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Abdomen
Abdomen
74
Medical
Graduate
12/04/2011

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Cards

Term
A blow to the body that fractures certain ribs can lacerate the spleen. Fracture of which ribs poses the greatest danger? (specify side and number)
Definition
left 9-11
Term
What are the different kinds of axons that travel in the anterior and posterior vagal trunks?
Definition
Visceral afferent (sensory) and parasympathetic preganglionic
Term
Where along the course of the ribs does a fracture pose the greatest threat of lacerating the spleen?
Definition
Posterior blow of left 9-11 ribs
Term
A patient with a lacerated spleen complains of pain in the ipsilateral shoulder. What is likely to be irritated by blood leaking from the spleen?
Definition
Diaphragm
Term
At surgery, the spleen must be mobilized to inspect it for lacerations. This is done by tearing the left layer of the lienorenal ligament and pulling forward the spleen and all the structures that run in the ligament. What are they?
Definition
Tail of pancreas, splenic artery, and splenic vein
Term
Congenital indirect inguinal hernias are more common in (1) because in this sex the possibility exists for (2)
Definition
1. Males
2. Patent processus vaginalis
Term
Portal hypertension due to cirrhosis of the the liver can cause the following change(s) in the appearance of the anterior abdominal wall
Definition
Dilated subcutaneous veins radiating from the umbilicus
Term
Thrombosis of the inferior vena cava can cause the following change(s) in the appearance of the anterior abdominal wall
Definition
dilated subcutaneous veins running from groin to axilla
Term
Portal hypertension due to compression of the portal vein by a tumor of the neck of the pancreas can cause the following change(s) in the appearance of the anterior abdominal wall
Definition
None (that is why it is so dangerous)
Term
Cancer of the head of the pancreas often reveals itself by painless jaundice whereas cancer of the tail does not, because of the head of the pancreas lies (1) to the (2).
Definition
1. Anterior
2. Common bile duct
Term
Associated with the jaundice is dilatation of the (1). This may be detectable by palpation if the fingers are placed on the anterior abdominal wall at the junction of the (2)with the (3), on the (4) side.
Definition
1. Gallbladder
2. Costal margin
3. Transpyloric plane
4. Right
Term
Tumor of the body and tail of the pancreas is often inoperable because it frequently engulfs the (1) and the (2).
Definition
1. SMA
2. Splenic artery
Term
Excluding peritoneum, identify the structures that form the boundaries of the epiploic foramen (of Winslow) 1. anteriorly, 2. superiorly, 3. posteriorly, 4. inferiorly
Definition
1. Portal vein
2. Duodenum
3. IVC
4. Transverse mesocolon
Term

[image]

  • Be specific with C and D.  Also define arrowheads 
  • Which letters correspond to arteries that directly anastomose with arteries of the Celiac trunk?
Definition

A.  Inferior pancreaticoduodenal artery

B.  Middle colic artery

C.  A jejunal artery

D.  An ileal artery

E.  Ileocolic artery

F.  Right colic artery

Arrowheads: (Marginal artery) of Drummond

Term
What branches of the SMA directly anastomose with branches of the celiac trunk?
Definition
Inferior pancreaticoduodenal artery and middle colic artery

(anastomose with superior pancreaticoduodenal artery and gastroepiploic arcade respectively)
Term
What branches of the SMA directly anastomose with branches of the celiac trunk?
Definition
Inferior pancreaticoduodenal artery and middle colic artery

