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193 Cards in this Set
- Front
- Back
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How many vertebrae?
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33
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Cervical?
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7
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Thoracic?
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12
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Lumbar
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5
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Sacral
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5
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Primary curves
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thoracic and sacral
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Secondary curves
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cervical and lumbar
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Kyphosis
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exaggeration of THORACIC curvature that may occur in elderly persons as a result of osteoporosis or disk degeneration
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Lordosis
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exaggeration of LUMBAR curvature that may be temporary and occurs as a result of pregnancy, spondylolisthesis, potbelly
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Scoliosis
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complex lateral deviation or torsion that is caused by poliomyelitis, a leg-length discrepancy or hip disease
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Altanto-occipital joints
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nodding head
between C1 (atlas) and occipital condyles synovial joints and have no IV disk anterior and posterior altanto-occipital membranes limit excessive mvmt at joint |
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Atlanto-axial joints
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turn head side to side
between C1 and C2 synovial joints and have NO IV disk alar joints limit excessive mvmt at joint |
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Atlanto-axis disolocation
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tearing of transverse (cruciform) ligament bc of trauma or RA
to move within vertebral vanal mobility contributes to risk of injury to cervical spinal cord and medulla leading to sudden death |
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inflammatory osteoarthritis affects lumbar and sacroiliac joint
annulus fibrosus of IV disks may become ossideid bamboo spine most are positive for HLA-b28 |
ankylosing spondylitis
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fish mouth vertebra
central depression in vertebral body |
sickle cell anemia
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pedicles of lumbar vertebra degenerate or do not dev properly
body of lumbar vertebra moves anterior w/ respect to vertebrae below it causes lordosis |
spondylolisthesis
degenerative - L4-5 congenital - L5-S1 |
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hemivertebrae
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portion of vertebral body does not develop
occurs in scoliosis |
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breast lung prostate cancers metastasize to brain bc
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internal vertebral venous plexus, basivertebral veins, external vertebral venous plexus that surround vertebral column communicate w/ cranial dural sinuses and veins of thorax, abdomen, pelvis
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C4 landmark
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hyoid bone
bifurcation of common carotid artery |
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C5 landmark
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thyroid cartilage
carotid pulse palpated |
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C6
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cricoid cartilage
start of trachea start of esophagus |
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T2
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sternal notch
arch of aorta |
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T4
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sternal angle
junction of superior and inferior mediastinum bifurcation of trachea |
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T5-T7
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pulmonary hilum
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T8
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IVC hiatus
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T10
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esophageal hiatus
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T12
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aortic hiatus
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L1
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superior mesenteric artery
upper pole of right kidney end of spinal cord in adult (conus medullaris) and pia mater |
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L2
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renal artery
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L3
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end of spinal cord in newborn inferior mesenteric artery
umbilicus |
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L4
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iliac crest
bifurcation of aorta |
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S1
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sacral promontory
start of sigmoid colon |
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S2
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end of dural sac, dura, arachnoid, subarachnoid space, CSF
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S3
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end of sigmoid colon
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C4-C5 disk herniation
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compressed nerve root is C5
shoulder and lateral surface of upper limb (dermatome) muscle: deltoid mvmt weak: abduction of arm nerve and reflex involved: axillary nerve, decr biceps jerk |
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C5-C6 disk herniation
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C6 compressed
thumb dermatome affected weak muscles: bicpes brachialis brachioradialis weak mvmt: flexion of arm, supination or pronation nerve reflex: musculocut nerve, decr biceps jerk, decr brachioradialis jerk |
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C6-C7 disk herniation
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C7 compression
posterior surface of upper limb middle and index fingers mm: triceps, wrist extensors mvmt weakness: extension of forearm and wrist nerve/reflex: radial nerve, decr tricep jerk |
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L3-L4 disk herniation
