artery»>anterior scrotal arteries

229
Q

______artery&raquo_space;>_____artery»>posterior scrotal arteries

A

Internal pudendal artery»>Perineal artery»>posterior scrotal arteries

230
Q

What is function of panpiniform plexus?

A

cool blood and keep testicles right temperature

231
Q

Right testicular vein drains to____

232
Q

Left testicular vein drains to?

A

left renal vein and then IVC

233
Q

What is testicular varicocele?

A

Dilation of panpiniform plexus

Can cause fertility issues due to loss of thermoregulation

Caused by malfunction of venous valves, renal problems, nutcracker syndrome

234
Q

Why does testicular varicocele occur more often the left side?

A

Because Superior Mesenteric Artery can clamp down on left renal vein
Nutcracker syndrome

235
Q

Layers of scrotum

A

Skin
Dartos fascia
external spermatic fascia
cremaster muscle
internal spermatic fascia
tunica vaginalis
tunica albuginea

236
Q

Tunica vaginalis encloses

A

epididymis and testis

237
Q

What is Patent Processus Vaginalis?

A

normally the tunica vaginalis of testis forms with closure of peritoneal sac. If the peritoneum sac never closes this leaves a clear opening in the abdominal cavity where intestines or fluid can enter scrotum

238
Q

WHAT IS A TESTICULAR HYDROCELE?

A

ACCUMULATION OF SEROUS, CLEAR FLUID BETWEEN PARIETAL AND VISCERAL LAYERS OF TUNICA VAGINALIS CAUSED BY DRAINAGE OR KIDNEY PROBLEM

239
Q

HOW DO YOU DIAGNOSE TESTICULAR HYDROCELE?

A

SHINE A LIGHT THROUGH TESTICLES IN DARK ROOM TO SEE IF THEY LIGHT UP»> RED GLOW/TRANSLUCENT COLOR INDICATES PRESENCE OF FLUID

240
Q

IF TESTING FOR A HYDROCELE AND TESTICLES DO NOT LIGHT UP (SO APPEAR OPAQUE), WHAT ARE POSSIBLE DIAGNOSES?

A

TESTICULAR CANCER
HEMATOCELE
HERNIA
INFECTION

241
Q

What is function of the epididymis?

A

site of sperm maturation and storage

242
Q

The seminiferous tubules are divided into lobules of the testis and have ducts running to the head of the epididymis. What is function of the seminiferous tubules?

A

Sperm production

243
Q

WHAT LYMPH NODES DO THE TESTES DRAIN DIRECTLY INTO?

A

LATERAL LUMBAR AORTIC NODES (AKA PARAAORTIC)

244
Q

What is gubernaculum?

A

strong ligament between the tunica vaginalis and tunica albuginea which aids in pulling testicles from abdominal cavity through superficial ring into scrotal sac during development

245
Q

A patient with cryptorchidism is at increased risk of?

A

testicular cancer

246
Q

Testicular cancer is most common in what demographic ?

A

males aged 15-35

247
Q

What is femoral hernia?

A

hernia below the inguinal ligament into femoral canal

248
Q

What is the most common hernia?

A

Inguinal hernia (90%)

249
Q

What is inguinal hernia?

A

hernia of small intestine or fat enters inguinal canal and occurs ABOVE inguinal ligament

250
Q

WHAT IS RELATIONSHIP OF A DIRECT INGUINAL HERNIA TO THE INFERIOR EPIGASTRIC ARTERY?

A

A DIRECT INGUINAL HERNIA RUNS MEDIAL TO THE INFERIOR EPIGASTRIC ARTERY

251
Q

WHERE IS PATH OF DIRECT INGUINAL HERNIA?

A

IN HESSELBACH’S TRIANGLE

GOES ONLY THROUGH THE SUPERFICIAL RING AND DOES NOT GO INTO THE SPERMATIC CORD

252
Q

WHAT ARE CAUSES OF DIRECT INGUINAL HERNIA?

A

USUALLY DEVELOPS IN ADULTS/ELDERLY

MAY BE DUE TO HEAVY LIFTING AND WEAK ABDOMINAL WALL

253
Q

WHAT IS INDIRECT INGUINAL HERNIA RELATIONSHIP TO INFERIOR EPIGASTRIC ARTERY?

A

INDIRECT INGUINAL HERNIA RUNS LATERAL TO INFERIOR EPIGASTRIC ARTERY

254
Q

WHAT IS PATH OF INDIRECT INGUINAL HERNIA?

A

GOES THROUGH THE DEEP AND SUPERFICIAL RINGS INOT SPERMATIC CORD AND SCROTUM

255
Q

WHAT ARE CAUSES OF INDIRECT INGUINAL HERNIA?

