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88 Cards in this Set
- Front
- Back
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thoracic outlet syndrome
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Caused by Cervical ribs which are present in approximately 1% of the population. Will stretch or compress the inferior trunk of the brachial plexus or the subclavian artery or vein
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Costochondritis
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Costochondritis is an inflammation of the costochondral or sternocostal joints that causes localized pain and tenderness.
Patients may mistake the pain as a myocardial infarction (heart attack), but the condition is benign. Costochondritis is a common cause of chest pain in children and adolescents. |
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Shingles
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An intercostal nerve may be involved in a painful herpes zoster infection (aka shingles) with red vesicles in the dermatome supplied by the involved nerve. chicken pox stays dormant in nerves and once active will only stay within one dermatome
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Breast Cancer
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↑ Age
Familial Hx Long menstrual Hx Early menarche Late menopause Nulliparity or late parturition (30+) Obesity Oral contraceptives /estrogen therapy Alcohol use/abuse Clinical Signs Dimpling of skin Retraction of nipple Peau D’orange sign Lump Fixed, amorphous, firm Tenderness is rare, especially early on Mammography can detect much earlier than physical exam CHANGE is Key |
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Gynecomastia
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Breast enlargement may occur in males due to
medication (e.g. diethylstilbestrol for prostate cancer-no longer in use) certain types of tumors hormonal changes with age Gynecomastia also occurs in 40% of postpubertal males with Klinefelter syndrome (XXY trisomy) |
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poor technique in attempting to access(puncture) the subclavian vein
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can result in a collapsed lung
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pleural effusion
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Fluids may collect in costomediastinal recess and costodiaphragmatic recess
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pleurisy
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Inflammation or disease if pleura
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Pleural Effusion
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The accumulation of excess fluid in the pleural cavity is known as pleural effusion.
Fluids that can accumulate in the pleural cavity include serous fluid (hydrothorax), blood (hemothorax), and chyle (chylothorax). |
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Lung Disease
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enlarged air spaces (emphysema)
Carbon deposits Enlarged/blackened lymph nodes |
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Why do ppl bend over after running?
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Reason they bend over=stop the movement of the trap, scapula-swapping the origin to the insertion and these muscles are opening the ribs and stabilized the scapula so these muscles are used to hold the scapula but can be used to increase inspiration
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Pneumothorax
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Air in the thoracic cavity, pleural cavity. Puncture of lung causing shifting of the heart.
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Tension Pneumothorax
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allows air but on expiration the air can’t get back out. The pressure is greater and the heart and lung get pulled to the otherside and shut down the other lung as well. Veins will shut down first cuz they are thinnest. To fix this- a needle is stuck in and the air comes out.
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Non-Tension Pneumothorax
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A hole is punched into the wall, the lung collapses, pressure in the other lung increases. Cardiac shift cuz the air will rush out –Open Pneumothorax(on the left) air is comign in and out of a hole in their lungs. Getting into the pleura but not to the lung.
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Thoracocentesis / Chest Tube Placement
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Important to know:
Location of the VAN Location of the Costodiaphragmatic recess Location of the lung |
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Calcific Aortic Stenosis
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Calcification of heart valves
Primarily age related Due to “wear & tear” Will usually occur earlier and more aggressively in someone w/ a congenital valve malformation May Cause: Systolic murmur, L. ventricle hypertrophy, Angina, Syncope, Heart failure, Arrhythmia |
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What Happens When a Coronary Artery is Blocked?
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Angina pectoris = Intermittent chest pain caused by reversible cardiac ischemia
Myocardial Infarction (heart attack) = a localized area of myocardial necrosis induced by local ischemia |
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Angina Pectoris
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Intermittent chest pain caused by reversible cardiac ischemia,
angina chest pain caused by reversible ischemia. partially blocked artery demands more |
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Myocardial Infarction
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(heart attack) = a localized area of myocardial necrosis induced by local ischemia. no recovery cuz of tissue death.
ose that part of the heart(that part of the heart is dead). |
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The three most common sites of coronary artery occlusion are the:
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anterior interventricular branch of the LCA (40-50%) most are happneing at that particular artery
RCA (30-40%) circumflex branch of the LCA (15-20%) |
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CAD is the most common cause of death in the U.S.