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L4 medial surface of leg and big toe
mm: quadriceps mm weakness: extension of knee nerve/reflex: femoral nerve/ decr knee jerk |
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L4-L5 disk herniation
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L5 lateral surface of leg
dorsum of foot affected mm: tibialis anterior, extensor hallucis longus,extensor digiti minimi mvmt: dorseflexion, extension of toes, eversion of foot Nerve/reflex: common peroneal, knee jerk |
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L5-S1 disk herniation
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S1 posterior surface of lower limb
little toe (gastrocnemius and soleus) plantar flexion of ankle/flexion of toe Tibial nerve decr ankle jerk |
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teardrop fracture
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Hyperflexion of cervical region
spinal cord at risk tears posterior longitudinal ligament |
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hangman fracture
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hyperextension of cervical region
tears anterior longitudinal ligament |
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jefferson fracture
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compression of cervical region
tears transverse ligament |
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thoracolumbar column trauma
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hyperflexion of thoracic or lumbar region
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gray matter of spinal cord consists of neuronal cell bodies
divided into |
dorsal horn
ventral horn lateral horn |
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white matter consists of
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neuronal fibers
divided into dorsal funiculus, ventral funiculus, lateral funiculus |
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conus medullaris
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end of spinal cord
L1 in adults L3 in newborn |
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cauda equina
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dorsal and ventral nerve roots of spinal nerves L2 through coccygeal 1
nerve roots travel in subarachnoid space below conus medullaris |
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filum terminale
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extension of pia mater that reaches from conus medullaris to end of dural sac at vertebral level S2 where it joins dura
dura continues caudally as filum of dura mater which attaches to the dorsum of the coccygeal bone |
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epidural space
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contains fat and internal vertebal venous plexus
located between vertebrae and dura mater |
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dura mater
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tough, outermost layer of meninges
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subdural space
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located btwn dura and arachnoid
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arachnoid
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filmlike transparent layer that connected to pia mater by trabeculations
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subarachnoid space is located between
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arachnoid and pia
filled w/ CSF |
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pia mater
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pia mater is a thin layer that adheres closely to spinal cord
lateral extensions (denticulate ligaments) attach to dura mater thereby suspending spinal cord w/i dural sac |
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anterior spinal artery
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arises from vertebral arteries
supply ventral 2/3 of spinal cord |
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posterior spinal arteries
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2 posterior spinal arteries that arise from vertebral arteries of posterior inferior cerebellar arties
supply dorsal 1/3 of spinal cord |
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radicular arteries
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arise from vertebral, deep vervical, ascending cervical posterior intervostal, lumbar, lateral sacral
enter vertebral canal through IV Foramina and br into anterior and posterior radicular arteries |
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Great radicular artery
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arises from left side from posterior interocostal artery
important contribution to anterior spinal artery provides main blood supply to lower part of spinal cord ligation of great radicular artery during resection of abdominal aneurysm resulted in anterior spinal artery syndrome |
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anterior spinal artery syndrome
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paraplegia
impotence loss of voluntary control of bladder and bowerl incontinence loss of pain and temp sensation |
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lumbar puncture
the needle passes through |
skin --> superficial fascia --> supraspinatus --> interspinous ligament --> ligamentum flavum --> epidural space containing internal vertebral venous plexus --> dura mater --> arachnoid --> subarachnoid space containing CSF
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dimpling in breast cancer due to
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suspensory ligament shortening
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if breast cancer invades RETROMEMMARY SPACE
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contraction of pec major may cause whole breast to move superiorly
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glandular tissue within breast is a modified sweat gland consisting of acini
acini are drained by 15-20 lactiferous ducts each lactiferous duct expands into lactiferous sinus which serves as |
a reservoir for milk during lactation
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chief venous drainage is to
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axillay vein
internal thoracic, lateral thoracic, intercostal veins breast cancer may metastasize to brain by following routes: cancer cells enter an intercostal vein --> external vertebral venous plexus --> internal vertebral venous plexus --> cranial dural sinuses |
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nipple secretion
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contains exfoliated duct cells, alpha-lactalbumin, immunoglobulins, lactose, cholesterol, steroids, fatty acids
along w/ ethanol, caffeine, nictoine, barbs, pesticides, techentium |
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nipple discharge