A

USUALLY CONGENITAL

ANY AGE, COMMON IN YOUNG CHILDREN/BABIES

MAY BE DUE TO PATENT OR REOPENED PROCESSUS VAGINALIS

256
Q

Rectus abdominis function

A

main flexor of trunk

257
Q

Rectus abdominis is supplied by what artery?

A

Inferior epigastric artery

258
Q

Pyramidalis is supplied by what artery ?

A

Inferior epigastric artery

259
Q

What is McBurney’s point?

A

McBurney’s point is in the RLQ and is the point of maximal tenderness in appendicitis

260
Q

What is the specific location of McBurney’s point?

A

1/3 of the way from anterior superior iliac spine to umbilicus

261
Q

GI tract from mouth to anus

A

Mouth
Pharynx
Esophagus
Stomach
Duodenum
Jejunum
Ileum
Cecum and appendix
Ascending colon
Hepatic (right) flexure
Transverse colon
Splenic (left) flexure
Descending colon
Sigmoid colon
Rectum
Anus

262
Q

How is pain felt in Parietal peritoneum?

A

Parietal peritoneum is sensitive to pain, pressure, heat, and cold

Pain is well-localised/acute to exactly where it is coming from (somatic nerves)

263
Q

How is pain felt in visceral peritoneum?

A

Visceral peritoneum is insensitive to touch, heat, cold, and laceration

Pain is NOT localised and is referred to the dermatomes of the spinal ganglion providing the sensory fibers (visceral afferent nerves)

264
Q

Where is pain first felt in appendicitis?

A

Vague, dull periumbilical (T10) visceral pain

265
Q

What is the Epiploic foramen of Winslow?

A

The epiploic foramen, also called the foramen of Winslow, is a small vertical passage between the greater sac (peritoneal cavity proper) and the lesser sac (omental bursa), allowing communication between these two spaces.

266
Q

What structure forms the anterior wall of the epiploic foramen of Winslow?

A

Hepatoduodenal ligament

267
Q

What are intraperitoneal organs and list them?

A

Intraperitoneal organs have a mesentery suspending them from the abdominal wall

Liver and gallbladder
Spleen
Stomach
Duodenum (1st part)
Jejunum
Ileum
Transverse colon
Sigmoid colon
Tail of pancreas

268
Q

What are secondarily retroperitoneal organs and list?

A

Secondarily retroperitoneal organs are ones whose mesentery fuses to posterior abdominal wall

Duodenum (besides 1st part)
Ascending colon
Descending colon
Upper rectum
Pancreas (except tail)

269
Q

What are retroperitoneal organs and list?

A

Retroperitoneal organs are not covered by visceral peritoneum and not connected by mesentery

Esophagus (thoracic portion)
Anal canal
kidneys
Adrenal glands
ureters
IVC
aorta

270
Q

What are sub peritoneal organs and list?

A

Subperitoneal organs lie inferior to the peritoneal cavity

Lower rectum
bladder

271
Q

What is the Kocher Maneuver?

A

Kocher maneuver is a dissection of the avascular lateral peritoneal attachments of the duodenum in order to visualise the posterior duodenum, pancreas, and retroperitoneal structures

272
Q

What is mesentery?

A

Mesentery is double layered extensions of visceral peritoneum that results from invagination of organs into peritoneum

273
Q

What is omentum?

A

omentum is an extension of mesentery from the stomach that hangs down from stomach and divides into the greater and lesser momentum

274
Q

Mnemonic to remember retroperitoneal abdominal organs

A

SAD PUCKER

Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (except first part)
Pancreas (head and body)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum (mid-distal)

275
Q

What are three parts of Greater omentum?

A

Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament (stomach to transverse colon)

276
Q

What is lesser omentum?

A

Visceral peritoneum that extend superiorly from lesser curvature of stomach to the porta hepatis of liver

277
Q

Lesser omentum contains what two ligaments?

A

Hepatogastric ligament
Hepatoduodenal ligament

278
Q

What is Foramen of Winslow (aka epiploic foramen)?

A

formed by right border of lesser omentum and opens into the lesser sac (omental bursa)

279
Q

What is Pringle manurer?

A

When the hepatoduodenal ligament (and portal triad) is clamped surgically to slow blood flow to the liver

280
Q

What structures are contained in the portal triad?

A

Portal Vein
Hepatic artery
Bile duct

281
Q

What is a peritoneal recess?

A

a pouch that formed by a peritoneal fold

282
Q

Where is subphrenic space located?

A

between diaphragm and liver

283
Q

What divides the right and left subphrenic spaces?

A

Falciform ligament

284
Q

What allows communication between the greater and lesser sacs?

A

Epiploic foramen of Winslow

285
Q

What is another name for lesser sac?

A

omental bursa

286
Q

What is special about the hepatorenal recess?

A

rich in lymphatics

Fluid accumulates here when supine

Infections spread easily through here because of contact with peritoneal fluid and lymphatic system

287
Q

What are paracolic gutters?

