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SRGRY3 > MNTM > Flashcards

MNTM Flashcards

1
Q

True about the omentum

a. triple sheath of flattened endothelium
b. L side is longer with tongue-like projections
c. has amoboid like activity
d. usually found in areas where there is infection or pathologic process

A

D

a. double sheath of flattened endothelium
b. R side is longer with tongue-like projections
c. no amoeboid like activity

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2
Q

True about the omentum

a. Lesser omentum covers the small intestine like an apron
b. The greater omentum is attached to the colon
c. The portal triad is contained inside the greater omentum.
d. NOTA

A

B.

Greater omentum: double-layered sheet of visceral fibroadipose tissue descending from the greater curvature of the stomach, covering the small intestines, folds back on itself and attaches onto the anterior peritoneum of the transverse colon

Lesser omentum: a.k.a hepatoduodenal + hepatogastric. The portal triad (cbd, portal vein, hepatic artery) is located within the inferolateral margin of the lesser omentum.

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3
Q

Free edge of lesser omentum forms _____ which is used to encircle the portal triad during a pringle manuever

A

foramen of winslow

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4
Q

Describe the Pringle Maneuver

A

A large atraumatic haemostat is used to clamp the hepatoduodenal ligament (free border of the lesser omentum) interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to control bleeding from the liver.

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5
Q

The organ twists along its axis from sudden forceful movements, thrombosis, or vasculitis of omental vessels or omental venous outflow obstruction

a. Primary omental torsion
b. Secondary omental torsion
c. idiopathic segmental infarction
d. cysts

A

A

Secondary causes of torsion are most often due to hernias, tumors, or adhesions.

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6
Q

Abdominal exam findings in omental infarction (2)

A

peritoneal tenderness with a possible palpable mass

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7
Q

Ultrasound findings in omental infarction

A

hyperechoic noncompressible intraabdominal mass attached to the abdominal wall.

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8
Q

CT scan findings of omental torsion

A

streaking whirling pattern of fatty tissue in the anterior abdomen

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9
Q

mild vascular constriction in omental torsion will cause

A

edema

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10
Q

strangulation in omental torsion will cause

A

infarction and eventually frank gangrene

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11
Q

Pre-requisite conditions of torsion (2)

A

redundant and mobile segment

fixed point around which a segment can twist

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12
Q

Predisposing factors of omental torsion except

a. tongue-like/bifid configuration
b. accessory omentum
c. obesity
d. venous redundnacy
e. large and bulky with narrow pedicle

A

NOTA

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13
Q

Precipitating factors of omental torsion (6)

A 
CHHeeSSe
Coughing
Heavy exertion
Hyperperistalsis
Sudden change in body position
Straining
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14
Q

Predisposing factors of omental torsion (5)

A 
VALOT
Venous redundnacy
Accessory omentum
Large and bulky with narrow pedicle
Obesity
Tongue-like/bifid configuration
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15
Q

presents with Torsion with adhesion of the free end to a cyst, tumor, foci of intra-abdominal inflammation, post-op wounds and scarring, int./ ext. hernias

A

Secondary omental torsion

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16
Q

True about secondary omental torsion

a. precipitating factors is same as primary
b. usually unipolar
c. initially causes serosanguinous fluid
d. AOTA

A

A
b. usually bipolar - torsion of central component occur between two fixed points in clockwise manner

c. initially causes restricted venous return, thus congestion, and eventually edema
d. NOTA

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17
Q

Omental torsion usually occurs in what decade of life and gender?

A

4th to 5th decades of life, males

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18
Q

What is the predominant symptom of omental torsion?

A

Pain

19
Q

True about symptoms of omental torsion

a. Movement intensifies the pain
b. Nausea and vomiting in 30%
c. Leukocytosis and high grade fever
d. direct but no rebound tenderness

A

A

b - nausea and vomiting in 50%

c. Leukocytosis and moderate fever
d. direct and rebound tenderness

20
Q

True about diagnostics and management of omental torsion EXCEPT

a. CT is not sensitive but specific.
b. Treatment is Exploratory laparotomy
c. good prognosis

A

A; sensitive but not specific

21
Q

Idiopathic segmental infarction criteria for diagnosis (4)

A

No CATT

Not associated with cardiovascular disease
No local intra-abdominal pathologic conditions
no history of external abdominal trauma
No torsion

22
Q

True of pathology/etiology of idiopathic segmental infarction

a. condition is precipitated by thrombosis of omental vein secondary to endothelial injury
b. stretching or primary rupture of omental vein
c. gravitational pull of extremely fatty omentum
d. anatomic peculiarity of venous drainange

A

AOTA

23
Q

True about clinical manifestation of idiopathic segmental infarction EXCEPT

a. young to middle aged adults, 3:1 male
b. non-specific manifestation
c. usually involves L lower portion
d. well-demarcated, edematous, hemorrhagic or gangrenous involved segment
e. usually adheres to parietal peritoneum or viscera

A

C. R lower portion

24
Q

CT scan finding of Idiopathic segmental infarction

A

Smudged appearance

25
Q

Treatment of Idiopathic segmental infarction

A

Exploratory laparotomy

Resection of infarcted area

Serosanguinous free fluid

26
Q

Cyst from obstruction of lymphatic channels / growth of congenitally misplaced lymphatic tissue that does not communicate with the vascular system

a. Lymphangioma
b. Dermoid
c. Pseudocyst
d. True cyst

A

D

27
Q

Describe a true omental cyst

A

serous fluid, unilocular or multilocular

28
Q

Omental Cyst with endothelial lining

A

Lymphangiona

29
Q

Omental Cyst with sqamous cell lining, hair, teeth, and sebaceous components.

A

Dermoid cyst

30
Q

Omental cyst with fat necrosis, trauma and foreign body reation. Fibrous and inflammatory lining, cloudy/bloody

A

pseudocyst

31
Q

True about omental cysts

a. usually in children, young adults
b. small cysts are asymptomatic
c. large cyst may present as abdominal mass, heaviness, pain
d. complications include torsion, infection, rupture and obstruction
e. diagnosis only at explore lap

A

AOTA

32
Q

clinical manifestations of large omental cysts

A

HAP

Heaviness
Abdominal mass
Pain

33
Q

Complications of omental cyst

4

A

ROTI

Rupture and obstruction
Torsion
Infection

34
Q

Xray findings of omental cysts

A

soft tissue haziness and displaced bowel loops

35
Q

Ultrasound/CT findings of omental cyst

A

fluid filled mass

36
Q

Treatment of omental cyst

A

exploratory laparotomy

Local excision

37
Q

Omental solid tumors - most metastatic carcinoma of the omentum come from (4) primary sites

A

COPS

Colon
Ovary
Pancreas
Stomach

(CSPO)

38
Q

CT scan finding of omental metastatic carcinoma

A

omental cake

39
Q

Primary omental solid tumors are rare, usually in ___ years old

A

50

40
Q

True about omental solid tumors

a. mesodermal in origin
b. 30% malignant
c. benign lesions are usually lipoma, leiomyoma, fibroma, neurofibroma
d. malignant are usually leiomyosarcoma and hemangioendothelioma

A

C.
A. mesenchymal origin
B. 50% malignant
D. Leiomyosarcoma and hemangiopericytoma

41
Q

Tx for benign omental solid tumors

A

Surgical excision

42
Q

Treatment of malignant omental solid tumors

A

Resection of adjacent organs and total omentectomy

43
Q

Palliation omentectomy is usually done to control _____

A

associated ascitis in patients with omental metastases

SRGRY3 (44 decks)

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