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benign cause typically green, milky yellow or brown is bilateral
not spontaneous and affects mult ducts milky discharge is acc by headache and loss of peripheral vision may indicate a pituitary adenoma nipple discharge from a malignant cause typically is bloody or clear, unilateral, spontaneous affects a single duct |
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fibroadenoma
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benign proliferation of CT in which mammary glands are compressed into cords of epihtelium
sharply circumscribed, spherical nodules that moves freely |
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infiltrating ductal carcinoma
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malignant proliferation of duct epithelium in which tumor cells are arranged in cell nests, cords, anastomosing masses
MOST COMMON type of breast cancer accounting for 65-80% of all cases |
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pleuritis - visceral
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no pain
the visceral pleura receives no nerve fibers of general sensation |
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parietal pleura causes
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sharp local pain and referred pain
innervated by intercostal nerves and phrenic nerve C3-5 pain may be referred to thoracic wall and root of neck respectively |
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pleura may be damaged inadvertently
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posterior surgical approach to kidney
abdominal incision at right infrasternal angle stellate ganglion nerve block brachial plexus nerve block knife wound to chest wall above clavicle fracture of lower ribs |
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malignant mesothelioma
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most serious pleural neoplasm
history of asbestos exposure increases risk of malignancy |
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spontaneous pneumothorax
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air enters pleural cavity
ruptured BLEB of diseased lung that result in negative pressure and collapsed lung chest pain, cough, mild to severe dyspnea |
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open pneumothorax
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parietal pleura is pierced and pleural cavity is opened to outside atmosphere
on inspiration, air is sucked into pleural cavity lung collapses common causes: chest trauma, iatrogenic factors |
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tension pneumothorax
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occur as a sequeal to open pneumothorax if inspired air cannot leave pleural cavity through wound on expiration
results in collapsed lung on wounded side and compressed lung on opposite side due to a deflected mediastinum CP, SOB,m absent breath sounds on affected side, hypotension, mediastinal shift compresses SVC, IVC, --> obstructing venous return |
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cricoid cartilage vertebral level
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C6 and ends at sternal angle T4
where it bifurcates into right and left main bronchi |
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carina
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on bronchoscopy
last tracheal cartilage |
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compression of trachea
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may be compressed by either an enlarged thyroid gland or an aortic arch aneurysm
aneurysm may tug on trachea w/ each cardiac systole can be felt by palpating trachea at sternal notch vertebral level T2 |
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distortions in position of carina
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indicate mets of bronchogenic carcinoma into tracheobronchial LN that surround the tracheal bifurcation or enlargement of LA
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aspiration of foreign objects
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aspirated material enters different parts of lung
dependong on person's position at time of aspiration |
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sitting or standing aspiration
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aspirated material enters RIGHT LOWER LOBAR bronchus and lodges within lower portion of right lower lobe
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supine - aspiration
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aspirated material enters RIGHT LOWER LOBAR BRONCHUS
lodges w/i UPPER PORTION OF RIGHT LOWER LOBE |
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lying on right side
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right upper lobar bronchus
within posterior portion of right upper lobe |
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lying on left side
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left upper lobar bronchus
within lingula of left upper lobe |
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common peroneal
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trauma to the lateral aspect of leg or fibula neck fracture
motor def: foot eversion, dorseflexion, toe extension sensory def: anterolateral leg and dorsal aspect of foot |
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tibial
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knee trauma
motor def: foot inverion, plantar flexion, toe flexion sensory def: sole of foot |
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superior gluteal
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posterior hip dislocation or polio
motor def: Positive Trendenlenberg sign, thigh abduction |
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obturator
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anterior hip dislocation
motor def: adduction of thigh sensory: medial thigh |
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inferior gluteal
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posterior hip dislocation
motor def: cant jump, climb stairs or rise from seat |
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how is axillary nerve lesioned?
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surgical neck fracture
dislocation of humerus dislocation of humerus intramuscular injections |
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how is radial nerve injured?
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spiral groove
lesioned by midshaft fracture of humerus compressed in axilla by incorrect use of crutch |
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how is C7 compressed?
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compressed by cervical disk lesion
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how is lower trunk of brachial plexus injured?
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Klumpke's palsy or pancoast tumor
compressed by cervical rib |
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how is median nerve injured?