A

found on either side of ascending and descending colon

moves fluid superiorly, especially when laying down

288
Q

What is the function of the Right Lateral Paracolic gutter?

A

Directly connects pelvic cavity to hepatorenal recess and thus transmits things between these two areas easily
-spread of infection or disease
-if appendix/diverticulum is ruptured or there is an absence in pelvis, spreads very fast throughout body via lymph

Reabsorpiton of peritoneal fluids

289
Q

How is liver connected to anterior abdominal wall?

A

Falciform ligament

290
Q

Where does the esophagus enter the abdomen?

A

Esophagus enters the abdomen at the esophageal hiatus at T10

291
Q

What sphincter prevent food from refluxing into airways?

A

Upper esophageal sphincter

292
Q

Stomach produces ______ and releases into duodenum

293
Q

What two chemicals are produced in stomach and by what cells?

A

Parietal cells-HCL

Chief cells-Pepsinogen

294
Q

What’s the part of the stomach that contacts esophagus called?

295
Q

What’s the part of the stomach that the dilated superior part of stomach beneath left diaphragmatic dome and above the cardiac notch ?

296
Q

How does fundus of stomach tend to appear on radiograph?

A

Fundus appears black due to ingested air while standing

297
Q

What part of stomach accumulates food (starts digestion)?

A

Pyloric antrum

298
Q

Which part of the stomach ends in thick muscular layer (pyloric sphincter)?

A

Pyloric canal

299
Q

Unlike the rest of GI tract (which have 2 layers), the stomach has 3 muscle layers. Name them

A

Outer longitudinal layer
Middle circular layer
Innermost oblique layerWh

300
Q

Which layer of the stomach is unique to the stomach and what is its function?

A

Innermost oblique layer churns up contents

301
Q

What sits in the C-shaped part of duodenum?

A

head of pancreas

302
Q

What type of glands found in duodenum?

A

Brunner’s glands secrete mucus and protect against acidic chyme

303
Q

Function of duodenum?

A

receive and neutralize acidified chyme with bicarbonate produced from pancreas

304
Q

Which part of the duodenum is most susceptible to ulceration and why?

A

1st part (superior) because lack of Brunner’s glands

305
Q

What is one of the few things absorbed by duodenum?

306
Q

What structures are found in the 2nd part (descending/vertical) duodeum?

A

Major and minor duodenal papillae

307
Q

What does the major duodenal papilla contain?

A

Ampulla of Vater (hepatopancreatic) and the surrounding Sphincter of Oddi

308
Q

What is the ampulla of Vater

A

junction of common bile duct and pancreatic duct

309
Q

What anatomical features do the 2nd-4th part of duodenum have that the 1st doesn’t?

A

Plicae circulares which are permanent circular transverse mucosal membrane folds that don’t expand (increase surface area)

310
Q

What is the ligament of Treitz?

A

triangular suspensory ligament of peritoneum that marks the division between duodenum and jejunum and maintains the bent angle of duodenaljejunal junction

311
Q

How does jejunum appear on X-ray?

A

feathery due to taller plicae circulares

312
Q

How does ileum appear on X-ray?

A

sausage appearance because fewer and shorter place circulares

313
Q

Jejunum has _______________ than ileum

A

Jejunum has less encroaching mesentery/fat than ileum

Jejunum has more vascular, pinker or deeper red collar than ileum

314
Q

Where are Peyers patches found?

315
Q

WHAT IS MECKEL’S DIVERTICULUM?

A

OUTPOUCHING OF ILEUM AND REMNANT OF YOLK STALK

316
Q

WHERE IS MECKEL’S DIVERTICULUM FOUND AND WHAT IS RULE OF 2’S?

A

FOUND ON THE ANTIMESENTERIC BORDER OF ILEUM

2 INCHES LONG
2 FEET FROM ILEOCECAL JUNCTION
2X MORE COMMON IN MALES
FOUND IN 2% POPULATION
2 TYPES ECTOPIC MUCOSA (GASTRIC AND PANCREATIC)

317
Q

WHAT ARE POSSIBLE COMPLICATIONS OF MECKEL’S DIVERTICULUM?

A

GASTRIC MUCOSA CAN FORM ULCERS

CAN BECOME INFLAMED AND CAUSE DIVERTICULITIS WITH SYMPTOMS SIMILAR TO APPENDICITIS

318
Q

Watery, nutrient poor material from ileum empty into?

A

cecum via ileocecal valve

319
Q

WHAT IS DIFFERENCE IN ARCADES BETWEEN JEJUNUM AND ILEUM

A

JEJUNUM HAS SIMPLER ARCADES

ILEUM HAS MULTIPLE COMPLEX ARCADES

320
Q

WHICH HAS A LARGER DIAMETER, JEJUNUM OR ILEUM?

