Sd2 Abdominal Clinical Applications

Front 1

hydrocele

Back 1

peritoneal fluid in persistent processus vaginallis

1-2/100 male newborns; typically absorbed during 1st year

may occur as adult due to injury/swelling of epididymis

Front 2

indirect inguinal hernia

Back 2

congenital

parietal peritoneum & viscera protrude into deep inguinal ring LATERAL to epigastric vessels, travel through canal, emerge through superficial ring into scrotum

most common ab hernia, 20x moreso in men

Front 3

direct inguinal hernia

Back 3

acquired

parietal peritoneum & viscera protrude through weak area in post wall of canal MEDIAL to epigastric vessels

usu doesn't enter scrotum

enclosed by hernia sac formed by transversalis fascia

Front 4

peritonitis

Back 4

inflammation of peritoneum --> ascites (excess fluid)

caused by trauma or infection

drained by paracentesis

Front 5

omental foramen problems

Back 5

fluid accumulation in omental bursa after perforation of post stomach or injured pancreas

loop of intestine may herniate through into omental bursa

cystic artery may be severed --> pringle maneuver

Front 6

celiac ganglia block

Back 6

controls pain in patients w inoperable ab malignancy (pancreas, stomach, duodenum, prox bowel, liver, biliary tract tumors)

Front 7

hirschsprung's disease

Back 7

congenital aganglionic megacolon

birth defect where nerves in wall of large intestine (control peristalsis) are undeveloped so muscles of lg intestine do not relax and waste is prevented from moving through

results in trapped stool, infection, inflammation and constipation

tx: surgical removed of part of colon

Front 8

referred pain

Back 8

viseral sensory & general sensory dermatomes confused in SC

viseral heart pain felt in T1-T4 dermatome

Front 9

adenocarcinoma of stomach

Back 9

• Malignant tumor originating from glandular epithelium
• Most common >50yo in men>women
• Aggressive spread to adjacent organs & peri by early lymphatic metastasis to regional lymph nodes & liver

Front 10

diverticula (diverticulitis)

Back 10

• Pouches/sacs branching out from hollow organs – typically in intestine on mesenteric border
• Can become inflamed – diverticulitis
• Mecke’s diverticulum – congenital anomaly in ~2% of people
o Remnant of prox part of embryonic yolk stalk on antimesenteric border of ileum
o 1-2in long about 20in from ileocecal junction

Front 11

adenocarcinoma of descending colon

Back 11

• Peak age 60s-70s
• Risk factors: polyps, ulcerative colitis, genetic factors, low fiber & high animal fat diet
• Cancer cells pass to paracolic/epicolic lymph nodes through intermediate colin nodes along L colic art & ultimately to inf mesenteric nodes
• “apple-core” lesion (narrowing) seen on CT scans

Front 12

liver cirrhosis

Back 12

• Chronic liver disease characterizezd by generalized disorganization of hepatic architecture w/ scarring & nodule formation  increased portal venous pressure  esophageal varices, rectal hemorrhoids, paraumbilical venous collaterals & splenomegaly
• Esophageal varices – result from blood being rerouted from L gastric vein (portal) to IVC (systemic/caval)
o Result of portal hypertension producing enlarged varicose veins
• Caput medusae appearance results from blood being rerouted in paraumbilical veins
• Hemorrhoids (internal) result from blood being rerouted form sup rectal vein

Front 13

gallbladder disease

Back 13

• Cholecystitis
o Acute pyogenic inflammation manifesting along with nausea, vomiting, fever, and pain in RUQ or chronic thickening of gall bladder wall as a result of fibrosis & complicated w/ gallstones
• Cholelithiasis (gallstones)
o Typically a mixture of cholesterol & calcium salts
o Assoc with obesity & multiple pregnancies; F > M

Front 14

carcinoma of pancreas

Back 14

• Common tumor arising in head of pancreas and obstructing bile duct
• Often “silent” prior to widespread dissemination
• Manifests clinically by ab pain radiating through to back (due to irritated/inflamed parietal peri), weight loss, enlarged gall bladder & associated obstructive jaundice
• Usu results in death within 1 year

Front 15

polycystic kidney desease

Back 15

• Partial replacement of renal parenchyma by cysts on both kidneys
• Autosomal dominant
• Manifests b/t 15-30yo w/ HT, hematuria, palpable renal masses  renal failure

Front 16

hydronephrosis

Back 16

• Progressive dilation of renal pelvis and calyces usually as a result of urinary tract obstruction (renal stones or benign prostatic hyperplasia)

Front 17

pelvic & horseshoe kidney

Back 17

• Pelvic kidneys – failed to ascend during development; presumably ascension blocked by vasculature (IMA)
• Horseshoe kidneys – fusion of non-ascended kidneys
• UTIs, kidney stones, hydronephrosis – common complications

Front 18

renal cell carcinoma

Back 18

• Most common renal malignancy
• Usu in upper pole – 50-70/m; smokers
• Symptoms: hematouria, palpable mass, fever, flank pain (tumor stretches fribous capsule, referred pain to flank)

Front 19

aneurysm of abd aorta

Back 19

• Aneurysm – permanent ballooning in wall of artery; pressure of blood passing can force part of weakened art to bulge outward forming a think-skinned blister
• Considered to be an aneurysm when widened part of aorta is 1.5x normal size
• Caused by atherosclerosis, HT, penetrating wounds & infections
• Filled w/ thrombus (clot)  death from rupture