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compressed by supracondylar fracture of humerus
pronator teres syndrome |
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how is medial nerve compressed distally?
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compressed in carpal tunnel syndrome
DISLOCATED LUNATE! |
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how is anterior interosseous compressed?
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in deep forearm
it is a branch of median nerve |
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how is recurrent br of median n injured?
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lesion by superficial laceration
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how is ulnar nerve lesioned?
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repeated minor trauma
fracture of medial epicondyl of humerus lersion by trauma of heel of hand, fracture of HOOK OF HAMATE |
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scaphoid fracture can lead to what?
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injury of radial artery
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brachial plexus
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Roots
Trunks Divisions Cords Branches Randy Travis Drinks Cold Beer |
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Clavicle fracture
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relatively common - brachial plexus is protected from injury by subclavius muscle
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musculocutaneous nerve
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C5-C7
upper trunk compression motor def; flexion of arm at elbow sensory: lateral forearm |
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Ulnar nerve
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C8-T1
PROX: fracture of medial epicondyle DISTAL: fracture of hook of hamate (falling onto outstretched hand) Motor def: medial finger flexion, wrist flexion, abduction/adduction of fingers (interossei), adduction of thumb, extension of 4th and 5th fingers (lumbricals) sensory: medial 1.5 fingers, hypothenar eminence sign: radial deviation of wrist upon wrist flexion Pope's blessing, hand of benefiction |
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Median nerve
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C6-C8, T1
prox: fracture of supracondylar humerus distal: carpal tunnel syndrome, dislocate LUNATE motor def: opposition of thumb, lateral finger flexion, wrist flexion dorsal and palmar aspect of lateral 3.5 fingers, thenar eminence dorsal and palmar aspects of lateral 3.5 fingers sign: ape hand, ulnar deviation of wrist upon wrist flexion |
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radial nerve
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C5-C8
fracture of midshaft of humerus Sat. night palsy extended compression of axilla by back of chair or crutches motor def: wrist extension, finger extension at MCP joints supination thumb extension abd abduction sensory def: posterior arm, dorsal hand and thumb sign: wrist drop |
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axillary
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C5, C6
fractured surgical neck of humerus, dislocation of humeral head motor: arm abduction at shoulder sensory def: over deltoid muscle sign: flattened deltoid |
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paracentesis
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needls is inserted through layer of abdominal wall to w/d excess peritoneal fluid (knife wounds to abdomen penetrate layers of abdominal wall)
Midline approach: tinea alba --> transversalis fascia --> extraperitoneal fat --> parietal peritoneum flank approach: skin --> superficial fascia, --> external oblique muscle, internal oblique muscle --> transversus abdominis, trasversalis fascia --> extraperitoneal fat |
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inguinal region
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weak area in anterior abdominal wall bc it is where testes and spermatic cord or round ligament of uterus penetrates during embryologic development
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surgical hernia repair may damage
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iliohypogastric nerve --> anesthesia of ipsilateral abdominal wall and inguinal region
ilioginguinal nerve --> anesthesia of ipsilateral penis, scortum, medial thigh |
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scrotum
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outpoutching of lower abdominal wall where by layers of abdominal wall continue into scrotal area to cover spermatic cord and testis
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Cyptorchidism
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testis fails to descend into scrotum
usually occur at 3 months undescended testis may be found w/i inguinal canal or abdominal cavity bilateral cryptorchidism results in sterility |
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hydrocele
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small patency of processus vaginalis remains from embryologic dev
peritoneal fluid than can flow into processus vaginalis creating a gluid-filled cyst |
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scrotum cancer mets to
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superficial inguinal nodes
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tests mets to
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deep lumbar nodes near renal hilus
also called para-aortic |
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extravasated urine occurs due to what injury?