A

JEJUNUM HAS LARGER DIAMETER

ILEUM HAS SMALLER DIAMETER

321
Q

WHAT IS DIFFERENCE IN PLICA CIRCULARES BETWEEN JEJUNUM AND ILEUM?

A

JEJUNUM HAS DENSE AND TALL PLICA CIRCULARES

ILEUM HAS FEW AND SHORT PLICA CIRCULARES

322
Q

WHAT IS DIFFERENCE IN VASA RECTA BETWEEN JEJUNUM AND ILEUM

A

JEJUNUM HAS LONG VASA RECTA

JEJUNUM HAS SHORT VASA RECTA

323
Q

WHAT IS DIFFERENCE IN ENCROACHING MESENTERY/FAT BETWEEN JEJUNUM AND ILEUM?

A

JEJUNUM HAS LESS ENCROACHING MESENTERY/FAT

ILEUM HAS MORE ENCROACHING MESENTERY/FAT

324
Q

WHAT IS DIFFERENCE BETWEEN VASCULARIZATION OF JEJUNUM VS ILEUM?

A

JEJUNUM IS MORE VASCULAR (PINKER)

ILEUM IS LESS VASCULAR (BROWNER)

325
Q

What is function of large intestine?

A

absorb water and salt (Na, Cl, K)

2L of water from ileum&raquo_space;>200 mL of water content in feces

secrete mucus

produce and store compact stool

326
Q

What part of the large intestine forms the top two corners of the frame of small intestine?

A

Left Colic Flexure
Right Colic flexure

327
Q

What is another name for Left Colic Flexure?

A

Splenic flexure

328
Q

What is another name for Right Colic flexure?

A

Hepatic flexure

329
Q

Splenic flexure can be used as a reference point for what?

A

Point at which parasympathetic innervation switches from vagus to pelvic splanchnic

330
Q

what is a watershed region?

A

A watershed zone lies on the edges of two different areas of blood circulation each supplied by a main artery on the opposite side of where the watershed zone sits. The tiny overlap between the two areas is the watershed zone. Because that zone is the farthest away from each of the main arteries that feeds it, the zone has the weakest blood flow in both directions.
“A watershed zone is very vulnerable. It relies heavily on both those areas to function well, and if something goes wrong and the blood supply is diminished, then it’s very vulnerable to infarction or damage from loss of blood flow,” says Scott. The eye and the brain are not the only organs with watershed zones; they exist in the kidneys and in the intestines as well.

331
Q

What part of the GI tract is a watershed region and what consequences can this have?

A

Splenic Flexure is a watershed region and is therefore prone to ischemia

332
Q

Where is location of ascending colon?

A

The ascending colon lies on the right side of the abdominal cavity,

333
Q

WHERE IS MCBURNEYS POINT AND WHAT CAN BE PALPATED THERE?

A

APPENDIX CAN BE PALPATED HERE

1/3 OF WAY FROM ANTERIOR SUPERIOR ILIAC SPINE (ASIS) TO UMBILICUS

334
Q

WHAT IS THE MOST COMMON POSITION OF THE APPENDIX IN RELATION TO CECUM?

A

RETROCECAL

335
Q

What part of the colon is most likely to develop volvulus if too long?

A

Sigmoid colon because it is fairly mobile and therefore can twist on itself if too long

336
Q

What structures in the rectum help support weight of fecal material?

A

3 semicircular rectal folds/valves of Houston

337
Q

What muscles pull the anus up over the exiting feces?

A

Levator ani muscles

338
Q

WHAT IS PSOAS SIGN?

A

PHYSICAL EXAM TEST IN WHICH PATIENT FLEXES THEIR LEG AT THE HIP AGAINST THE RESISTANCE OF THE EXAMINER’S HAND OR THE PATIENT LIES ON LEFT SIDE AND RIGHT LEG IS EXTENDED AT HIP

THIS ACTION TENSES THE RIGHT ILIOPSOAS WHICH MAY BE IRRITATED DUE TO INFLAMED RETROCECAL APPENDIX

339
Q

WHATS A POSITIVE PSOAS SIGN AND WHAT IS THIS INDICATIVE OF?

A

IF PATIENT HAS ANY PAIN IN THE RLQ WITH FORCED HIP FLEXION OR PASSIVE HIP EXTENSION

ACUTE APPENDICITIS

340
Q

What are two causes of peptic ulcer disease in duodenum?

A

Helicobacter pylori
NSAID use

341
Q

What happens with Perforating ulcers in duodenum and where do they occur?

A

Perforating ulcers occur in the anterior wall and cause peritonitis due to food and digestive enzymes entering the peritoneal cavity

342
Q

What happens with Penetrating ulcers and where do they occur?

