Anatomy Exam 5: Dissector, Abdominal Cavity & Gi Tract

Front 1

The accumulation of excess fluid within the peritoneal cavity, known as _______________, can result from a number of pathological conditions (e.g., cirrhosis, cancer, infection).

Back 1

ascities

Front 2

The peritoneal cavity may be punctured and some of the fluid aspirated for analysis or the excess fluid may be drained, known as ___________. ( e.g., to relieve respiratory distress)

Back 2

paracentesis

Front 3

In females, the open _________________provides a potential pathway for an external infection to enter, resulting in peritonitis.

Back 3

peritoneal cavity

Front 4

The patency of the uterine tubes can be examined radiographically by injection of a radiopaque dye into the _____________, from where it normally flows through the uterine tubes into the peritoneal cavity (hysterosalpingography)

Back 4

uterine cavity

Front 5

A _____________ in a newborn may result in urine leaking
from the umbilicus.

Back 5

patent urachus (urachal fistula)

Front 6

Where does a direct inguinal hernia leave the abdominal cavity?

Back 6

The inguinal triangle

Front 7

Where does an indirect inguinal hernia leaves the abdominal cavity?

Back 7

The deep inguinal ring

Front 8

In a supine patient the __________________ is the lowest part of the peritoneal cavity. Therefore,
gravity may cause infectious fluids to drain into it from the __________ or _____________>

Back 8

hepatorenal recess

subphrenic recesses or omental
foramen.

Front 9

The subphrenic recesses are frequent sites of abscess formation, which may result in referred pain to the ___________ from irritation of the diaphragmatic peritoneum.

Back 9

shoulder

Front 10

The ____________________ is a mobile structure and is important in part because it “walls off” areas of localized infection (e.g., during appendicitis) by forming adhesions around them. What does this do?

Back 10

greater omentum

This sometimes prevents the spread of infection throughout the peritoneal cavity with the development of a potentially fatal general peritonitis.

Front 11

The ______ and _________ lie deep to the lower ribs but is separated from them by the diaphragm and the costodiaphragmatic recess of its side.

Back 11

liver and spleen

Front 12

The liver and spleen may be damaged by blunt
abdominal trauma with or without fractures the lower ribs. During biopsies of the spleen and liver, care must be taken not to damage __________________.

Back 12

a lung or its pleura

Front 13

During a liver biopsy, a trocar or needle inserted through the right 9th or 10th intercostal space in the midaxillary line would penetrate what?

Back 13

in order:
skin and superficial fascia
intercostal muscles
endothoracic (extrapleural) fascia
costal pleura
costodiaphragmatic recess
diaphragmatic pleura
diaphragm
diaphragmatic peritoneum
subphrenic recess
visceral peritoneum
liver

Front 14

In patients with ascites or increased risk of bleeding a transjugular approach may be used to perform the liver biopsy. What is the pathway used and why?

Back 14

internal jugular vein-->brachiocephalic vein-->superior venacava-->right atrium-->inferior vena cava-->hepatic vein-->liver

*Thus, any resultant bleeding is back into the venous system

Front 15

The ileocecal valve prevents the reflux of chyme into the terminal ileum. How may this valve become obstructed?

Back 15

The valve may be obstructed by a gallstone (gallstone ileus) that has entered the lumen of the intestine (the
superior part of the duodenum) via a fistula with the gallbladder (cholecystenteric fistula).

Front 16

Why is the variability in anatomical position of the appendix important?

Back 16

because it determines the signs and symptoms as an inflamed appendix (appendicitis) irritates contiguous structures

Front 17

Typically appendicitis presents with vague periumbilical pain which later shifts to become severe right lower quadrant pain. What type of fibers innervate these areas and cause the associated types of pain?

Back 17

vague perilumbilical pain: visceral afferent (GVA) innervation
sharp right lower quadrant pain: somatic afferenc (GSA) innervation
(^results from irritation of the parietal peritoneum, which is innervated by somatic afferent (GSA) nerve fibers)

Front 18

Flexing the right thigh without resistance may relieve the patient’s pain by relaxing the___________, but flexing the thigh against resistance or extending it may increase pain due to the irritation resulting from inflammation.

