Clinical Notes

Question 1

Infection in the ___ or ___ ___ moves into the Psoas Fascia

Answer 1

Lumbar or Thoracic Vertebrae

Question 2

Psoas Abscess

Answer 2

• Infection within the Psoas Fascia
• Fascia thickens due to accumulating pus and creates tube-like structure running the length of the muscle

Question 3

Symptoms of Psoas Abscess

Answer 3

• Back pain
• Leg and hip pain triggered by movement
• Fever
• Inguinal mass
• Limp

Question 4

Positive Psoas Sign

Answer 4

• Positive when patient has Psoas Abscess
• Positive test occurs when patients lower abdominal pain is exacerbated by extending the thigh

Question 5

Pringle Maneuver

Answer 5

Clamping of the Hepatoduodenal Ligament to stop hemorrhaging of the liver during surgery

Question 6

Peritonitis

Answer 6

Infection and inflammation of the peritoneum due to injury, surgery, or bacterial infection/bursting of an organ (ex. appendix)

Question 7

Symptoms of Peritonitis

Answer 7

• Release of pus and other excretions into the cavity
• Pain in the overlying skin
• Fever
• N/V

Question 8

Ascites

Answer 8

• Condition that can occur due to peritonitis, cancer and liver disease
• Excess fluid released from the abdominal organ (ascitic fluid) builds up within the cavity
• Fluid follows the flow created within the abdominal cavity towards the pelvic cavity

Question 9

Inguinal Hernias

Answer 9

• Most common type of hernia
• Occur mostly in men due to passage of spermatic cord through the area
• Occurs when the abdominal viscera and peritoneum protrude through weak areas in the abdomen

Question 10

Direct Hernia

Answer 10

• Occurs due to weakness in the abdominal wall near the medial inguinal fossa (inguinal triangle: inguinal ligament, lateral border rectus abdominis, lateral umbilical ligament)
• Pushes through the abdominal wall and can push through the superficial inguinal ring (impacts sensory innervation in the region by pressing on the nerves in the area such as the ilioinguinal n)

Question 11

Indirect Hernia

Answer 11

• Located lateral to the inferior epigastric vessels
• Follows the path of the contents of the spermatic cord or round ligament outside of the body via the deep inguinal ring
• May result in the viscera and associated fascia entering the scrotum or labia majora

Question 12

During a sliding hiatal hernia, what portion of the stomach moves through the esophageal hiatus?

Answer 12

Cardia of the Stomach

Question 13

In a Para-Esophageal Hiatal Hernia, what portion of the stomach moves through the esophageal hiatus?

Answer 13

Fundus of the Stomach

Question 14

Hiatal Hernia

Answer 14

• Occurs when part of the stomach moves superiorly through the esophageal hiatus of the thoracic diaphragm and enters the mediastinum
• Two types: Paraesophageal, Sliding Hiatal

Question 15

Sliding Hiatal Hernia

Answer 15

• Common type of hiatal hernia
• Esophagus, Cardiac region, and Fundus of the stomach move superiorly through the esophageal hiatus
• Regurgitation of food can occur
• Amount of stomach displacement can change based on body positioning

Question 16

Ileal Diverticulum (Meckel Diverticulum)

Answer 16

• Outpouching or bulge of the middle to the distal part of the small intestine, containing all layers of the intestinal wall
• Most common abdominal congenital condition (present at birth)
• Occurs in 2% of the population, 2” long, within 2” of the ileocecal valve, and presents before 2 years of age

Question 17

Cause of Ileal Diverticulum (Meckel Diverticulum)

Answer 17

• Incomplete obliteration of the Omphalomesenteric duct (vitelline duct –> connecting the yolk sac to the small intestine)
• Because of this the diverticulum can be attached to the umbilicus

Question 18

Appendicitis

Answer 18

Inflammation of the Vermiform Appendix causing abdominal pain

Question 19

Appendicitis: Cause

Answer 19

Blockage of the lumen of the appendix either by lymphatic follicles or feces — blocks drainage of appendix