A

Penetrating ulcers occur in the posterior wall and cause erosion of gastroduodenal artery which can cause upper GI bleeding

343
Q

Damage to the gastroduodenal artery causes?

A

Damage to gastroduodenal artery causes upper GI bleeding

344
Q

Duodenal ulcer relieved by ?

345
Q

Gastric ulcer relieved by?

A

lying down, vomiting

346
Q

How long does a duodenal ulcer take to heal?

A

1-2 months

347
Q

How long does a gastric ulcer take to heal?

348
Q

Does vomiting occur in duodenal ulcer?

349
Q

does vomiting occur in gastric ulcer?

A

common (relieves pain)

350
Q

How is appetite with duodenal ulcer?

A

Good, no weight loss

351
Q

How is appetite with gastric ulcer?

A

Poor, weight loss

352
Q

What should patients with gastric ulcer avoid?

A

fried food

353
Q

Stenonis means?

354
Q

What is intestinal atresia?

A

complete obstruction of the lumen due to congenital malformation

355
Q

What is SMA syndrome?

A

SMA syndrome is when the superior mesenteric artery passes over the transverse segment of the duodenum and compresses it leading to compression and lack of normal Gi movement

356
Q

What group of patients are more likely to present with SMA syndrome?

A

Patients with anorexia nervosa or persons with low body fat

Mesenteric fat pads that support the SMA are consumed which shortens the angle between the SMA and aorta

357
Q

What is volvulus?

A

rotation of gut on its mesentery

Sigmoid mesocolon is long and can twist on itself

358
Q

Diverticulitis vs diverticulosis

A

Diverticulitis is inflammation of diverticula

Diverticulosis is presence of multiple small bulging pockets in the GI tract without evidence of infection/inflammation

359
Q

How does diverticulitis present, where does it occur, and how is it prevented?

A

Diverticulitis usually occurs in sigmoid colon

Presents with LLQ abdominal pain

Prevented by consuming fibre

360
Q

WHICH SIDE OF THE BODY IS SIGMOID COLON FOUND?

361
Q

What region is the foregut?

A

epigastric region

362
Q

Where is visceral pain from the liver and gallbladder referred to?

A

right shoulder and upper back

363
Q

Where is visceral pain from the spleen referred to?

A

left shoulder

364
Q

What region is the midgut?

A

periumbilical region

365
Q

ON PE, PATIENT IS GUARDING ABDOMEN? (VOLUNTARILY TENSING ABDOMEN IN ANTICIPATION OF PALPATION)

A

PERITONITIS

366
Q

WHAT IS REBOUND TENDERNESS?

A

PAIN UPON REMOVAL RATHER THAN APPLICATION OF PRESSURE (OFTEN SIGN OF PERITONITIS)

367
Q

WHAT IS ROVSING’S SIGN?

A

Rovsing’s sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen.J

368
Q

MURPHY’S SIGN IS INDICATIVE OF ?

A

CHOLECYSTITIS

369
Q

HOW TO PERFORM TEST FOR MURPHY’S SIGN?

A

Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

370
Q

What is function of phrenicocolic ligament?

A

Connects Left Colic Flexure to diaphragm and blocks peritoneal fluid from reaching subphrenic space

371
Q

What ligament contains the portal triad?

A

Hepatoduodenal ligament

372
Q

What does the falciform ligament do?

A

divides right and left lobes of liver
attaches liver to anterior abdominal wall

373
Q

What does round ligament do?

A

Its the obliterated left umbilical vein

374
Q

Name 3 abdominal arteries that are end arteries

A

Most vasa recta of Gi tract

Splenic artery

Short gastric arteries

375
Q

Name the Great Vessels that come anteriorly off of the aorta

A

Celiac
Superior Mesenteric Artery
Inferior Mesenteric Artery

376
Q

What vertebral level is the Celiac trunk found?

377
Q

What structures does the celiac trunk supply?

A

Embryonic foregut

Esophagus
Stomach
First part of duodenum

378
Q

What are the three main branches of the celiac trunk?

A

Left Gastric artery
Splenic artery
Common hepatic

379
Q

What is the esophageal hiatus?

A

the esophageal hiatus is an opening in the diaphragm through which the esophagus and the vagus nerve pass.

380
Q

Left gastric artery runs along what path and anastomoses with what?

A

Left gastric artery runs along superior portion of lesser curvature of stomach and anastomoses inferiorly with right gastric artery

381
Q

Left gastric artery goes up to the _________ and gives rise to _________

A

Left gastric artery goes up to the esophageal hiatus and gives rise to esophageal branches

382
Q

On xray, which of the celiac branches appears the most curvy?

A

Splenic artery

383
Q

What ligament does the splenic artery travel within ?

A

Splenorenal ligament

384
Q

Short gastric arteries supply?

A

Fundus of stomach

385
Q

What are the branches of the Splenic artery?