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~1.2 million MI’s/year
~1/2 million deaths A significant # of people die before receiving Tx (~50%) 50% are fatal and half of those people get to the hospital in time. |
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Clubbing of the Nails
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Strong correlation with serious disease. Not really known. Multiple etiologies
Exact pathophysiologic mechanism remains unknown Often associated with cardiac disease, pulmonary disease, and/ or malignancy |
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dextrocardia
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Abnormalities of Cardiac Looping
If the heart tube loops to the left instead of the right, then the heart is located on the right side of the thorax instead of the left |
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situs inversus
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Abnormalities of Cardiac Looping.
complete reversal of asymmetry in all organs. Dextrocardia may coincide with it |
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Atrial Septal Defects (ASDs)
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Can be due to excessive resorption of the septum primum or inadequate development of the septum secundum.
May result in a significant left-to-right shunting of blood due to higher pressures on the left side after birth. An atrial septal defect may also result from complete absence of the atrial septum, which results in a common atrium (cor triloculare biventriculare). Always associated with serious defects elsewhere in the heart. |
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Ventricular Septal Defects (VSDs)
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Most common form involves malformation of the membranous part of the interventricular septum (12 in 10,000 births).
May be found as an isolated lesion or may be associated with abnormalities in partitioning of the conotruncal region. Small VSDs may close spontaneously. |
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Tetralogy of Fallot
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The most frequently occurring abnormality of the conotruncal region is Tetralogy of Fallot (9.6/10,000 births ), which results from anterior displacement of the conotruncal septum.
It involves four malformations: - a ventricular septal defect - pulmonary stenosis - overriding aorta - right ventricular hypertrophy Results in a right-to-left shunting of blood with cyanosis near the time of birth due to poorly oxygenated blood entering the arterial circulation. boot-shaped heart on X-rays |
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Transposition of the Great Arteries
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Failure of the aorticopulmonary septum to spiral as it descends may result in transposition of the great arteries.
In this condition, the aorta originates from the right ventricle, and the pulmonary artery originates from the left ventricle. Incompatible with postnatal survival unless accompanied by a shunt (typically a patent ductus arteriosus, but could be an ASD or VSD) to allow oxygenated blood to enter the aorta. Occurs in 4.8 in 10,000 births. |
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Cardiomegaly
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diameter of the heart is greater than half the diameter of the chest cavity
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guarding or rigidity
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involuntary muscle spasms may occur due to inflam-mation that irritates their nerve supply (e.g., in acute appendicitis) or during palpation with cold hands
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obstruction of the inferior vena cava
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blood may be rerouted through the azygos vein in order to return to the heart. This typically results in substantial dilation of the azygos vein. it adjusts to the flow needed to run through it.
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Left Recurrent Laryngeal Nerve possible compression caused by...
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Due to the inferior position of the leftIf someone has a raspy-horse voice and no reason for it(no cold, flu or cough), a chest xray will show damage or compression to the left recurrent laryngeal nerve which innervates larynx. Problems could be aortic aneurism or arch calsification, tumor from lung cancer, lymph node enlargement.
recurrent laryngeal nerve, it is highly susceptible to compression by a pathologic mass, which can lead to vocal cord paralysis and hoarseness of the voice. Lymph node enlargement, often due to the spread of lung cancer, is a common cause of this problem. Chest x-rays are often performed on patients who present with a hoarse voice. |
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Chylothorax
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Lymphatic fluid accumulating in the pleural cavity
Caused by leak of thoracic duct Lymphoma or direct trauma are the most common causes Thoracic duct transports up to 4 L of chyle per day This allows rapid accumulation of fluid in the chest |
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Referred pain
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When cardiac cells die during a myocardial infarction, pain fibers (visceral afferents) are stimulated.