Back 18

iliopsoas muscle

= (positive psoas/iliopsoas sign)

Front 19

Vomiting, when it occurs, characteristically (follows/precedes) the onset of appendicitis pain, whereas vomiting that (follows/precedes) pain suggests another cause, such as intestinal obstruction.

Back 19

follows (appendicitis)

precedes (another cause)

Front 20

Located lateral to the ascending and descending colons are vertical grooves lined with parietal
peritoneum. These right and left ______________, respectively, provide pathways for the movement of infectious fluid or cancer cells into the_____________ in the upright patient.

Back 20

paracolic gutters


pelvic cavity

Front 21

Patients with peritonitis may be propped in a seated position to facilitate the flow of infectious fluid into the pelvis, why is this advantageous?

Back 21

the absorption of toxins is slower in the pelvis than it is nearer to the diaphragm

Front 22

Since the ascending and descending colons are secondarily ____________ with a mesentery that fused to the posterior abdominal wall on their medial side during development, the _____________ also provide an approach for surgical mobilization of the ascending and descending colons that doesn’t endanger their nerve and blood supplies.

Back 22

retroperitoneal organs


paracolic gutters

Front 23

The_______________ is the most common site of volvulus resulting from twisting of the colon around its mesentery with intestinal obstruction and possible necrosis due to loss of the blood supply.

Back 23

sigmoid colon

Front 24

The sigmoid colon is also the most frequent location for the development of _________________________, which commonly occurs in middle-aged and elderly individuals, probably due to a lifetime of insufficient fiber in the diet.

Back 24

outpouchings of the intestinal mucosa (diverticulosis)

Front 25

What are diverticula (outpouchings of intestinal mucosa) prone to?

Back 25

Diverticula are prone to infection and inflammation
(diverticulitis), hemorrhage, and perforation (producing peritonitis)

Front 26

The omental foramen may be the site of an___________ if a loop of small intestine becomes entrapped there.

Back 26

internal hernia

Front 27

Fluid sometimes accumulates within the __________ (e.g., following a perforation through the posterior wall of the stomach).

Back 27

omental bursa

Front 28

Injury and inflammation of the pancreas (pancreatitis) can result in an encapsulated collection of pancreatic fluid, usually in the posterior wall of the omental bursa, known as......

Back 28

pancreatic pseudocyst

Front 29

The autonomic innervation of the gastrointestinal tract follows the blood vessels that supply it. Since the general visceral afferent nerve fibers that accompany_____________________ carry pain from
visceral organs, knowledge of their arrangement provides a basis for understanding pain
referred to the ____________.

Back 29

sympathetic fibers



body wall

Front 30

The cystic artery typically arises within what triangle bounded on the left side by the common hepatic duct, on the right side by the cystic duct, and above by the liver?

Back 30

cystohepatic/hepatocystic triangle

Front 31

The hepatocystic triangle is important during the surgical removal of the gallbladder (cholecystectomy). Why?

Back 31

The triangle contains a lymph node (Calot’s node), which is enlarged during inflammation of the gallbladder (cholecystitis) or bile ducts (cholangitis)

Front 32

The___________ artery may hemorrhage due to a peptic ulcer that erodes through the posterior wall of the first part of the duodenum, the most common location for a peptic ulcer.

Back 32

gastroduodenal artery

Front 33

Alternatively, a duodenal ulcer may erode inferiorly into the ______________ producing ___________, or anteriorly into the ____________ causing ___________, both potentially life-threatening conditions

Back 33

inferiorly- pancreas, producing pancreatitis

anteriorly- peritoneal cavity, causing peritonitis

Front 34

The ________________may be the cause of fatal hemorrhage following the rare erosion of a peptic ulcer through the posterior wall of the stomach.

Back 34

splenic artery

Front 35

Fatal hemorrhage also may result from the rupture of a _______________, while an ___________ may cause severe epigastric pain and vomiting (emesis)

Back 35

splenic artery aneurysm

unruptured aneurysm

Front 36

What is the difference btwn and "aberrant" or "accessory" hepatic arteries?

Back 36

abberant= sole blood supply
accessory= supplemental blood supply

to lobe of liver

Front 37

Chronic reflux of gastric contents into the lower esophagus may cause:

This Barrett’s esophagus predisposes to the development of what?