A

Short gastric arteries
Left Gastroepiploic
Pancreatic branches

386
Q

Left Gastroepiploic artery supplies?

A

Superior portion of greater curvature of stomach and greater omentum

387
Q

Left gastroepiploic anastamoses with what inferiorly?

A

Right Gastroepiploic

388
Q

Common Hepatic artery runs to patient’s right then splits into?

A

Hepatic Artery Proper
Gastroduodenal artery

389
Q

Hepatic Artery Proper gives off what branch at the same time splits into right and left hepatic arteries?

A

Right gastric artery

390
Q

Damage to Hepatic Artery Proper can cause?

A

damage to biliary tree

391
Q

What are branches of the Gastroduodenal artery?

A

Right Gastroepiploic artery
Superior Pancreaticoduodenal artery

392
Q

Superior Mesenteric Artery is found at what vertebral level?

393
Q

Superior Mesenteric Artery supplies what structures?

A

Midgut

Duodenum (except first part)

Small intestine

Cecum

Ascending colon and first 2/3 of transverse coon

394
Q

SMA SYNDROME

A

SMA constricts duodenum which causes intestinal obstruction

395
Q

Name 5 branches of the Superior Mesenteric Artery

A

Inferior Pancreaticoduodenal artery

Jejunal and Ileal branches

Right Colic Artery

Middle Colic Artery

Ileocolic Artery

396
Q

Inferior pancreaticoduodenal artery anastomoses with __________ which branches from ________

A

Inferior pancreaticoduodenal artery anastomoses with Superior Pancreaticoduodenal artery which branches from the Gastroduodenal Artery

397
Q

Right Colic artery supplies?

A

Supplies ascending colon

398
Q

Middle Colic artery supplies?

A

Supplies mesentery of transverse colon (and in some people the splenic flexure)

399
Q

Middle Colic Artery anastomoses with ____________ to prevent ischemia

A

Middle Colic Artery anastomoses with Left Colic artery

400
Q

What are branches of the Ileocolic artery ?

A

Anterior cecal artery
Posterior cecal artery
Appendicular artery
Colic (ascending branch) artery
Iliac (descending branch) artery

401
Q

Inferior Mesenteric Artery is found at what vertebral level?

402
Q

What structures does the Inferior Mesenteric Artery supply?

A

Embryonic hindgut
Last 1/3 of transverse colon
Descending colon
sigmoid colon
Rectum
upper 1/2 of anus

403
Q

What are the three main branches of the Inferior Mesenteric Artery?

A

Left Colic Artery
Sigmoid Artery
Superior Rectal artery

404
Q

Left colic artery anastomoses with _______

A

Middle colic artery of SMA

405
Q

ALL LYMPHATICS OF THE GREAT VESSELS AND THEIR BRANCHES DRAIN TO

A

LYMPH NODES OF THEIR GIVEN NAME

406
Q

What is the Marginal Artery (of Drummond)?

A

Collection of anastomoses of the branches of the mesenteric arteries that runs parallel to the entire length of the inner border of the colon

Provides collateral circulation between middle colic artery (SMA) and left colic artery (IMA)

407
Q

_______ is occluded in 50% of men over 50

408
Q

WHEN SMA OR IMA IS OCCLUDED IN PATIENTS WITH ATHEROSCLEROSIS, WHAT HAPPENS?

A

WEAK AREAS OF THE MARGINAL ARTERIES CAN BECOME OCCLUDED LEADING TO ISCHEMIA

409
Q

What happens if the vasa recta of Gi tract damaged?

A

Ischemia and infarct can happen because vasa recta are end arteries

410
Q

What is function of the Portal venous system?

A

transport deoxygenated, nutrient rich blood from GI tract to liver where it is processed and dumped in to the IVC

411
Q

What is function of the sinusoids in liver?

A

Sinusoids are specialised capillaries that filter the blood and then drain the portal vein branches and the hepatic duct branches into hepatic veins

412
Q

What happens if you lose the portal vein?

A

necrosis of liver

hepatocytes survive from the blood perfused from portal vein

413
Q

What 3 veins come together to form Portal Vein?

A

Splenic Vein
Superior Mesenteric Vein
Inferior Mesenteric Vein

414
Q

What provides VENOUS return of the foregut?

A

Splenic vein

415
Q

What provides VENOUS return of the midgut?

A

Superior Mesenteric vein

416
Q

What provides VENOUS return of the hindgut?

A

Inferior Mesenteric vein

417
Q

Where is the portal vein located in hepatoduodenal ligament ?

A

Posterior to hepatic artery and bile duct

418
Q

Does the portal vein have valves?

A

Portal vein VALVELESS

419
Q

What can you access if you put finger in Foramen of Winslow?

A

lesser sac
hepatic pedicle (bile duct, hepatic arteries, portal veins)

420
Q

Where is the Triangle of Calot located and why is it important in surgery?

