Board review 2

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Board review 2

  1. 1. Abdominal Pain and Pathology
  2. 5. Upper Right Hypochondriac <ul><li>Gall Bladder – Band that goes around the quadrant and ascends </li></ul><ul><li>Liver –band that goes around the quadrant and descends. </li></ul><ul><li>Shoulder and neck region </li></ul><ul><li>Portal Hypertention </li></ul>
  3. 7. Cystic Duct Common Bile Duct Hepatic Duct
  4. 8. Cystic Duct Hepatic Duct Common Bile Duct Main Pancreatic Duct
  5. 9. LIVER
  6. 11. Portal Hypertention <ul><li>Portal –Systemic Anastomosis </li></ul><ul><li>Esophageal </li></ul><ul><li>Paraumbilical </li></ul><ul><li>Rectal </li></ul><ul><li>Retroperitoneal </li></ul><ul><li>Phrenic </li></ul>
  7. 13. Diaphragm <ul><li>Innervated by phrenic nerve C3 –C5 </li></ul><ul><li>Shoulder area – brachial plexus C5 </li></ul><ul><li>Lower Neck – Cervical plexus C3,C4 </li></ul>
  8. 16. STOMACH <ul><li>Ulcer </li></ul><ul><li>Lesser curvature of the stomach </li></ul><ul><li>Greater or lesser sac </li></ul>
  9. 19. PANCREAS <ul><li>Pancreatitis – Alcohol </li></ul><ul><li>Pancreatitis – Gall Stone </li></ul>
  10. 21. Head Duct Body Duct Tail Duct Neck Uncinate Process
  11. 23. SPLEEN <ul><li>Trauma </li></ul><ul><li>Infection </li></ul>
  12. 26. Urinary Tract <ul><li>Kidney Stones </li></ul><ul><li>Infections </li></ul>
  13. 28. Cortex Medulla Ureter
  14. 30. Appendicitis <ul><li>Pain non-descript in the umbilical region </li></ul><ul><li>Moves to lower right hand quadrant when affects the peritoneum </li></ul><ul><li>Duodenal ulcer, Meckel’s diverticulum and pelvic anatomy can give similar symtoms </li></ul>
  15. 32. Parietal Peritoneum Mesoappendix Appendix Appendicular Artery Ileocolic Artery
  16. 34. HERNIAS <ul><li>Direct Inguinal </li></ul><ul><li>Indirect Inguinal </li></ul><ul><li>Femoral </li></ul>
  17. 35. Spermaticord Superficial Inguinal Ring Inguinal Ligament External Abdominal Oblique Aponeurosis External Abdominal Oblique
  18. 36. Internal Abdominal Oblique Conjoint Tendon (Falx Inguinalis) Cremaster Muscle
  19. 37. Transversus Abdominis Conjoint Tendon Transversalis Fascia Deep Inguinal Ring Inferior Epigastric Artery Inguinal Ligament
  20. 38. HERNIAS Inguinal A. Indirect- Most common type of hernia 1. Enters deep to inguinal ring – lateral to the inferior epigastric artery
  21. 40. HERNIAS Inguinal A. Indirect- Most common type of hernia 1. Enters deep inguinal ring – lateral to the inferior epigastric artery. B. Direct – Bulges anteriorly through posterior wall of the canal 1. Medial to inferior epigastric artery 2. About 15% of inguinal hernias
  22. 43. HERNIAS Inguinal A. Indirect- Most common type of hernia 1. Enters deep inguinal ring – lateral to the inferior epigastric artery B. Direct – Bulges anteriorly through posterior wall of the canal 1. Medial to inferior epigastric artery 2. About 15% of inguinal hernias. Femoral A. Passes posterior to the inguinal ligament B. In the femoral canal C. Most frequent in women
  23. 45. HERNIAS Umbilical A. Congenital B. Acquired
  24. 46. HERNIAS Umbilical A. Congenital B. Acquired Epigastric A. Widest part of the linea alba B. Xiphoid to umbilicus
  25. 47. HERNIAS Umbilical A. Congenital B. Acquired Epigastric A. Widest part of the linea alba B. Xiphoid to umbilicus Divarication of the Recti Abdominis A. Old women with weak muscles B. Hernial sac bulges between medial margins of recti
