Cabs Unit 4 Gi Flashcards

Front 1

What line is considered the transitional point in the rectus sheath?

Back 1

Arcuate

Front 2

Where is McBurney's point located?

Back 2

(McBurney’s point 1/3 distance from the ASIS to the umbilicus)- root of the appendix

Front 3

What are the first three layers of the abdominal wall (no matter where you are, these are always constant)?

Back 3

Skin, campers, scarpa’s fascia

Front 4

Above the arcuate line, what are the layers of the anterior abdominal wall?

Back 4

Skin, camper's fascia, scarpa's fascia, anterior rectus sheat comprised of: external oblique aponeurosis and anterior part of the internal oblique aponeurosis), rectus abdominis, posterior rectus sheath comprised of: posterior part of the internal oblique aponeurosis, tranversus abdominis fascia, transversalis fascia, layer of peritoneal fat, visceral peritoneum

Front 5

What are the last three layers of the anterior abdominal wall (no matter where you are)?

Back 5

Transversalis fascia, peritoneal fat, shiny parietal peritoneum

Front 6

What are the abdominal layers below the arcuate line?

Back 6

Skin, camper's, scarpas, external oblique apon, internal oblique apon, transversus abdominis apon, rectus abdominis, transversalis fascia, peritoneal fat, parietal peritoneum

Front 7

What are the abdominal layers on the lateral wall?

Back 7

Skin, campers, scarpas, external oblique muscle, internal oblique muscle, transversus abdominis, transversalis fascia, peritoneal fat, parietal peritoneum

Front 8

When is a pfannenstiel incision done?

Back 8

Done only in women for a c-section (transverse along the pubic symphysis

Front 9

What is the transpyloric plane?

Back 9

Interconnects the tips of the costal cartilages at the level of the 8/9 rib; this is where the pylorus of the stomach is located

Front 10

What is the greater omentum and where is it located?

Back 10

Layer of mesentary to protect abdominal contents (embedded fat)- begins on the greater curvature and reflects back onto the transverse colon

Front 11

What does the greater omentrum reflect back onto?

Back 11

Transverse colon

Front 12

What is the portion of mesentary that supports the transverse colon from the posterior abdominal wall?

Back 12

Transverse mesocolon

Front 13

The sigmoid colon is loosely supported by mesentary- what is this called?

Back 13

Sigmoid mesocolon

Front 14

There are two parts of the large intestine that are intraperitoneal- what are they?

Back 14

transverse and sigmoid colon (attached by respective mesocolons)

Front 15

What is the area called that is located behind the stomach anterior to the pancreas?

Back 15

Lesser sac or omental bursa

Front 16

What is the opening to the lesser sac/omental bursa called?

Back 16

Omental foramen or epiploic foramen of Winslow

Front 17

Is the pancreas intraperitoneal or retroperitoneal?

Back 17

Retroperitoneal

Front 18

Which parts of the duodenum are retroperitoneal?

Back 18

2,3,4; The superior part (1) is intraperitoneal

Front 19

The foregut is supplied mostly by which artery off of the abdominal aorta?

Back 19

Celiac trunk (esophagus, stomach and parts 1/2 of the duodenum)

Front 20

The midgut is supplied primarily by which artery off of the aorta?

Back 20

Superior mesenteric (3,4 duodenum through the splenic flexure of the large intestine)

Front 21

The hind gut is supplied primarily by which artery off of the abdominal aorta?

Back 21

Inferior mesenteric artery (from the splenic flexure of the large intesting 1/2 way down the anal canal)

Front 22

Where is the lesser mesentary located?

Back 22

Lesser curvature of the stomach to the liver.

Front 23

What is the free border of the lesser omentum called?

Back 23

Hepatoduodenal ligament- contains the portal triad

Front 24

What does the portal triad consist of?

Back 24

CBD, hepatic artery, hepatic portal vein

Front 25

What does the 'bed of the stomach' consist of?