Back 37

metaplastic change of the mucosa, ulceration, and stricture formation (Barrett's esophagus)

esophageal adenocarcinoma

Front 38

The ________ is the wide end of the gallbladder that projects slightly below the inferior border of the liver. Its surface projection is near the junction of the tip of the ________________ and __________________ (i.e., about the midclavicular line).

Back 38

fundus


right 9th costal cartilage and the linea semilunaris

Front 39

A patient with an inflamed gallbladder (cholecystitis), which often results from ________, experiences pain at the midclavicular line and abruptly stops inspiration with the pressure of palpation, this is referred to as ________

Back 39

gallstones



Murphy’s sign

Front 40

Alternatively, the inflamed gallbladder may irritate diaphragmatic peritoneum, referring pain to the _________.

Back 40

right shoulder

Front 41

An inflamed gallbladder may adhere to the superior part of the duodenum with development of what?

A gallstone entering the duodenum through this development may pass distally and obstruct the ______________.

Back 41

cholecystenteric fistula


ileocecal junction (gallstone ileus)

Front 42

Instead of the superior part of the duodenum, an inflamed gallbladder may adhere to the transverse colon and develop a cholecysteneric fistula with it. Would this result in gallstone ileus?

Back 42

no??

Front 43

What may develop as a pathological change and be a site of gallstone accumulation?

Back 43

A pouchlike dilatation of the neck of the gallbladder
(Hartmann’s pouch)

Front 44

Rarely, the superior mesenteric vessels may compress the duodenum. What would this lead to?

Back 44

Obstruction of the passage of intestinal contents (superior mesenteric syndrome)

Front 45

The superior mesenteric artery is also a common site for acute mesenteric ischemia which may be produced by what?

Back 45

-by a thromboembolus dislodged from the heart
-by a sudden occlusioin at a focus of long-standing atherosclerosis
-by intestinal vasospasm

Front 46

The appendicular artery is an end artery, what does this mean?

Consequently, if acute infection and inflammation of the appendix (acute appendicitis) results in edema compressing the artery or in the artery’s
thrombosis, what will occur?

Back 46

it doesn’t have anastomoses


necrosis and perforation of the appendix may result

Front 47

A potentially fatal generalized peritonitis may be prevented if the greater omentum does what?

Back 47

walls off the site of infection, producing a localized abscess

Front 48

A gallstone that has traversed the cystic and bile ducts may become impacted within the
___________________, causing the reflux of bile into the pancreas with the development of pancreatitis.

Back 48

hepatopancreatic ampulla

(A tumor within the hepatopancreatic ampulla may have the same result)

Front 49

The tail of the pancreas occupies the _______________ with the splenic vessels and is in danger during removal of the spleen (splenectomy).

Back 49

splenorenal ligament

Front 50

______________ cancer is the 4th leading cause of cancer deaths with a 5-year survival rate of 5%

Back 50

Pancreatic cancer

Front 51

Adenocarcinoma of the head of the pancreas may cause extrahepatic obstruction of the bile duct. Excess bile is absorbed into the blood, producing yellowing of mucous membranes, conjunctiva, and skin, known as?

Back 51

obstructive jaundice

Front 52

Painless jaundice is often the first indication of cancer involving the head of the pancreas. Pancreatic cancer involving the body and tail commonly causes what?

Back 52

severe epigastric pain that radiates to the back

Front 53

New-onset diabetes mellitus or hyperglycemia in
individuals over the age of 50 without a family history may be the first indication of what?

Back 53

pancreatic cancer

Front 54

The intraperitoneal part of the duodoenum has a distinct appearance on radiographs using contrast medium and is called the _______________

Back 54

duodenal cap (ampulla)

Front 55

The duodenojejunal flexure is supported by a fibromuscular slip of tissue, the ____________________, which is a surgical landmark.

Back 55

suspensory muscle of the duodenum (ligament of Treitz)

Front 56

The duodenojejunal junction is where the small intestine again becomes intraperitoneal. It is also the demarcation between ___________________, which have different clinical characteristics.

Back 56

upper and lower GI bleeding