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saddle injury
leaking into superficial perineal space located between colles fascia and dartos muscle and external spermatic fascia |
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vasectomy
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skin --> colles fascia and dartos --> external spermatic fascia --> cremasteric fascia and muscle --> internal spermatic fascia --> extraperitoneal fat
tunica vaginalis is not cut |
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Direct inguinal hernia
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protruydes directly through anterior abdominal wall within Hasselbach triangle
(laterlly bound by inferior epigastric artery and vein, medially by rectus abdominis, inferiorly by inguinal ligament common in OLDER males, rare in women mass in inguinal region that protrudes on straining and disappears at rest, constipation, prostate enlargement hernia can be detected w/ pulp of finger |
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indirect inguinal hernia
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protrudes through deep inguinal ring to enter inguinal canal
may exit through superficial inguinal ring into scrotum protrudes lateral to inferior epigastric artery and vein protrudes above and medial to pubic tubercle common in young males more common than direct inguina hernia clinical signs: tender, painful mass in inguinal region that continues to scrotum hernia can be felt w/ type of finger |
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femoral hernia
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protrudes thr femoral canal below inguinal ligament
below and lateral to pubic tubercle medial to femoral vein more common in females appears on right early strangulation |
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layers of abdominal wall --> testes and spermatic cord coverings
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skin--> skin
superficial fascia --> colles and dartos muscle superficial space (etxtravasated urine) external oblique --> external spermatic fascia internal oblique --> cremasteric fascia and muscle transverse abdominus does not continue into scrotal area transveralis fascia --. internal spermatic fascia extraperitoneal fat --> extraperitoneal fat parietal paritoneum --> tunica vaginalis |
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peritoneal cavity
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potential space between visceral peritoneum
divided into lesser and greater peritoneal sacs |
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omental foramen of Winslow
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opening of connection btwn lesser and greater peritoneal sacs
if surgeon places a finger in omental foramen, IVC lies posterior and portal vein lies anterior to his or her finger |
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omentum - lesser
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fold of peritoneum that extends from the porta hepatis of liver to lesser curvature
consists of hepatoduodenal ligament and hepatogastric lligament portal tried lies in the free margin of hepatoduodenal ligament |
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intraperitoneal organs
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stomach
part 1 of duodenum jejunum ileum cecum appendix transverse colon sigmoid colon liver gallbaldder tail of pancreas spleen |
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Celiac artery supplies
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foregut
at T12 to the first part of duodeum |
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superior mesenteric artery
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supplied midgut at L1 up to proximal 2/3 of trasverse colon
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inferior mesenteric
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located at vertebral level L3 supplies viscera that derive embryologically from hindgut, distal 1/3 of transverse colon --> upper portion of rectum
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abdominal aortic aneurysm
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below L1
most common site of rupture is left posteriolaterla wall immediate cpmpression of aorta gainst vertebral bodies above celia trunk left renal vein is put in jeaopardy inferior mesenteric lies in middle of AAA sudden onset of sever central abdominal pain may radiate to back pulsatile tender abdominal mass and hypotension, delirium ischemic colitis is result of ligation of inferior mesenteric spinal ischemia due to ligation of greater radicular artery |
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acute mesenteric ischemia most commonly caused by
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superior mesenteric artery
severe abdominal pain that is out of proportion to physical findings no evidence of peritonitis acute mesenteric ischemia usually occurs inelderly pts |
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right gonadal vein vs left
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right gonadal drains directly into IVC
left gonala vein drains into left renal vein |
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in a woman, right sided hydronephrosis may indicate
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thrombosis of right ovarian vein which would constrict ureter b/c right ovarian vein crosses vein crosses ureter to drain into IVC
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in a man: left sided testicular varicocele may indicate occlusion of
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left testicular vein or left renal vein by malignant tumor of kidney
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Esophagus varices
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Portal: Left gastric vein
Systemic: esophageal vein |
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Caput medusa
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portal: paraumbilical vein
IVC: superficial and inferior episgastric vein |
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rectal hemorroids
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Portal: superior rectal
systemic: middle and inferior rectal veins |
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is splenic vein systemic or portal?
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portal
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portal hypertension results in
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vomiting copious amounts of blood, history of alcoholis, liver cirrhosis, schistosomiasis, enlarged abdomen as a result of fluid and splenomegaly
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esophageal cancer (adenocarcinoma) metastasize below diaphragm to
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CELIAC LN
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bronchogeni carcinoma may indent esophagus as a result of enlarged...