These fibers follow the course of sympathetic fibers that innervate the heart and enter the spinal cord at the same level as somatic afferent nerves from T1 -T4 dermatomes. The brain is unable to distinguish clearly between the visceral and somatic sensory distribution and therefore the pain is interpreted as arising from the somatic regions rather than the visceral organ. Afferents travel the same road back that efferents took to get there. Sensory enters at t1-t4 and somatic leaving from t1-t4. GSA fibers-visceral pain coming back-synapse with neurons and goes up to brain to be interpreted. Brain has to guess whether its coming from the heart or dermatomes and guesses somatic(dermatomes) side evertime(bc neurons in somatic pool are much greater in number). Brain interprets its from one side that it |
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acute appendicitis
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surgical emergency. appendix cuts off blood supply and become gangrenous or perforate causing infection of the peritoneal membrane lining of the abdominal cavity-peritonitis
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Peritonitis
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Acute inflammation of the appendix (acute appendicitis) is a surgical emergency; the appendix may become gangrenous or perforate, causing infection of the peritoneal membrane lining of the abdominal cavity
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Intussusception
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ileocecal junction. the telescoping of a proximal segment of the intestine into a more distal part
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Volvulus
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ileocecal junction. twisting of the intestine on itself
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Gallstone ileus
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ileocecal junction. a gallstone blocks the ileocecal junction
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cirrhosis
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May be damaged by toxins or viruses with destruction of liver cells (hepatocytes) and their replacement by fibrous connective tissue (fibrosis) -causes include chronic alcoholism and hepatitis B & C
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Barrett’s esophagus
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the esophageal epithelium undergoes metaplastic(epithelium changes from squamous to columnar) change (i.e., the normal epithelium is [reversibly] replaced by a different type of epithelium).
The metaplastic epithelium in Barrett’s esophagus is prone to ulceration and to stricture development, causing obstruction; the metaplastic epithelium may develop adenocarcinoma |
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cholelithiasis
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gallstones
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cholecystitis
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May develop gallstones (cholelithiasis), which can obstruct the passage of bile to cause inflammation of the gallbladder
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fistula
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opening(betwn the gallbladder and duodenum may develop into the superior part of the duodenum with the callstone causing obstruction. gallstone ileus
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cancer of the pancreatic head
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60% of pancreatic cancers. obstructs bile duct. ; the retained bile causes yellowing of body tissues (jaundice), such as skin and mucous membranes. painless jaundice is often the first indication of cancer in this location
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painless jaundice
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is often the first indication of cancer in this location
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Pancreatic cancer of body and tail
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Is the fourth leading cause of cancer death in the U.S. with a 5-year survival rate of < 5%
Of the body and tail typically does not present until metastasis has occurred—fewer than 20% are resectable; abdominal pain is often the first symptom with weight loss, anorexia, malaise and weakness. tumor blocks the flow of the pancreatic enzymes. they escape into the pancreas and start to digest the pancreas itself. |
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ascites
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In some pathological conditions (e.g., cirrhosis of the liver, chronic heart failure, ovarian cancer) excess peritoneal fluid accumulates
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paracentesis
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excess fluid may be removed for diagnostic or therapeutic purposes
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peritonitis
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Bacteria may infect the peritoneum causing inflammation of peritoneum. For example, due to perforation of a peptic ulcer or a penetrating wound (such as a stab wound)
Which is potentially a life-threatening condition due to the peritoneum’s large surface area and the rapid absorption of bacterial toxins Which results in severe abdominal pain and tenderness, nausea and vomiting, fever, and constipation |
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peritoneal adhesions
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Peritonitis due to trauma (e.g., surgery) or infection may result in the formation of peritoneal adhesions (fibrous bridges), which can cause chronic pain and bowel or uterine tube obstruction
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internal hernia
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The omental foramen may be the site of an internal hernia when a loop of small intestine becomes entrapped within it. can cause obstruction and strangulation of the bowel.
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Spread of infection between the abdominal cavity to the pelvic cavity through...