A

Triangle of Calot is located between the bifurcation of right and left bile ducts and lower edge of liver

It is important in surgery because the cystic artery is located inside the triangle

421
Q

Blood from the Superior Mesenteric VEIN flow to what side of liver?

A

Right side

422
Q

Blood from Inferior Mesenteric VEIN and Splenic VEIN flow to what side of liver?

423
Q

Which lobe of liver is larger?

A

Right love of the liver is larger

424
Q

Right and left lobes of liver are divided by ______ which originates at the level of the _______

A

Right and left lobes are divided by falciform ligament which originates at level of the round ligament

425
Q

Name the anatomical lobes of liver

A

Right lobe
Left lobe
Caudate lobe
Quadrate lobe

426
Q

What structures are found in the left sagittal fissure of the liver?

A

ligmanetum venosum

ROUND LIGAMENT (AKA LIGAMENTUM TERES)

427
Q

THE ROUND LIGAMENT OF THE LIVER
(LIGAMENTUM TERES) IS THE FETAL REMNANT OF ?

A

LEFT UMBILICAL VEIN

428
Q

What structures are found in the Transverse fissure of the liver?

A

Structures that run in the hepatoduodenal ligament
Portal triad
Hepatic arteries
Portal vein
Bile duct

429
Q

Caudate lobe of the liver sits against _________

430
Q

What is Coronary ligament of the liver?

A

Coronary ligament of the livers is located along superior edge of liver and connects liver to diaphragm

431
Q

Blood comes from the _____ and _____ through the liver _______ to the _______ which empties into ______

A

Blood comes from the portal vein and hepatic artery through the liver sinusoid to the hepatic veins which empties into IVC

432
Q

What are components of Hepatic/Portal triad?

A

Bile ducts
Portal Vein
Hepatic artery

433
Q

If a liver lobe is supplied by _______, it is a right FUNCTIONAL lobe

A

If a lobe is supplied by right hepatic artery, it is a right functional lobe

434
Q

Which lobe of the liver is neither left or right functional lobe?

A

Caudate because it receives blood from both the right and left hepatic arteries

435
Q

Hepatic arteries, hepatic duct, and portal vein are ____________segmental

A

Hepatic arteries, hepatic duct, and portal vein are INTRAsegmental

436
Q

Each segment of the liver has its own _____

437
Q

Hepatic veins are _______segmental

A

hepatic veins are intersegmental

438
Q

Hepatoduodenal ligament connects the liver to the first part of the duodenum in the lesser omentum and contains the portal triad. List the components of the portal triad from anterior to posterior

A

BIle duct
hepatic artery
portal vein

439
Q

What lies behind the hepatoduodenal ligament ?

A

Foramen of Winslow

440
Q

What is Pringle Maneuver?

A

When the hepatoduodenal ligament (and therefore portal triad) is clamped to prevent blood flow from the portal vein and hepatic artery

441
Q

Function of gallbladder?

A

store, concentrate, and release bile made by liver

442
Q

Why is gallbladder pain well-localised?

A

The gallbladder contact the anterior abdominal wall and cholecystitis inflames the parietal peritoneum there

443
Q

What sign is positive for cholecystitis?

A

positive Murphy’s sign

444
Q

How perform Murphys sign?

A

Palpate area of the gallbladder and ask the patient to take a breath. If the patient shows pain upon inspiration (Parietal peritoneum touches the palpation upon inspiration since goes up), positive Murphy sign

445
Q

Gallbladder drapes over what two organs?

A

duodenum
transverse colon

446
Q

Which lobe of the liver is the gallbladder found?

447
Q

Which arteries responsible for biliary tree?

A

hepatic arteries

448
Q

What’s the course of the common bile duct?

A

Enters through neck of pancreas
Exits through head of pancreas
Ampulla of Vater
Sphincter of Oddi
Major Duodenal Papilla
Duodenum

449
Q

What is Ampulla of Vater?

A

dilation distal to the junction of Common bile duct and Pancreatic duct

450
Q

What is function of Sphincter of Odds?

A

controls opening from ampulla of Vater to major duodenal papilla

451
Q

THE MAJOR DUODENAL PAPILLA OPENS FROM THE SPHINCTER OF ODDI INTO WHAT PART OF DUODENUM?

A

2ND PART OF DUODENUM

452
Q

What is the spiral valve of Heister?

A

The spiral valve of Heister is a bidirectional spiral valve that allows the lumen of the cystic duct to remain open for bile to both enter and exit

453
Q

What structure is found within Triangle of Calot?

A

cystic artery

454
Q

What forms borders of Triangle of Calot?

A

Common hepatic duct
Cystic duct
Inferior border of the liver

455
Q

What organ can also be damaged if there is duodenal ulcer?