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MEDIASTINAL LN
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forceful vomiting due to alcoholism, bulimia, pregnancy -->
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retroperitoneal pain after vmiting and extravasated contrast medium
Mallory-Weiss tears involved only mucosal and submucosal layers Boerhaave syndrome tears through all layers of esophagus |
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sliding hiatal hernia
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stomach herniates through diaphragm into thorax
deep burning retrosternal pain reflux of gastric content (bitter taste?) |
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paraesophageal hiatal hernia
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only stomach herniates through
no reflux of gastric contents strangulation of obstruction may occur |
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achalasia
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failure of LES to relax during swallowing
b/c of absence of MYENTERIC plexus progressive dysphagia (difficult swallowing) barium swallow shows dilated esophagus above LES CHAGAS disease may lead to achalasia |
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esophageal reflux
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dysfunction of LES allows gastric acid to reenter lower esophagus
substernal pain and heartburn may worsen w/ bending or lying down |
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esophageal strictures (narrowing)
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caustic strictures are result of injury caused by ingestion of vaustric agents
mucosal destruction due to gastric reflux |
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barrett esophagus
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replacement of stratified sq epithelium w/ gastric epithelium
may lead to esophageal adenocarcinoma |
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general feature of stomach
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muscular organ that functions in food digestion and storage
divided into 4 parts: CARDIA FUNDUS BODY ANTRUM |
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gastric ulcers occur in
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body along lesser curvature
predominantly PARIETAL cells caused by damage to mucosal barrier result of smoking, excessive salicylate ingestion, NSAIDs 70% assoc w/ H pylori BURNING PAIN increases after meal (lose weight) |
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hypertrophic pyloric stenosis
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congenital conditions that present w/i weeks of birth
PROJECTILE vomiting, no bile, visible PERISTALSIS, hard,mobile mass palpated on epigastric region |
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dumping syndrome
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abnormally rapid emptying of hyperosmotic stomach contents
occurs after partial gastrectomy or vagotomy performed to treat an ulcer or obesity clinical findings: epigastric dicomfort, rumbling sounds caused by gas movement, palpitations, dizziness, diarrhea, hypoglycemia |
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where does the stomach metastasize to?
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supraclavicular Lymph nodes (VIRCHOW nodes) on left side
can be palpated w/i posterior triangle of neck |
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Duodenum - superior part
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intraperiotenal begins at pyloris of stomach
duodenal cap or bulb |
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descending part of duodenum is retroperitoneal, receives common bile duct and main pancreatic duct via
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ampulla of Vater
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horixontal part is retroperitoneal, at vertebrae
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L3 between superior mesenteric anterior and aorta and iVC posterior
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ascending part
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intraperiteonal and ascends to meet jejunum at duodenojejunal flexure which supported by ligament of treitz (cranial end of dorsal mesentery)
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perforation of duodenum anterior or posterior would cause severe hemorrhage?
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posterior b/c it erods into gastroduodenal artery
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duodenal ulcer
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most often in superior part
damage to mucosal barrier and hypersecretion of gastric acid 100% pts have assoc H pylori severe epigastric pain DECR after meal tx: H2 receptor antagonists, antacids, sucralfate, bismuth, omeprazole, Bismuth, metronidazole, tetracycline |
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celiac disease
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hypersensitivity to gluten and gliadin protein
found in wheat and grains contribute to immunologic damage to mucosa GLIADIN antibodies detectable in blood chronic diarrhea, flatulence, weight lloss and fatigue |
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where is the sight of B12 absorption?
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ileum
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where are their Peyer patches?
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ileum
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where are there teniae coli
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large intestines
three longitudinal bands of SM also have fatty tags and haustra |
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where is there long vasa recta?
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jejunum
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what is the main site of absorption?
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jejunum
thicker wall, more vascular, redder than illeum long finger-shaped villi |
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where are there crypts and no villi?
