Tieman - Clinical Correlations CIS II Flashcards
Course of arterial supply of the appendix (starting from aorta)?
SMA to ileocolic to appendicular branch/artery
Why is the early pain of appendicitis vague and periumbilical and the later pain specific to the right lower quadrant?
Initially it inflames the viscera then continues to become inflamed until it comes into contact with the parietal peritoneum, where it elicits somatic nociceptive fibers
What lays adjacent to the appendix?
Ureter in both male and female
Female:
Male:
What inflamed structures can mimic appendicitis?
Ureters, …
What are the various locations of the appendix relative to the cecum?
Appendix can either be behind the cecum, medial (free peritoneal cavity), lateral along the pelvis, near the obturator nerve, right along the right psoas m., etc. (see variation illustration in Netter’s)
Know variations in position of the vermiform appendix
You can see RUQ pain in a pregnant women that actually has appendicitis
Gangrenous appendicitis
Necrotic; blackish in color
Abd pain with movement?
Peritonitis
“Scalloping” of the bowel…
Edema of the bowel and probably colitis
Ligation of IMA (due to AAA repair) can create ischemic colitis
AAA and ischemic colitis
“Important questions related to anatomy”
Which major artery must be ligated or reimplanted into the graft?
IMA
If the IMA is ligated, how is blood supplied to the distal 1/3 of transverse artery / descending colon?
Marginal artery
What vein runs posterior to the ligament of Treitz (suspensatory ligament of the duodenum)?
Inferior mesenteric vein
How could the patient in case II become paraplegic post surgery?
Anterior spinal artery laceration
Idiopathic thrombocytopenic purpura
splenectomy
Trace the blood supply to and from the spleen, beginning at the aorta and ending in the liver:
Celiac trunk comes off aorta, one of the three branches of the celiac trunk is the splenic artery, this runs just superior to the pancreas, gives off vessels that supply pancreatic head and tail, goes to hilum of the spleen, before this it gives off short gastric which supplies fundus of stomach; splenic vein is joined by inferior mesenteric vein, joins superior mesenteric vein to form the portal vein, which goes on to the liver
What are the two true ligaments of the spleen?
Gastrosplenic (fundus of stomach to spleen), splenorenal (lienorenal; fascia of superior kidney to spleen); sits on “shelf” of phrenicocolic ligament
Which vessels travel through the gastrosplenic ligament and which vessels do they originate from/drain into?
short gastric, arise from splenic
Esophageal varices vs. gastric varices
coronary veins drain into esophageal veins in order to get back to the azygos veins…but in a person who abuses EtOH, you can get gastric varices… how can this be? With several episodes of pancreatitis, you can get a splenic vein thrombosis (due to recurrent inflammation) and pressure backs up into the spleen and into the short gastric vessels which lead to the fundus of the stomach…problem with drainage out of the spleen which causes gastric varices.
In ligating the splenic artery and vein, which adjacent organ must we identify and be careful not to injure?
Pancreas?
If the splenic vein were thrombosed (obstructed), which veins would become dilated (varicose)?
short gastric and splenic