Back 25

pancreas, left kidney and adrenal glands, splenic artery/vein, left lobe of liver

Front 26

Which part of the pancreas is nestled between the C-shaped duodenum?

Back 26

Head of the pancreas (body and tail towards the spleen- not retroperitoneal)

Front 27

Does the superior mesenteric artery exit deep to or superficial to the head of the pancreas?

Back 27

Deep; the duodenum is even behind the superior mesenteric at this point

Front 28

What are the external tags on the large intestine called?

Back 28

Omental appendices

Front 29

What are the outpouchings along the large intestine called?

Back 29

Haustra

Front 30

What is the long band that lines the large intestine called?

Back 30

Taenia coli

Front 31

Where is diverticulosis of the colon normally found?

Back 31

Descending and sigmoid colon

Front 32

What causes diverticulosis?

Back 32

Typically results from increase in intracolonic pressures (thought to be maybe constipation); these herniations protrude through the wall but are not visible on the surface

Front 33

Which inflammatory bowel disease consists of skip lesions?

Back 33

Crohn's

Front 34

Where is Crohn's typically found?

Back 34

At the ileum

Front 35

How is Crohn's disease typically characterized by?

Back 35

Transmural inflammation throughout the entire colonic wall; involves the mucosa, submucosa and two longitudinal layers of muscle into the serosa

Front 36

Which inflammatory bowel disease causes inflammation throughout the entire thickness of the colonic wall (i.e. through the mucosa, submucosa and two layers of longitudinal muscle)?

Back 36

Crohn's disease

Front 37

Which inflam bowel disease can have fissures/fistulas seen commonly?

Back 37

Crohn's

Front 38

Which inflam bowel disease is restricted ONLY to the colon?

Back 38

Ulcerative Colitis

Front 39

Which inflam bowel disease is continuous-starting at the rectum and progressing proximally toward the small intestine?

Back 39

UC

Front 40

Which type of inflam bowel disease occurs only through the mucosa and submucosa - sparring the two layers of longitudinal muscle?

Back 40

UC

Front 41

Which type of inflam bowel disease more common has pseudopolyps?

Back 41

UC

Front 42

What is the pathogensis for inflammatory bowel diseases?

Back 42

Resemble autoimmune disorders- but not considered autoimmune. Dysfunction of immune system in which immune cells within submucosa of intestines have an exaggerated (unusual) response- over active to normal endogenous commensal bacterial antigens and possibly antigens from food; cellular immune response with T cells upregulating the immune response to activate neutrophils and macrophages

Front 43

Which inflammatory bowel disease would you see: strictures of the small intestine, linear ulcers, perforation with serositis and creeping fat?

Back 43

Crohn's

Front 44

Where does the vermiform appendix attach to?

Back 44

Cecum

Front 45

What is the concern with appendicitis?

Back 45

Swelling of the mucosa around the appendix-closes off the apendix causing swelling which can lead to a rupture of the appendix and peritonitis

Front 46

What is a common cause of appendicitis in the elderly?

Back 46

Fecolifts (poop)

Front 47

What is the arterial supply to the appendix?

Back 47

Superior mesenteric --> cecal artery --> appendicular artery

Front 48

What is the most common location for the tail of the appendix?

Back 48

64% retrocecal; 32% intrapelvic

Front 49

What is Meckel's diverticulum?

Back 49

Appendix like structure (not common)- in the ileum. Little remnant of the embryologic yolk sac found on the antimesenteric side of the ileum. Can become inflamed and produce symptoms similar to appendicitis. Should be part of your diff for RLQ pain appendicitis

Front 50

What is the 'rule of 2' regarding Meckel's diverticulum?

Back 50

2” long, occurs in 2% of people and about 2 feet from the ileocecal junction (2 feet proximal up the ileum)

Front 51

What are the three branches off of the superior mesenteric artery?

Back 51

Right colic, middle colic and cecal artery

Front 52

Where does the left colic artery branch from?

Back 52

Inferior mesenteric artery

Front 53

The superior rectal artery is a branch from where?