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large intestines
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chronic granulomatous inflammatory bowel disease that most commonly affects ileum
ulcers can coalesce to serpentine ulcers classic features is clear demarcation of iseased bowel skip areas mass in right lower quadrant, diarrhea, fever, weight loss, weakness strictures of intestinal lumen and formation of fistulas |
CROHN
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appendicitis
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initial pain in umbilical and epigastric region
right lumbar region, N/V, anorexia, tenderness to palpation and percussion McBurney point is located by drawing a line from right anterior superior iliac spine to umbilicus |
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toxic megacolon
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dilation of transverse colon that results in perforation of colonic wall
clinical signs include: abdominal pain, fever, leukocytosis |
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bile
what does it contain? |
produced primarily by hepatocytes at average rate of 600 ml/day
primarily: water, electrolytes, bilirubin glucoronide, cholic acid, chenodeoxycholic acid conjugated to glycine or taurine, cholesterol, lecithin, Ca2+, secretory IgA |
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liver biopsies - where?
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needle puncture through right intercostal space 8-10
skin --> superficial fascia --> external oblique muscle --> intercostal muscle --> costal parietal pleura --> costodiaphramatic recess --> diaphragmatic parietal pleura --> diaphragm --> peritoneum |
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affects dev of intrahepatic and extrahepatic bile ducts
presents w/i weeks of birth most common cause of persistent jaundice in infancy dark urine clay-colored stools bile duct proliferation w/ dilation of bile canaliculi and bile plugs |
congenital biliary atresia
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granulomatous destruction of medium-sized intrahepatic bild ducts
cirrhosis appears later in course of disease characterized by antimitochondrial autoantibodies |
primary biliary cirrhosis
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inflammation, fibrosis, and segmental dilation of intrahepatic and extraheptic bile ducts
occurs in assoc w/ chronic UC right hypochondriac region pain, painless jaundice, no fever or chills, pruritis, fatigue, nausea |
primary sclerosing cholangitis
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uncinate process develops from:
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ventral pancreatic bud
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head of pancreas dev from
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ventral pancreatic and dorsal bud
lies in duodenal C-loop |
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pancreatic neck is from
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dorsal pancreatic bud
lies at confluence of inferior mesenteric and splenic vein |
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body and tail dev from
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dorsal pancreatic bud
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annular pancreas occurs when
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ventral pancreatic bud fuses w/ dorsal pancreatic bud both dorsally and ventrally forming a ring
causes obstruction of duodenum shortly after birth |
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what develops from ventral pancreatic bud?
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uncinate process and head
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acute pancreatitis
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assoc w/ biliary tract disease or alcoholism
pain in epigastric region radiates to back nause,vomiting elevated amylase lipase retroperitonela hemorrhage --> flank ecchymosis (turner sign ) or periumbilica ecchymosis (cullen sign) |
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pancreatic adenocarcinoma
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very aggressive
poor prognosis radiates to back, weight loss, obstructive jaundice |
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whipple
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remove head of pancreas, dudoenum, distal common bile duct, fallbladder and distal stomach
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what is the primary function of sigmoid colon?
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store feces
goes from S1-S3 |
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diverticulosis
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presence of diverticular
most commonly found in sigmoid colon >60 yo |
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diverticulitis
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pain in left lumbar region
palpable inflammatory mass fever leukocytosis ileus peritonitis |
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flexible sigmoidoscopy
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large intestine may be puctured
bends in anterior direction and to left |
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colostomy
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sigmoid colon often used in colostomy
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Gardner syndrome
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variation of FAP characterized by adenomatous polups and mult osteomas
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Turcot syndrome
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variation of FAP in pts have adenomatous polyp and gliomas
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FAP
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is archetype of adenomatous poluyposis
rectosigmoid colon irregular in shape, sessile, more than 2 cm in diameter AD mutation in APC nationcogene progression from small to large polyp is ras progression from large polyp to carcinoma w/ mutations in DCC and p53 |
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protrusion of full thickness of rectum through anus
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bowel protruding through anus, bleeding, anal pain, mucous discharge, anal incontinence caused by strethcing of internal and external anal sphincters
stretch injury of pudendal nerve |
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above pectinate line
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columnar or cuboidal
portal venous system internal iliac nodes visceral sensory internal hemorroids |
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below pectinate line
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stratified sq
caval venous system superficial inguinal nodes somatic sensory external hemorroids |
