Peritoneum/Foregut/Pancreas Flashcards
what is a mucous plug & why is it important?
-blocks external opening of uterus -prevents infection but allows sperm to pass
what is the serosa?
covering of peritoneum
what is peritonitis?
bacterial contamination during surgery or trauma after a rupture of the peritoneal cavity
what is general peritonitis?
occurs when an ulcer perforates wall of stomach or duodenum; spills acid into peritoneal cavity
excess fluid in peritoneal cavity?
ascitic fluid
what is paradoxical abdominothoracic rhythm?
-abdomen drawn in during chest expansion -indicates peritonitis or pneumonitis
what is an adhesion?
scar tissue
what is a volvulus?
when intestine becomes twisted around adhesion and causes chronic pain or intestinal obstruction
what is an adhesiotomy?
surgical separation of adhesions
what is a paracentesis?
surgical puncture of peritoneal cavity for aspiration or drainage of fluid
where would a needle for paracentesis go?
-anterolateral abdominal wall into peritoneal cavity through linea alba -superior to empty urinary bladder to avoid inferior epigastric artery
what is an intraperitoneal injection used for?
anesthetic to peritoneal cavity because peritoneum is a semipermeable membrane (rapid uptake)
what is peritoneal dialysis?
removal of excess water and solutes from blood (because of renal failure) by transfer across peritoneum
what is the function of the greater omentum?
-prevents visceral peritoneum from adhering to parietal peritoneum -makes adhesions around diseased viscera
what is an abscess?
formation of pus because of duodenal ulcer perforation, rupture of gall bladder, or perforation of appendix
why are the peritoneal recesses of clinical importance?
they determine extent and direction of fluid spread during infection or disease of an organ
what are paracolic gutters?
lateral attachments of ascending/descending colon to posterolateral abdominal wall
why are paracolic gutters important?
provide pathway for ascitic fluid flow and spread of infection and cancer
how can fluid get into the omental bursa?
perforation of posterior wall of stomach and inflamed pancreas
if part of the intestine perforates into the omental foramen, why can’t you simply cut the boundaries of the foramen?
all boundaries have blood vessels, so the intestine must be emptied with a needle and put back in place
what is a cholecystectomy and what artery must be ligated during it?
-gall bladder removal -cystic artery
what is the most frequently injured organ in the abdomen?
spleen (ex: ruptured spleen from trauma)
how is a ruptured spleen treated?
repair is difficult, so splenectomy is preferred
what’s important about a sub-total (partial) splenectomy?
rapid regeneration
what are the side effects of splenectomy?
no major side effects; higher risk for bacterial infection
what is splenomegaly and when does it happen?
-enlargement of spleen -side effect of granulocytic leukemia & anemia
what is clinical important about an accessory spleen?
if not detected & removed during splenectomy, symptoms may still persist
what’s important about the relationship of the costodiaphragmatic recess and the spleen?
splenic needle biopsy and splenoportography can cause pleuritis if material enters the CD recess during these procedures
where is an important blockage site of a gallstone?
gallstones can lodge into hepatopancreatic ampulla and cause backup of bile and pancreatic juices
what causes pancreatitis?
bile backup from gallstone that enters pancreatic duct (normally prevented by hepatopancreatic sphincter)
what is endoscopic retrograde cholangiopancreatography used for?
diagnosis of pancreatic and biliary disease
where is accessory pancreatic tissue likely to develop and what’s its importance?
- stomach and duodenum
- can produce insulin and glucagon
what is removed during a pancreatectomy?
the body and tail of the pancreas (can’t remove entire head)
other than diabetes, what other major problem can occur with the pancreas?
rupture of the pancreas due to trauma, which can cause pancreatic juice to enter parenchyma & invade other tissues
what’s the major cause of extrahepatic obstruction of biliary ducts?
cancer of the pancreatic head
an enlarged gallbladder and jaundice most likely indicates?
cancer of the pancreatic head
cancer of the pancreatic neck & body can cause?
obstruction of inferior vena cava and hepatic portal vein
why is pancreatic cancer so difficult to control/detect?
the pancreas lymph drains to relatively inaccessible lymph nodes and it metastastizes to liver via hepatic portal vein
where are subphrenic abscesses likely to be?
right side subphrenic recess because of ruptured appendices and perforated duodenal ulcers
where is a subphrenic abscess drained?
incision inferior to or through the bed of the 12th rib (unnecessary to cut pleura or peritoneum)
what is the relevance of the fact that the left and right hepatic arteries/veins/ducts do not communicate?
hepatic lobectomies can be done with little bleeding
damage to the liver or cancer of the liver can be removed by?
hepatic segmentectomies (must use ultrasound to detect individual segments)
what is common source of aberrant right hepatic artery? left?
- right: superior mesenteric artery
- left: left gastric artery
in most people, the right hepatic artery crosses ___________ to hepatic portal vein?
anterior
in most people, the right hepatic artery crosses _________ to common hepatic duct
posterior
what can cause hepatomegaly?
- congestive heart failure, bacterial and viral diseases such as hepatitis
- metastatic carcinoma
hepatic cirrhosis causes?
- replacement of hepatocytes with fat and fibrous tissue
- portal hypertension
- mostly occurs in alcoholics
how is advanced hepatic cirrhosis treated?
surgical creation of portosystemic or portocaval shunt to anastomose the portal and systemic venous systems
where does a liver biopsy take place?
through right 10th ICS in midaxillary line
what’s clinically important about a mobile gallbladder?
- gallbladder is suspended from liver by mesentary
- subject to vascular torsion and infarction
what is a cholelithiasis made of?
gallstone: cholesterol
why does cholecystitis occur?
blockage of cystic duct via gallstone–> bile accumulation, enlargement of gallbladder
where can gallstones collect in a diseased gallbladder?
abnormal sacculation called Hartmann pouch at junction of neck of gallbladder and cystic duct
what causes a cholecysto-enteric fistula?
- inflamed gallbladder from gallstone can cause adhesions with nearby viscera and break down tissues between them
- duodenum and transverse colon
- gallstone can then enter GI tract & obstruct bowel
where does the cystic artery usually come from?
right hepatic artery in cyctohepatic triangle (calot triangle)
what are the borders of the cystohepatic triangle?
inferior: cystic duct
medially: common hepatic duct
superiorly: inferior surface of liver
varicose veins of lower esophagus indicate?
portal hypertension & caput medusae around umbilicus
how is portal hypertension treated?
- creating anastomose between hepatic portal vein and IVC (portosystemic shunt)
- join splenic vein to left renal vein after splenectomy (spenorenal shunt)