Back 53

Terminal branch off of the inferior mesenteric artery

Front 54

The middle and inferior rectal arteries are branches from what artery?

Back 54

Internal iliac artery

Front 55

Which artery supplies the anal canal?

Back 55

Internal pudendal artery

Front 56

What is mesenteric adenitis?

Back 56

Within the mesentary of the small intestines are lymph nodes that can become inflamed during viral infections

Front 57

All lymph below the diaphragm drains into where?

Back 57

Thoracic duct via the cistema chyli

Front 58

Which type of cells are found within the gastric crypts?

Back 58

Specialized cells for gastric function; parietal cells (secrete HCl and intrinsic factor), Chief cells (secrete proteases pepsinogen I and II) and Surface cells: provide a mucosal barrier

Front 59

What do the parietal cells secrete in the stomach?

Back 59

HCl and intrinsic factor (for B12 absorption)

Front 60

What is the pH of the stomach (range)?

Back 60

Between 1 and 2

Front 61

Which cells on the stomach provide a protective layer of mucosal barrier (some secrete bicarb to create a gel like layer on the surface)

Back 61

Surface cells

Front 62

What do chief cells in the stomach do?

Back 62

Secrete proteases: pepsinogen I and II; this is hydrolyzed by HCl to become pepsin which then is involved in the catalysis of proteins (breakdown)

Front 63

Where are the G cells located?

Back 63

Pyloric end of the stomach

Front 64

What do G cells do?

Back 64

Secrete gastrin- improtant for stimulating HCl secretion

Front 65

What is Zollinger Ellison syndrome?

Back 65

A syndrome marked by too much gastin produced by the G cells at the pyloric end of the stomach- leads to increased risk for ulcers (PUD)

Front 66

How do PPIs work?

Back 66

Inhibit the activity of the H,K pump in the stomach, thereby inhibiting the secretion of acids. The H,K pump pumps hydrogen into the stomach and reabsorbs K.

Front 67

Is HCL secreted intact?

Back 67

NO- the H,K pumps in the parietal cell pump hydrogen into the stomach and reabsorb K. Cl anion is secreted in a separate tract; they combine in the stomach to form acid

Front 68

What are the 3 stimuli for acid secretion?

Back 68

vagal stimulation (on the esophagus)- olden days did vagotomies to reduce acid in the stomach, gastrin – g cells in the pyloric region; histamine à HCl

Front 69

How does histamine work as a stimulus for acid secretion?

Back 69

Bind to the H2 receptors in the stomach (H1 is for allergic rxn) --> stimulates increase in calcium which causes an increase in cyclic cAMP which targets the K,H atp pump. More hydrogen is pumped in and K is reabsorbed out of the stomach

Front 70

What is the structures found on the surface area of the small intestine?

Back 70

Plica circularis

Front 71

What are some causes for acute gastritis?

Back 71

NSAIDS, ETOH, tobacco, cancer, uremia, viral infection, NG intubation

Front 72

Which bacteria is associated with both chronic gastritis and PUD?

Back 72

H. pylori

Front 73

What kind of baterium is H. pylori?

Back 73

Gram negative spirochete

Front 74

How does H pylori survive in the stomach?

Back 74

Secretes urease enzyme that converts urea to ammonia- pool of ammonia to protect from acid

Front 75

How does H pylori damage the tissue in the GI tract?

Back 75

Secrete proteases and causes phospholysis- damages epithelial tissue; CagA +: certain strains- secrete toxins that destroy the epithelial tissue; DOES NOT invade the tissue

Front 76

Are most people that are infected with H pylori develop PUD from it?

Back 76

No; only 10-20%

Front 77

How does PUD present?

Back 77

Epigastric pain (certain number of hours after meals), improved with food, worse at night

Front 78

What is the main physiologic characteristic of chronic gastritis and PUD?

Back 78

An imbalance between damaging and protective forces; pepsin (acid)- damaging; bicarb, blood flow, prostaglandins and mucous are protective

Front 79

Do peptic ulcers commonly go on to gastric cancer?