  26. 49. Sports Hernia a. Athletic Pubalgia, Gilmores’s Groin or Sportsman’s Groin b. tear in the conjoined tendon due to inability to oppose the effect of the thigh adductor muscles on the pubis. c. Characterized by pain in the inguinal and pubic areas. Conjoined Tendon Pubic Tubercle Pubic Body Inferior Pubic Ramus
  27. 50. Abdominal Infections <ul><li>Paracolic sulcus </li></ul><ul><li>Mesenteric sulcus </li></ul>
  28. 51. Rt. Paracolic Sulcus Rt. Mesenteric Gutter Lf. Paracolic Sulcus Lf. Mesenteric Gutter Mesentery
  29. 52. Abdominal Cancers <ul><li>Stomach </li></ul><ul><li>Pancreas </li></ul><ul><li>Colon </li></ul><ul><li>Liver </li></ul>
  30. 54. Developmental Anomalies of GI System
  31. 55. <ul><li>Anomalies of the stomach – uncommon except hypertrophic pyloric stenosis </li></ul><ul><li>1. Marked thickness in the pyloris – predominantely in the inner circular muscle layer </li></ul><ul><li>2. Stomach becomes distended and the infant experiences projectile vomiting </li></ul><ul><li>3. Treatment - cut the pyloric sphincter </li></ul><ul><li>Duodenal stenosis </li></ul><ul><li>1. Caused by incomplete canalization </li></ul><ul><li>2. Usually found in third or fourth part </li></ul><ul><li>3. Bile can be found in vomited stomach contents </li></ul><ul><li>Duodenal Atresia </li></ul><ul><li>1. Failure to recanalize </li></ul><ul><li>2. Found in second and third parts of duodenum </li></ul><ul><li>3. Infant vomits almost immediately after birth and vomit contains bile </li></ul><ul><li>4. Polyhydramnios - double bubble sign </li></ul>
  32. 56. Anomalies of the Midgut 1. Congenital Omphalocele – viscera do not go back in from umbilicus 2. Umbilcal hernia – viscera or fat herniate into a weakend umbilicus after intestines have gone back in. Hernia appears upon straining. 3. Gastrochisis – hernias in the abdominal wall other than in the umbilicus formation
  33. 57. 4. Malrotation of the gut a. Nonrotation - intestine does not rotate upon returning – causes the small intestines to be on the right and the large intestine on the left. b. Mixed rotation and volvulus – cecum lies posterior to the pyloris and is fixed to the posterior wall by peritoneal bands that pass over the duodenum –cause duodenal obstruction c. Reversed rotation - midgut loop rotates clockwise – duodenum lies anterior to the SMA and the transverse colon lies posterior to it which can cause the transverse colon to become occluded. d. Subhepatic cecum and appendix – cecum becomes attached to liver –complicates the diagnosis of appendicitis e. Mobile cecum – incomplete fixation of ascending colon – complcates diagnosis of appendicitis f. Internal hernia – through intestinal mesentery g. Midgut volvulus - failure of midgut loop to return properly – causing disruption of mesentery
  34. 58. 5. Stenosis and atresia of intestine – 25% duodenum and 50% ileum a. insufficient recanalization b. diaphragm c. blood supply disruption 6. Ileal diverticulum and other yolk stalk anomalies – Meckels 7. Duplication of intestine – usually incomplete recanalization
  35. 59. Anomalies of the Hind Gut <ul><li>1. Congenital Megacolon – Hirschsprung’s disease </li></ul><ul><li>2. Anal agenesis with and without a fistula </li></ul><ul><li>a. ectopic anus </li></ul><ul><li>b. anoperineal fistula </li></ul><ul><li>3. Anal stenosis </li></ul><ul><li>4. Rectal atresia </li></ul>