Question 20

Appendicitis: Symptoms

Answer 20

Palpitation at McBurney Point (1/3 distance btwn ASIS and umbilicus) results in tenderness once the parietal peritoneum becomes irritated (visceral peritoneum causes pain near the umbilicus)

Question 21

If the appendix bursts, it can cause ____

Answer 21

Peritonitis

Question 22

Renal Calculi (Kidney Stone)

Answer 22

• Accumulations of salts and other inorganic or organic material
• Can block the flow of urine if it becomes lodged, especially at sites of constriction (ureteropelvic junction, pelvic brim, ureterovesical junction)

Question 23

Locations of Renal Calculi

Answer 23

• Kidney (calyxes and pelvis)
• Ureters (Ureteric Calculi)
• Urinary Bladder

Question 24

If the calculus is larger than the structure it is trying to pass through, it may cause:

Answer 24

• Severe intermittent pain as the calculus moves through the system
• Blockage of the flow of urine (if becomes lodged)

Question 25

Gallstones (Cholelithiasis)

Answer 25

Created by the concretion of material within the gallbladder

Question 26

Gallstones: Symptoms

Answer 26

Often asymptomatic until they block the biliary ducts and start causing pain and jaundice

Question 27

If the gallbladder becomes dilated due to Gallstones, it may create a ____ between itself and the GI Tract, and the gallstone may enter the ___ ___

Answer 27

- Fistula - GI Tract

Question 28

Calot's Triangle

Answer 28

- Cystic Duct - Cystic Artery - Common Hepatic Duct - Lund's Node

Question 29

Hydrocele

Answer 29

- Occurs when peritoneal fluid accumulates within the Tunica Vaginalis and causes swelling with the scrotum - More common in babies than adults

Question 30

If light does not pass through the scrotum, ___ or ___ might be causing the scrotal mass

Answer 30

- Blood (Hematocele) - Tumor

Question 31

If light does pass through the scrotum, ___ ___ is likely causing the scrotal mass and physicians must check to make sure the ___ ___ is closed

Answer 31

- Peritoneal Fluid - Processus Vaginalis

Question 32

Varicocele

Answer 32

- Occurs when the veins that create the Pampiniform Plexus become dilated and tortuous - Gives scrotum a "bag of worms" appearance

Question 33

Varicocele: Causes

Answer 33

- Venous Valve Failure - Kidney issues

Question 34

Varicoceles are more common on the right or left side? Why?

Answer 34

Left because the left testicular vein empties into the left renal vein

Question 35

Varicoceles can be asymptomatic, but can impact ____, which may require surgical intervention.

Answer 35

Fertility

Question 36

Renal Vein Entrapment Syndrome

Answer 36

- Left Renal Vein normally passes between the Superior Mesenteric A and the Abdominal Aorta before reaching the IVC - This syndrome occurs when the superior mesenteric artery moves inferiorly and puts pressure on the renal vein - Sometimes called Nutcracker Syndrome

Question 37

Renal Vein Entrapment Syndrome: Symptoms

Answer 37

- Hematuria (blood in urine) - Proteinuria (protein in urine) - Left abdominal pain - Nausea - Vomiting (can contain bile b/c SMA can apply pressure to the horizontal part of the duodenum) - Left testicular pain (L gonadal vein empties into L renal vein)

Question 38

Referred Pain: Visceral Pain

Answer 38

- Pain arises from an organ - Pain can be mild to severe, and is often difficult to localize due to the way the autonomic innervation is supplied to the spinal cord and brain - Pain is brought to the spinal cord at the same level as a dermatome -- means that the pain associated with the skin and dermatomes are not necessarily associated with the organ leading to it (referred pain) - Ex. Stomach is supplied by Greater Splanchnic N that is from T5-T9; stomach pain can be associated above the level of the stomach and even into the upper back

Question 39

Somatic Pain

Answer 39

- Pain is felt at the location of injury due to the somatic (more direct) innervation of that part, and is not considered referred - Pain is more localized and can be more acute - Ex. if liver becomes inflamed and rubs on the diaphragm, the pain is felt over that area of the liver b/c of the more direct innervation pathway