Back 79

No

Front 80

Does chronic gastritis commonly advance to gastric cancer?

Back 80

Depends where the inflammation occurs- if you have chronic gastric antral gastritis- not likely develop gastric cancer (more common- where H pylori tends to exist), Pan gastritis- increased risk for adenocarcinoma of the stomach

Front 81

Where does H pylori tend to exist?

Back 81

In the antrum of the duodenum (anterior wall of the duodenum)

Front 82

What are the two types of hiatal hernia?

Back 82

Sliding and paraesophageal

Front 83

What is a sliding hiatal hernia?

Back 83

Occurs through respiratory diaphragm- The GEJ, cardia and fundus go through- will increase risk for GERD significantly

Front 84

What is a paraesophageal hernia?

Back 84

Occurs through the respiratory diaphragm- only the fundus herniates through the diaphragm- risk for GERD does not change in this condition

Front 85

Where do the left and right gastric arteries come from?

Back 85

Left gastric artery is a branch off of the celiac trunk- supplies the lesser curvature of the stomach; the right gastric artery is derived from the proper hepatic artery

Front 86

Which artery supplies the greater curvature of the stomach?

Back 86

The gastroomental arteries

Front 87

Where are the gastroomental arteries derived from?

Back 87

Gastroduodenal artery supplies the rt gastroomental artery; the left gastroomental artery is derived from the splenic artery --> these anastomose on the greater curvature

Front 88

What are the four parts of the duodenum?

Back 88

Superior, descending, transverse, ascending- 2,3,4 parts are retroperitoneal, 1 part- intraperitoneal

Front 89

What is the first part of the duodenum called?

Back 89

Ampulla or bulb

Front 90

What significant structure is found in the descending duodenum?

Back 90

Major duodenal papilla – the ampulla of vader opens here

Front 91

Which structure supports the duodenal jejunal junction?

Back 91

Ligament of treitz (slip of the respiratory diaphragm)

Front 92

Which quadrant is the jejunum primarily in?

Back 92

LUQ

Front 93

Which quadrant is the ileum primarily in?

Back 93

RLQ

Front 94

What does the arterial pattern within the mesentary for the jejunum look like?

Back 94

simple arcades of the branches off the superior mesenteric artery; long straight vasa recta to the jejunum

Front 95

What does the arterial pattern within the mesentary for the ileum look like?

Back 95

multiple arcades (2-3 levels)- with shorter vasa recta

Front 96

Which part of the small intestine contains many peyer's patches?

Back 96

many in the ileum, few in jejunum

Front 97

What are the two important primarily autonomic nerve plexuses in the gut that give us "gut feelings"?

Back 97

Myenteric auerbach plexus and submucosal Meissner plexus- enteric nervous system- brain of the gut – “gut feelings”- this aspect of the nervous system that mediates the gut feelings. Level of serotonin within the nervous system in enteric is greater than serotonin produced in the brain

Front 98

Is the level of serotonin found in the mid gut greater or less than that of the brain?

Back 98

Greater- trust your gut instinct!

Front 99

What is celiac's disease?

Back 99

An autoimmune process in which there is a gluten sensitivity and IgA Anti-endomysial antibodies & anti-tissue transglutaminase ab (antibodies develop against the connective tissue covering of smooth muscle cells)

Front 100

What are the most common symptoms of celiac's disease?

Back 100

Abdominal pain, diarrhea, malabsorption (sometimes)

Front 101

What is the physiologic result of celiac's disease?

Back 101

Villous atrophy- destruction of the villi- reduces absorption of nutrients- crypt hyperplasia (increase cells in the crypt, but impaired absorption)

Front 102

What are the clinical findings in a person with silent celiac's disease?

Back 102

No clinical symptoms, positive serolgoy and positive bx

Front 103

What are the clinical findings in a person with latent celiac's disease?