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Right paracolic gutter lateral to the ascending colon
Left paracolic gutter lateral to the descending colon |
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hepatorenal recess (Morison’s pouch)
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The lowest part of the abdominal peritoneal cavity in the supine position is the hepatorenal recess (Morison’s pouch) between the right lobe of the liver and the right kidney; infected fluid can easily enter the hepatorenal recess from the omental bursa or subphrenic recess (between the liver and diaphragm), a common site for abscesses
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splenomegaly
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enlarged spleen May become enlarged in some pathological conditions
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spleen issues
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most frequently ruptured abdominal organ with life-threatening hemorrhage, often by blunt trauma to the abdomen
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splenectomy
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the spleen also may be lacerated in fractures of the lower left ribs; traumatic injury or disease may require its surgical removal
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appendicitis
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The typical patient initially complains of vague central periumbilical pain that later becomes sharp, localized right lower quadrant pain at a point 1/3 of the distance on a line connecting the ASIS and umbilicus (McBurney’s point)
The appendix may perforate, resulting in life-threatening peritonitis A positive psoas (iliopsoas) sign Is pain on flexion of the right thigh against resistance (or passive extension of the right thigh with the patient lying on the left side) Results from movement against an inflamed appendix in contact with the fascia over the iliopsoas muscle An obturator sign Is pain on passive rotation of the flexed right thigh Results from an inflamed pelvic appendix (i.e., hanging down into the pelvis), which is in contact with the fascia over the obturator internus muscle; the muscle is stretched by passive internal rotation of the thigh |
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diverticulosis
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The sigmoid colon is prone to develop outpocketings of its wall as we age.diverticulosis is often asymptomatic but can cause intermittent cramping, continuous lower abdominal discomfort, bloating, and constipation or diarrhea
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diverticulitis
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Diverticula may become infected and inflamed
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peritonitis
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Diverticula may become infected and inflamed (diverticulitis), bleed (intermittent bleeding or rarely massive hemorrhage), cause obstruction, or perforate; if perforation occurs, a localized abscess may form or infection may spread. a fistula may form between the colon and adjacent organs, such as the urinary bladder or vagina
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Hirschsprung disease (congenital megacolon)
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Occurs 1:5,000 live births with male preponderance (5:1); 10% of cases occur in children with Down’s syndrome
Is the most common cause of neonatal obstruction of the colon Mostly affects the rectum and sigmoid colon Presents as abdominal enlargement and constipation in the neonate |
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Acute Pancreatitis
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o Abdominal pain, bruising, epigastric pain radiating to the back, nausea, and fever
o Caused by alcoholism, gallstones, obstructing bile flow |
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Chronic Pancreatitis
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Is characterized by permanent and progressive damage to the pancreas (fibrosis, calcification, ductal stricture), typically resulting in diminished exocrine and endocrine function with chronic pain, weight loss, diabetes mellitus, etc.
May result from recurrent bouts of acute pancreatitis, autoimmune disorders, toxins (e.g., chronic alcohol abuse), obstruction of pancreatic ducts (e.g., gallstones), or may be idiopathic; genetic disease (e.g., cystic fibrosis) may be a cause in children |
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portal hypertension
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Tributaries of the hepatic portal vein form connections (anastomose) with tributaries of the systemic venous system (venae cavae); these portacaval (portal-systemic) anastomoses ( ) may become abnormally dilated if there is resistance to portal blood flow (e.g., in cirrhosis), increasing pressure within the portal vein
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caput medusae
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the subcutaneous veins radiating from around the umbilicus dilate secondary to portal hypertension; the radiating veins reminded an early physician of the snakes on the head of Medusa of Greek mythology
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kidney stone (calculus)
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May become lodged within and obstruct the renal pelvis, ureter, bladder, or urethra; urinary tract obstruction causes urine to back up with distention of the renal pelvis and calices (hydronephrosis) and kidney failure
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aneurysm(abdominal aorta)
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common site for aneurysm. May develop a dilatation (aneurysm), usually inferior to the renal arteries; the aneurysm may rupture with fatal hemorrhage if not surgically repaired, which is usually complicated by the origin of the inferior mesenteric artery on the aneurysm
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Rectouterine Pouch
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Is formed from the Uteris and the pelvic fascia-can get infected if excess of free fluid can get in there.