(anastomose with superior pancreaticoduodenal artery and gastroepiploic arcade respectively)
Term
During surgery to repair an inguinal hernia, you put a surgical staple immediately medial to the deep inguinal ring. Damage to what structure will produce the most serious consequence?
Definition
Inferior epigastric artery
Term
After surgery to repair an inguinal hernia, the patient complains of numbness over the front of the scrotum and on the inside of the thigh adjacent to the scrotum. What has been injured?
Definition
Genitofemoral nerve
Term
What areportions of the GI tract that have mesenteries along virtually their entire lengths?
Definition
Stomach, jejunum, ileum, transverse colon, sigmoid colon.
Term
Of those portions of the GI tract that do not have mesenteries along virtually their entire lengths, which are secondarily retroperitoneal?
Definition
Duodenum, Cecum, ascending and descending colon
Term
Define Cantile's line
Definition
1. It runs through the left edges of the cystic and caval fossae of the liver
2. It indicates the division between the territories of distribution of the left and right hepatic aa.
3. It indicates the division between the territories of distribution of the left and right branches of the portal v.
4. It indicates the division between the territories of drainage of the left and right hepatic bile ducts
Term
Your patient has a few enlarged but painless superficial inguinal nodes. Define all from which spread of cancer to the superficial inguinal nodes would not be unusual. I haven't told you the sex of the patient, so check appropriate structures for both males and females
Definition
labium majus
scrotum
skin immediately inferior to the umbilicus
skin of big toe
skin of glans penis
skin over anterior thigh
subcutaneous tissue of buttock
subcutaneous tissue on medial aspect of lower leg
Term
What is the shortest route of blood vessels to the stomach if the celiac artery develops an occlusion at its origin?
Definition
Aorta-->SMA-->Middle Colic Artery-->Gastro-epiploic arcade (right and left)-->stomach
Term
What is the shortest route of blood vessels to the liver if the celiac artery develops an occlusion at its origin?
Definition
Aorta-->SMA-->inferior pancreaticoduodenal a.-->superior pancreaticoduodenal aa.-->gastroduodenal a.-->proper hepatic a.
Term
P. W. is a 60 year old former smoker who experiences severe diffuse abdominal pain 15 - 30 minutes after eating a full meal. You suspect intestinal angina and order an angiogram to look for blockage in the major artery that feeds most of the small intestine. What is this artery?
Definition
SMA
Term
You find that the SMA is almost completely blocked for a length of 3 mm at a site about one centimeter from its origin, yet the small intestine is obviously still alive. What are all the existing anastomoses that may contribute to keeping the small intestine alive?
Definition
1. left colic with middle colic
2. left gastroepiploic with middle colic
3. right gastroepiploic with middle colic
4. superior pancreaticoduodenal with inferor pancreaticoduodenal
Term
Where do the nodes commonly lie regarding carcinoma of the breast? Alongside what vessels do they lie?
Definition
In the axilla alongside the lateral thoracic vessels
Term
What percentage of breast lymph goes to the level 1 nodes?
Definition
75%
Term
Where does lymph not going to level 1 nodes go to?
Definition
Internal mammary nodes
Term
What are the level 1 lymph nodes for breast cancer?
Definition
those lateral to the pectoralis minor muscle (i.e., the pectoral, subscapular, lateral, and a few central nodes)
Term
What are the level 2 lymph nodes for breast cancer?
Definition
those deep to the pectoralis minor (i.e., most of the central nodes)
Term
What are the level 3 lymph nodes for breast cancer?
Definition
those medial to pectoralis minor (i.e., the apical axillary nodes)
Term
Mary presents with a swelling in the floor of her armpit. Ultrasound shows it to a nonmalignant fluid-filled cyst. In what structure is this cyst most likely to be located (be specific)?
Definition
Axillary tail of Spence
Term
M. H.-K. presents with diffuse poorly localized epigastric pain. You place your fingers along her right costal margin at the midclavicular line and ask that she take a deep breath. She begins her inspiration, but pain causes her to suddenly stop before completing it. What is likely to be inflamed?
Definition
gallbladder
Term
What spinal cord segments receive pain fibers from the gallbladder?
Definition
T7-T9
Term
Where is referred pain from the gallbladder most likely to be felt (specify side if pain not felt bilaterally)?
Definition
Right 7th-9th intercostal spaces
Term
Cancer of the lower lobe of the left lung poses a greater risk to the patient than cancer of the lower lobe of the right lung because lymph from the lower lobe of the left lung:
Definition
has a greater tendency to spread to the contralateral paratracheal lymph nodes than does lymph from the lower lobe of the right lung
Term
List the alternate blood route in portal hypertension that leads to the development of esophageal varices
Definition
Portal v.-->l. gastric v.-->esophageal vv.-->azygos v.
-->SVC-->r. atrium
Term
List the alternate blood route in portal hypertension that leads to the development of caput medusae
Definition
Portal v.-->paraumbilical vv.-->thoracoepigastric vv.
-->lateral thoracic v.-->axillary v.-->subclavian v.
-->brachiocephalic v.-->SVC-->r. atrium
Term
Trace two substantially different routes by which arterial blood can reach most of the small intestine in the case where there is a blockage of the SMA at its origin
Definition
Celiac trunk-->Common hepatic-->Gastroduodenal-->
Superior anterior and posterior pancreaticoduodenal a.-->
Inferior anterior and posterior pancreaticoduodenal a. --> SMA