Back 103

No clinical symptoms, positive serology, negative biopsy (more common in patients with family members who are +)

Front 104

Which disease might you see with a chief complaint of chorea, neurologic defecits?

Back 104

Celiac's disease

Front 105

What is nearly pathognomonic for celiac's disease?

Back 105

Dermatitis herpetiformis (pruritic papulovesicular rash)

Front 106

How can celiac's disease alter reproductive health?

Back 106

Delayed puberty; recurrent abortions

Front 107

What are the rome III criteria for IBS?

Back 107

Pain or discomfort for 3 months with onset at least 6 months ago + (2 of these): improvemtn of abd pain with defecation, onset assoc with change in freq of stool, onset assoc with change in appearance of stool

Front 108

What is the lowest space in the abdominal cavity?

Back 108

Hepatorenal recess

Front 109

The hepatorenal recess connects to a space in the diaphragm called?

Back 109

Subphrenic recess

Front 110

What might you be looking for on xray in the subphrenic recess and what would this indicate?

Back 110

Subdiaphragmatic air- indicates perforation in the GI tract (allows air to get in)- looks black on xray

Front 111

What structure separates the antatomic left and rt lobes of the liver?

Back 111

Falciform ligament (at the base has ligamentum teres)

Front 112

Where is the gallbladder typically found?

Back 112

Fundus of the GB typically found at the intersection of the 9th rib with the lunea semilunaris

Front 113

The posterior side of the liver has two additional lobes- what are they?

Back 113

Quadrate and caudate

Front 114

What is the doorway to the liver called?

Back 114

Porta hepatis- where the portal triad enters/exits

Front 115

On the diaphragmatic surface (posterior) side of the liver- a line can be drawn between the IVC and gallbladder- what is this line called?

Back 115

Cantlie line

Front 116

What is found on the left and right side of the cantlie line respectively?

Back 116

The left side of the cantley line: left lobe, quadrate and part of the caudate; right side- right lobe

Front 117

Where does the hepatic vein drain into?

Back 117

IVC

Front 118

Blood that drains into the liver is derived primarily from where?

Back 118

Hepatic portal vein- drains blood from between the esophagus and anal canal

Front 119

What is a hepatic lobule?

Back 119

Hexagonal structure – within the center is a central vein and on each corner is a branch of the portal triad.

Front 120

What are hepatic sinusoids?

Back 120

Capillaries within the liver are known as sinusoids (highly fenestrated with macrophages (Kupffer cells: function: stick pseudopods into the flow of hepatic portal vein blood and extract any bacteria in the barrier)- helps to take part in “cleansing of the blood”

Front 121

What is the significance and borders of Callot's triangle?

Back 121

Boundaries: visceral border liver, cystic duct, common hepatic duct; running through it is the: cystic artery (typically from the rt hepatic artery)

Front 122

Where do gallstones tend to collect in the gallbladder?

Back 122

Hartmann's pouch

Front 123

What forms the CBD?

Back 123

Cystic duct and common hepatic duct

Front 124

What is the name for a stone stuck within the CBD or ampula of vater?

Back 124

choledocolithiasis

Front 125

What is a stone called that is stuck within Hartmann's pouch or the cystic duct?

Back 125

Cholelithiasis

Front 126

What is the triad for cholangitis?

Back 126

RUQ pain, fever, jaundice

Front 127

What can also be caused with a gallstone stuck in the amupla of vater?

Back 127

Pancreatitis

Front 128

What is the hormone responsible for relaxation of the sphincter of odi?

Back 128

Cholecystokinin (secreted by duodenum)- also stimualtes contraction of GB and pancreas to secrete bicarb, proteases and amylases

Front 129

How is rt shoulder pain produced with GB pain?

Back 129

Via the phrenic nerve

Front 130

What is the proper name for green bilirubin?

Back 130

Biliverdin

Front 131

What is the process for bilirubin production in the spleen?

Back 131

Oxidation of heme to biliverdin that is then reduced to bilirubin --> travels to the liver bound to albumin as unconjugated (indirect) bilirubin

Front 132

What is the process for bilirubin production in the liver?