  36. 62. PELVIC EXAMINATION <ul><li>Anteverted/ Anteflexed Uterus </li></ul><ul><li>Cystocele </li></ul><ul><li>Rectocele </li></ul>
  37. 66. HYSTERECTOMY <ul><li>Water passes under the bridge </li></ul>
  38. 67. Uterine Artery Ureter
  39. 68. URINARY CONTINENCE <ul><li>Pelvic diaphragm </li></ul><ul><li>Pubococcygeus muscle </li></ul>
  40. 69. Pubococcygeus Muscle Iliococcygeus Muscle Coccygeus Muscle
  41. 70. PERINEAL ANESTHESIA <ul><li>Pudendal Nerve </li></ul><ul><li>Ilioinguinal Nerve </li></ul><ul><li>Perineal Br. Of Posterior Femoral Cutaneous Nerve </li></ul>
  42. 71. Ilioinguinal Nerve (Genitofemoral Nerve Perineal Br. Posterior Femoral Cutaneous Nerve Dorsal Nerve of the Clitoris Pudendal Nerve Perineal Nerve Inferior Rectal Nerve
  43. 72. EPISIOTOMY <ul><li>Perineal Body </li></ul><ul><li>Transverse Perineal Muscles </li></ul><ul><li>Perineal Membrane </li></ul>
  44. 73. Perineal Body Transverse Perineal Muscle Perineal Membrane
  45. 74. PROSTATE CANCER <ul><li>Posterior Lobe </li></ul><ul><li>Cavernous Nerve </li></ul><ul><li>Impotence </li></ul>
  46. 75. Median Lobe Posterior Lobe Ejaculatory Duct
  47. 76. MALE PELVIC TRAMA <ul><li>Deep Abdominal Fascia, Deep Penile Fascia (Buck’s), Deep Perineal Fascia </li></ul><ul><li>Superficial Abdominal Fascia (Scarpa’s), Superficial Penile Fascia, Dartos Fascia, Superficial Perineal Fascia </li></ul>
  48. 77. Deep Abdominal Fascia Deep Perineal Fascia Dartos Fascia Deep Penile (Buck’s Fascia Superficial Abdominal (Scarpa’s) Fascia
  49. 78. TESTES <ul><li>Hydocele </li></ul><ul><li>Vericocele </li></ul><ul><li>Torsion </li></ul><ul><li>Cancer </li></ul>
  50. 79. Pampiniform Plexus Vas (Ductus) Deferens Testicular Artery Tunica Vaginalis
  51. 80. HEMORROIDS <ul><li>Internal </li></ul><ul><li>External </li></ul>
  52. 81. Superior Rectal Veins Inferior Rectal Veins
  53. 83. LYMPHATICS
  54. 84. Superficial Inguinal Nodes External Iliac Nodes Internal Iliac Nodes Common Iliac Nodes Inferior Mesenteric Nodes Para-aortic Nodes
  55. 86. Abnormalities of Sexual Differentiation Turner’s Syndrome – XO – streak ovaries but normal female genitalia. True Hemaphrodism – both ovaries and testicular tissue – external genitalia female with hypertrophied clitoris. Female Pseudohermaphroditism – Genetically female (46XX) – external genitalia masculinized – CAH a cause. Male Pseudohermphroditism – (46 XY) – hypoplasia of phalus and persistence of paramesonephric duct – inadequate production of testosterone. Testicular Feminization Syndrome – androgen insensitivity due to lack of receptors – normal appearing female but has an internalized testes – characterized by amenorrhea .
  56. 87. <ul><li>Malformations of Genitalia </li></ul><ul><li>Hypospadius – failure of urogenital folds to fuse. </li></ul><ul><li>Epispadias – results with extrophy of the bladder </li></ul><ul><li>Duplication of the penis </li></ul><ul><li>Absence of the penis </li></ul><ul><li>Hormonal enlargement of the clitoris – exposure to androgens </li></ul>
  57. 88. HYPOSPADIUS
  58. 89. <ul><li>Double Uterus, Double Vagina </li></ul><ul><li>Double Uterus, Single Vagina </li></ul><ul><li>Biconuate Uterus, One Cervix </li></ul><ul><li>Septate Uterus </li></ul><ul><li>Unicornuate Uterus </li></ul><ul><li>Atresia of the Cervix </li></ul>
  59. 90. QUESTIONS?

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