Celiac trunk-->splenic a.-->right gastroepiploic-->
middle colic-->SMA
Term
A 45 yo premenopausal woman is scheduled to undergo uterine artery embolization to treat uterine fibroids. You are obligated to inform her that the procedure may induce menopause. What is the anatomic reason for this?
Definition
In older women a majority of the arterial blood for the ovaries may be supplied by the ovarian branch of the uterine artery.
Term
What blood vessels supply the left ventricle in a left coronary dominant heart?
Definition
Left main coronary, diagonal, LAD, obtuse marginal, circumflex coronary, PDA
Term
What blood vessels supplies the interventricular septum in a right coronary dominant heart?
Definition
Left main coronary, LAD, right coronary, PDA
Term
What blood vessels supplies the right atrium in a right coronary dominant heart?
Definition
Right coronary
Term
What blood vessels supplies the right ventricle in a right coronary dominant heart
Definition
Right coronary, acute marginal, LAD, PDA
Term
Name the first groups of lymph nodes to which the mammary gland drains
Definition
Axillary and internal mammary
Term
Name the first groups of lymph nodes to which the testes drains
Definition
Para-aortic
Term
Name the first groups of lymph nodes to which the ovaries drain
Definition
Para-aortic
Term
Name the first groups of lymph nodes to which the uterus drains
Definition
Pelvic
Term
Name the first groups of lymph nodes to which the transverse colon drains
Definition
Pre-aortic
Term
Name the first groups of lymph nodes to which the vulva drains
Definition
Superficial inguinal
Term
Name the first groups of lymph nodes to which the skin of the hallux drains
Definition
Superficial inguinal
Term
Name the first groups of lymph nodes to which the skin of the pollex drains
Definition
Axillary
Term
Name the first groups of lymph nodes to which the skin of the glans penis drains
Definition
Superficial inguinal
Term
What lymph nodes do NOT drain into the part of the thoracic duct that lies in the abdomen and thorax
Definition
Axillary and internal mammary
Term
What effect does the parasympathetic nervous system have on heart rate?
Definition
Decreases (vagus)
Term
What effect does the parasympathetic nervous system have on the pyloric sphinctor
Definition
Relaxes (vagus)
Term
What effect does the parasympathetic nervous system have on the urinary bladder
Definition
Relaxes (S2-S4 pelvic splanchnic nerves)
Term
What effect does the parasympathetic nervous system have on the vasculature of the corpus cavernosum
Definition
Dilates (S2-S4 pelvic splanchnic nerves)
Term
What effect does the parasympathetic nervous system have on the sphincter urethrovaginalis
Definition
None (this is a voluntary muscle)
Term
What effect does the parasympathetic nervous system have on tear production
Definition
Increases (CN7)
Term
What effect does the parasympathetic nervous system have on saliva production
Definition
Increases (CN7 and CN9)
Term
What is the relationship between the ureter and the psoas major?
Definition
Ureter is anterior to it
Term
What is the relationship between the ureter and the iliac arteries?
Definition
Ureter crosses the bifurcation of the common iliac arteries
Term
What is the relationship between the ureter and the infundibulopelvic ligament?
Definition
Ureter crosses about 1cm superiomedial to it
Term
What is the infundibulopelvic ligament?
Definition
Fold of peritoneum that is raised by the ovarian vessels, nerves, and lymphatics as they pass to and from the ovary. It can be seen as a indentation of the broad ligament of the uterus just lateral to the fimbrae of the fallopian tube
Term
What is the relationship between the ureter and the lateral fornix of the vagina (lateral wall of cervix)
Definition
About 1 fb lateral to it
Term
What is the relationship between the ureter and the uterine artery?
Definition
Crosses below it
Term
Where should you attempt to palpate the gallbladder to see if it is painful?
Definition
At the intersection of the linea semilunaris and the costal margin on the right side
Term
How would pancreatic cancer cause nonpainful jaundice?
Definition
Head of the pancreas lies anterior to the common bile duct. If it grows due to cancer, it can occlude the common bile duct and cause jaundice
Term
Where should you look for blood-borne metastases to cancer of the head of the pancreas on CT?
Definition
Liver
Term
A patient that underwent resection of the rectum for treatment of cancer is impotent following surgery. Why?
Definition
Because the pelvic plexus has been damaged and therefore no parasympathetic innervation to corpus cavernosus.
Term
What gives rise to the Artery of Adamkiewitz?
Definition
T10-T11 intercostal arteries, subcostal artery, or upper lumbrical arteries
Term
Why is it acceptable to treat internal hemorrhoids, but not external hemorrhoids, by rubber band ligation
Definition
Anal canal above pectinate line (where internal hemorrhoids develop) is only sensitive to visceral pain. Below this, the anal canal is sensitive to somatic pain.
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