Back 132

Comes from the spleen bound to albumin, it is then conjugated (made water soluble) by UGT1A1 and then excreted as conjugated bilirubin

Front 133

Which enzyme is responsible for conjugating bilirubin?

Back 133

UGT1A1

Front 134

Some people have no UGT1A1 congenitally- what is this condition called and what is the prognosis?

Back 134

Crigler–Najjar syndrome- type 1; will die without a liver transplant. Their levels of unconjugated bilirubin will become soo high develop kernicterus. Can cross the BBB and damage neurons in the CNS

Front 135

What is Gilbert's syndrome?

Back 135

Gilbert’s syndrome is a fairly common genetic disorder of decreased function of the UGT1A1 enzyme (30% activity)- elevated levels of bilirubin in the blood- look slightly jaundice, but have icterus; worse if they fast or are under stress (fairly benign)

Front 136

What happens to bilirubin once it leaves the liver?

Back 136

Travels through the biliary tree to the large intestine, it is then unconjugated by bacteria in the colon and becomes urobilinogen (this is water soluble though) and can either recirculate by enterohepatic circulation or excreted in the urine

Front 137

Is it normal to have urobilinogen in the urine?

Back 137

Yes, won't show up though because it is water soluble

Front 138

Is it normal to have unconjugated bilirubin in the urine?

Back 138

NO- unconjugated will show up

Front 139

What are the three causes of jaundice?

Back 139

Hemolytic, hepatocellular and obstructive

Front 140

What are the three locations in the portal system that can cause jaundice?

Back 140

Pre-hepatic, hepatic and post hepatic

Front 141

Medical treatment of jaundice can often occur if the etiology is from which locations in the portal system?

Back 141

Prehepatic and hepatic

Front 142

Surgical treatment of jaundice is often necessary if the etiology is from which location in the portal system?

Back 142

Post-hepatic (obstruction)

Front 143

What are the causes of indirect (unconjugated) hyperbilirubinemia?

Back 143

Overproduction of bilirubin or impaired uptake and conjugation disorders of bilirubin

Front 144

How is overproduction of bilirubin caused?

Back 144

Hemolysis is the most common cause. More bilirubin produced in spleen- bilirubin levels increase in blood (anemia with reticulocytes often seen) Another cause is ineffective erythropoiesis from a severe vitamin B12 or folate deficiency (megaloblastic anemia)

Front 145

What are examples of impaired uptake and conjugation disorders associated with unconjugated hyperbilirubinemia?

Back 145

Gilbert's syndrome, crigler-najjar syndrome, advanced hepatitis/cirrhosis

Front 146

What are the causes of direct (conjugated) hyperbilirubinemia?

Back 146

Impaired excretion, hepatocellular disease (viral hepatitis or cirrhosis), alcoholic hepatitis, extrahepatic biliary obstruction (gallstones or malignancy of the head of the pancreas)

Front 147

How do you differentiate between alcoholic vs viral hepatitis?

Back 147

AST and ALT; which is more elvated in alcoholic? AST; ALT more elevated in viral

Front 148

Which enzyme is most specific for liver disease?

Back 148

ALT - L stands for LIVER

Front 149

Disorder of the biliary tree- which enzyme is most elevated?

Back 149

Alkaline phosphatase (ex- primary biliary cirrhosis)

Front 150

Chronic liver disease with Hep C- alt and ast levels start to decline- good or bad sign?

Back 150

BAD; because the liver has stopped producing these enzymes anymore. This is verified by PT- prothrombin time; based upon coagulation factors developed by the liver. PT time begins to elevate! Declining AST/ALT and increase in PT – liver disease is worsening!

Front 151

What test might be ordered to determine if liver disease is worsening?

Back 151

PT

Front 152

Gallstones- which liver enzyme would be most affected?

Back 152

Alk phos

Front 153

With intrahepatic disease- which enzyme would most likely be highest?