A

head/neck of pancreas

456
Q

Pancreas lies _____ to stomach

A

Pancreas lies posterior to stomach

457
Q

Painless jaundice in older adults is a sign of what ? What causes it?

A

Pancreatic cancer

When cancer is in the head of the pancreas, common bile duct gets obstructed near the ampulla of Vater resulting in jaundice

458
Q

What type of structure is Pancreas (except for tail)?

A

Secondary retroperitoneal structure

459
Q

Four signs of portal hypertension

A

caput medusae (umbilical vein)
esphogeal varices- 1st sign cirrhosis
haemorrhoids (IMV)
splenomegaly (splenic vein)

460
Q

WHERE IS SPLEEN LOCATED?

A

SPLEEN IS LOCATED IN LEFT MIDAXILLARY LINE AT THE LEVEL OF T10

461
Q

Is spleen palpable in healthy individuals?

A

no, only palpable with spenomegaly

462
Q

Splenorenal ligament connects ?

A

Splenorenal ligament connects spleen to left kidney

463
Q

WHAT STRUCTURES DOES THE SPLENORENAL LIGAMENT CONTAIN?

A

TAIL OF PANCREAS
SPLENIC ARTERY

464
Q

WHAT IS THE MOST COMMONLY DAMAGED ORGAN DURING BLUNT TRAUMA LIKE A CARWRECK?

465
Q

WHAT IS THE MOST COMMON CAUSE OF RUPTURE TO THE SPLEEN?

A

INJURY TO THE SPLENORENAL LIGAMENT

466
Q

What is Abdominal Aortic Aneurysm ?

A

Enlargement of abdominal aorta

Can rupture leading to internal bleeding

467
Q

What is Splenic Infarction?

A

Splenic tissue necrosis due to damage to splenic artery (end artery)

468
Q

What is Ischemic colitis?

A

Normally effects Left Colic artery/Left Splenic Flexure (aka Left Colic Flexure)
watershed region

also can affect Ileocolic jxn and rectosigmoid jin

469
Q

What does Splenic Infarction look like on CT?

A

Spleen will be darker overall or in one area compared to rest of spleenI

470
Q

_______NERVE INNERVATION STOPS AT SPLENIC FLEXURE (LEFT COLIC FLEXURE) AND THEN DISTALLY TO THE SPLENIC FLEXURE IS SUPPLIED BY ________ NERVES

A

VAGUS NERVE INNERVATION STOPS AT SPLENIC FLEXURE (LEFT COLIC FLEXURE)

DISTAL TO SPLENIC FLEXURE IS SUPPLIED BY PELVIC SPLANCHNICS

471
Q

SPLENIC FLEXURE IS PART OF HINDGUT SO DOMINANTLY SUPPLIED BY ______ WITH SOME ANASTOMOSIS FROM _______

A

LEFT COLIC ARTERY

MIDDLE COLIC ARTERY

472
Q

What is Mesenteric Ischemia and which structures most often affected?

A

Atherosclerosis can occlude mesenteric arteries leading to ischemia

SMA is most often affected followed by SMV

SMV occlusion causes venous thrombosis leading to necrosis

473
Q

WHAT IS PORTAL HYPERTENSION?

A

INCREASED PRESSURE IN PORTAL VENOUS SYSTEM

474
Q

ETIOLOGY OF PORTAL HYPERTENSION?

A

BACKFLOW IN THE PORTAL SYSTMEN LEADS TO SHUNTING OF VENOUS BLOOD TO THE SPLENIC VEINS, SMV, AND IMV WHICH IS POSSIBLE SINCE PORTAL VEINS DON’T HAVE VALVES

475
Q

What are causes of Post-hepatic hypertension?

A

Obstruction of hepatic vein
thrombosis
compression

Blood cannot pass into IVC

476
Q

What are causes of Intra-hepatic hypertension (most common)

A

Obstruction of liver sinusoids
Cirrhosis

477
Q

What are causes of Pre-hepatic hypertension?

A

Obstruction of portal tributaries that lead into the liver (by pancreatic tumour)

Blood cannot enter the liver

478
Q

WHY DO YOU GET HEMATEMESIS WITH PORTAL HYPERTENSION?

A

INJURY TO SWOLLEN ESOPHAGEAL VEIN

479
Q

WHY DO YOU GET INTERNAL HEMORRHOIDS WITH PORTAL HYPERTENSION?

A

PAINLESS BLEEDING FROM SWOLLEN SUPERIOR RECTAL VEIN

480
Q

WHAT CAUSES SPLENOMEGALY WITH PORTAL HYPERTENSION?

A

ENLARGEMENT OF SPLENIC VEIN

481
Q

WHAT ARE TWO TREATMENTS (TREATS SYMPTOMS) FOR PORTAL HYPERTENSION?

A

PORTACAVAL SHUNT

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

GAR (11 decks)

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