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Pelvic arteries and/or veins
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May be sources of fatal hemorrhage following traumatic fractures of the pelvis
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vertebral venous plexus
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provides a pathway for pelvic cancer to metastasize to the spinal cord and brain from the prostate. this plexus goes up through the spinal cord through veterbrae
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Peritoneal cavity
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CT fibers secrete lots of things. when its open you can cause adhesion and problems can form. During surgeries you can cause more secretions to occur
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Anterolateral Abdominal Wall
o Support and protection of abdominal organs |
involuntary muscle spasms may occur due to inflam-mation that irritates their nerve supply (e.g., in acute appendicitis) or during palpation with cold hands (guarding or rigidity)
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Endometriosis
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Normal endometrial tissue found in an abnormal location
10-15% of women ages 25-44 Familial inheritance plays a role Signs/symptoms: pain (pelvic and low back pain), pelvic mass, dysmenorrhea, infertility, dyspareunia, pain w/ defecation or urination, onset coincides w/ onset of menses Bleeding → inflammatory response → fibrin deposition → adhesion formation → problem Definitive dx made w/ laparoscopy |
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salpingitis
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May become obstructed due to inflammation, secondary to sexually transmitted disease or abdominal infections, increasing the risk of infertility or ectopic pregnancy
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Ectopic Pregnancy
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Abnormal pregnancy characterized by implantation of the embryo outside the uterus, most commonly in the uterine (fallopian) tube.
Development of a fertilized ovum outside of the uterine cavity Common Causes: prior infection, PID, congenital abnormalities, etc. DX w/ beta-HCG levels, ultrasound Mostly develop in the uterine tube (95%) “tubal pregnancy” Can develop anywhere inside the abdominal cavity Potentially life-threatening situation! |
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culdocentesis
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fluid can be aspirated from the rectouterine pouch
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Pelvic Organ Prolapse
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Common condition due to weakness of supporting musculature, ligaments, and fascia especially levator ani muscles and the uterosacral, transverse cervical, and pubocervical ligaments such as during child birth.
Loss of support for the pelvic viscera - uterine and/or vaginal prolapse Alteration in the position of the neck of the urinary bladder and urethra - stress incontinence Incidence increases w/ age and parity: Obstetrical injury, congenital weakness, ↓ estrogen, ↑ abdominal pressure Symptoms include: Pelvic pressure, protrusion of tissue, pelvic pain, low back pain, bowel/bladder symptoms |
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Rectocele
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Protrusion or herniation of the rectum into the vagina
Difficulty with defecation or sexual intercourse Etiology similar to uterine prolapse |
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Cystocoele
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Protrusion or herniation of the bladder into the vagina
Signs, symptoms, and etiology very similar to other pelvic organ prolapse |
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Enterocoele
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A herniation of the small bowel into the rectovaginal or vesicovaginal pouch
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Congenital Abnormalites
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Uterus didelphys- 2 vaginal canals, 2 uteruses
Uterus bicornis- 1 Vagina, 2 uteruses Vaginal atresia- Closed vagina Cervical atresia- Closed Cervix |
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Bartholinitis
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note that the greater vestibular (Bartholin’s) glands, which can be a site of infection with inflammation (Bartholinitis) or adenocarcinoma, are overlapped posteriorly by the bulbs of the vestibule
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vaginismus
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the sphincter urethrovaginalis may spasm with the levator ani, causing difficulty during pelvic exams or intercourse
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median episiotomy
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Uterine prolapse: Is larger in females and helps to provide support for pelvic viscera; if overstretched or torn during childbirth, the uterus, bladder, or rectum may sag into the vagina (prolapse)
May be surgically incised during childbirth (median episiotomy) to prevent jagged tears |
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Hemorroids
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Are enlarged submucosal rectal veins and may be a source of rectal bleeding
If they prolapse through the anal aperture from the internal rectal plexus, may be compressed by contracting anal sphincters with strangulation and ulceration |
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portal hypertension
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HemorroidsMay result from pregnancy, constipation (e.g., due to too little fiber in the diet), straining at the stool, etc. May be a sign of portal hypertension through enlargement of anastomoses between the portal and systemic venous systems.
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Internal Hernia
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due to intestine getting trapped in the omental foramen between the lesser and greater sac
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