Back 153

ALT (except for alcoholic induced- AST)

Front 154

What else can cause an increase in alcohol affects on the liver (fatty like)?

Back 154

? GGT (gamma glutamyl transpeptidase)

Front 155

In obstructive jaundice- alk phos is elevated, RUQ pain and nausea. If they have obstructive jaundice, will they have urobilinogen in the urine?

Back 155

No- results from deconjugation of bilirubin in the tract. With obstruction, no bile enters the intestinal tract for them to work on. Will have 0 urobilinogen in the urine; what about

Front 156

In obstructive jaundice- alk phos is elevated, RUQ pain and nausea. If they have obstructive jaundice, will they have bilirubin in the urine?

Back 156

YES because the liver is conjugating bilirubin making it water soluble, but it is not able to leave and is backed up in the blood. Now have conjugated bilirubin elevated.

Front 157

What is the stool color in obstructive jaundice?

Back 157

Clay colored –contains fat (not well absorbed without the bile in the duodenum); Urobiliogen is further metabolized into stercobilin which makes stool brown – without this, stool is not dyed brown à steatorrhea

Front 158

What is the biggest lymph organ?

Back 158

Spleen

Front 159

What is the importance of the spleen for fighting infections?

Back 159

Responsible in terms of B cells to produce antibodies which facilitate the destruction of incapsulated bacteria

Front 160

Without the spleen it is hard to erradicate which organisms?

Back 160

Hard to eradicate encapsulated bacteria, such as: Step pneumonia, neisseria meningitidis and haemophilus influenzae typeb; therefore a person who has splenectomy à mandatory immunization against those bacteria!

Front 161

What is the arterial supply to the pancreas?

Back 161

Splenic artery off of the celiac trunk- along the superior border of the pancreas within the bed of the stomach (retroperitoneal)- drained via the splenic vein into the hepatic portal vein (unites with the superior mesenteric vein to create the hepatic portal vein)

Front 162

Where is referred pain for pancreatitis?

Back 162

Epigastric and straight to the back!- mid back pain

Front 163

Why does early appendicitis have early referred pain?

Back 163

Nerve root- T 10 at the umbilicus

Front 164

Flank pain is derived by which nerves?

Back 164

Iliohypogastric, ilioinguinal, genitofemoral (into the external genitalia in men)

Front 165

The hepatic portal vein is derived from which two veins?

Back 165

splenic and superior mesenteric

Front 166

The Hepatic portal vein drains:

Back 166

Lower esophagus until the superior part of anal canal

Front 167

What are the 3 portocaval anastomoses discussed?

Back 167

Esophageal, paraumbilical and rectal

Front 168

What is the significance of portocaval anastomoses?

Back 168

Causes for enlarged veins, varices, hemorrhoids or capute medusae

Front 169

What is the relationshipof the esophageal portocaval anastomoses?

Back 169

Relationship between esophageal veins that drain into the SVC and the left gastric vein that drains into the hepatic portal vein

Front 170

What is the relationship of the paraumbilical portocaval anastomoses?

Back 170

Paraumbilical veins that drain into the HPV and the superficial epigastric veins within the subcutaneous fat that drain into the caval system (primarily IVC)

Front 171

What is the relationship of the rectal portocaval anastomoses?

Back 171

Between superior rectal veinà inferior mesenteric --> hepatic portal vein; middle and inferior rectal vein drain into the internal iliac vein to the caval system

Front 172

How are esophageal varices, hemorroids and capute medusae associated with the portocaval anastomoses?

Back 172

Increased pressure within the hepatic portal system (normal is 8-10mm Hg)

Front 173

What are some of the signs of portan hypertension?

Back 173

hepatic encephalopathy (ESRD), varices, splenomegaly (splenic vein back up), caput medusae, hemorrhoids, ascites (third spacing), testicular atrophy (interferes with androgens)

Front 174

What are the three major single arteries off of the abdominal aorta?

Back 174

Celiac trunk, superior mesenteric, inferior mesenteric (CSI)