Abdomen clinical review from KLM

1.LIPOSUCTION:
Method for removing unwanted substances by tubes sudermaly placed. When closing abdominal skin incision,membranous layer of subcutaneous layer below level of umblica it accordance to provide strength.

2.SPACE OF BORGUS:
Antrolateral space of pectinate space b/w fascia transversa;is & parital perotonium is used to insert prosthesis when repairing inguinal hernias.

3.PROTRUBERANCE OF ABDOMEN:
Normal in infants & young children bcs GIT contains air, present in these 6 F. Food,fluid,fat,feces,flauts,fetus

4.ABDOMINAL HERNIAS:
Antrolateral abdominal wall is site of hernias. Inguinal,Umblical,Epigastric are common types. -Umblical hernias is present in newborns bcs umblical ring is weak in low weight infants.(congenital) Acquired umblical hernia is in obese or females,extraperitonial fat or perotonium protrudes where lines of aponurosis interlace. -Epigastric hernia : through linea alba -Spigelian hernia: through linea semilunaris (<40 year age)

5.GUARDING:
Involantry spasm of muscles when cold hands are applied in palpitation. *muscles & visceras are retracted towards not away from the plane of neurovascular plane

6.MEDIAN OR MISLINE INCICION:

Linea alba is avascular so chances of necrosis

7.PARAMEDIAN INCISION:
Muscles retracted lateraly to prevent tension & injury to vesesls & nerves

8.GRIDION INCISION:
For appendectomy, illiohypogastric nerve is preserves deep to internal oblique muscle.

9.PFANESTIAL /BIKNIS INCISON:

For gynoclogical or obstetrical operation, illiohypogastric & illioinguinal nerve is preserved.

10. 11. 12. 13. 14.

TRANSVERSE INCISION: SUBCOSTAL INCISION: HIGH RISK INCISIONS: INCISIONAL HERNIA: CRYPTORCHID TESTIS:

Not in intersections bcs of superior epigastric vesesls To access gall bladder ,bile duct,spleen.T7,T8 spinal nerve is saved. These are pararectal & inguinal . in inguinal incision illioinguinal nerve is damaged Protrusion of omentum bcs aponeurotic /muscular layer dont heal properly.

Hidden testsis,if undescended or not retractable,commonly rest in inguinal canal,cause problem if there is cancer.

15.

EXTERNAL SUPERVESICAL HERNIA:

Occurs in supravesical pouch,illiohypogastric nerve is in danger. *postnatal patency of umblical vein is used for exchanged transfusions in enwborns e.g in erthroblastosis fetalis.

16. 17.

METASTASIS OF UTERINE CANCER: INGUINAL HERNIA:

To labium majousvia round ligament & to superficial inguinal nodes Common in males.due to spermatic cord to inguinal canal.2 types direct & indirect.indirect is in 2/3 patients. Detection of impulse at superficial ring and mass at deep inguinal ring indicates indirect hernia.if direct is present it passes through medial 3rd of inguinal canal ,external to process vaginalis.

18.

CREMESTERIC REFLEX:

Illioinguinal nerve supplies the area stroking medial side of thigh,elevation of testis.

19. HYDROCELEOF SPERMATIC CORD & TESTIS:

Excess fluid presnt in persistent processus vaginalis.present with indirect inguinal hernia.transilumination (red brown light) indicates hydrocele. Injury/inflammation of epidydmis may produce hydrocele in adults.

20. 21.

HEMATOCELE: TORSION OF TESTIS:

Collection of blood in tunica vagianlis e.g rupture of testicular artery,no transilumination.

Twisting,due to necrosis of cells cause obstruction of venous return cause edemathat occurs at upper pole of testis.

22. 23. 24. 25.

ANESTHISIA TO SCROTUM: SPERMATOCELE: EPIDYDMAL CYST: VARICOCELE:

Antrolateral lumbar peluxes via inguinal nerve+ posteroinferios sacral peluxes via pudendal nerve Collection of fluid in epidydimis ner its head. Collection of fluid anywhere in epydidmis Dilation of pampiniform peluxes.feels like bag of worms.common on left side due to problem in testicular vein or kidney or renal vein problem.

26.

CANCER OF TESTIS & SCROTUM:

Testsis: initialy in retroperitoneal lumbar lymph nides further in medistinal & supraclavicular nodes Scrotum: to superficial inguinal lymph nodes And via bloodto liver,brain & vertebrae

27. 28.

PERITONITIS: ASCITIC FLUID:

Inflammation of peritoneum,due to bacteria & ulcers causing tenderness ,constipation,vomitingnausea Excess fluid in peritoneal cavity due to mechanical injury,starvation,portal hypertension etc

29.

PERITONIAL ADHESION:

If peritoneum is damaged by stab,wound,infected.peritonial surface becomes inflamed making sticky with fibrin.slowly fibrin replaces with scar tissue is called adhesion

30.

PARACENTISIS:

Aspiaration of fluid,usulay superior to empty bladder or anywhere avoiding inf epigastric artery.

31. 32. 33. 34. 35. 36.

FUNCTIONS OF GREATER OMENTUM: ABSCESS FORMATION: FLOW OF ASCISTIC FLUID: FLUID IN OMENTAL BURSA: SEVERANCE OF CYSTIC ARTERY: ESOPHAGEAL VARICES:

Forms adhesion adjacent to inflamed organs,chushions,insulation. Pus formation,due to perforation of duodenal ulcer,rupture of gallbladder,appendix.usulay in subphrenic space When uptright it goes in pelvic cavity,when supine goes in subphrenic recess via paracolic gutters. Injury to stomach or pancrease cause fluid in omental bursa It is clamped during cholecystectomy ,if ruptured hepatic artery is compressed by help of omental bursa In alcoholic chirosis,bcs subdermly protosystemic anastomosing veins present,so in hypertension portak veins blood goes reversal to esophageal tibutries,veins dilates.

37.

PYROSIS:

Heartburns,due to regurgitation of small amount of food or gastric fluid in lower esophagus(GERD) ,cause pain.

38.

HIATAL HERNIA:

Protrusion of part of stomach in mediastinal through esophageal hitus due to weakening of diaphragmatic muscles -less common paraesophageal type cardia remains in position,parts of peritoneum+fundus of stomach protrudes,no GERD. -most commonis sliding hital hernia.abdomial part of stomach+cardia moves,GERD present.

39.

PYLOROSPASM:

Spasmodic contraction of pylorus ,sometimes in infants.

40. CONGENITAL HYPERTROPHIC PYLORIC STENOSIS:

Thickening of smooth muscles resist gastric emptying+stomach dilates

41.

CARCINOMA OF STOMACH:

Variety of lymph nodes,all lymph nodes can be excised but head of pancrease ,aortic & ceolic nodes removal is difficult. Cancer frequently occurs in pyloric region.

42.

GASTRIC & PEPTIC ULCERS:

Gastric ulcers are lesions of mucosa of stomach,whereas peptic ulcer is specific for pyloric canal & dudenoum.ulcers erodes gastric arteries & its life threatning.posterior erosion erodes splenic artery.

43. 44. 45.

VAGOTMY: DUODENAL ULCER: PARDUDENAL HERNIA:

In selective vagotmy parital cells area is denervated & in truncal vagotmy,any one trunk is cut. Gastrodudenal artery ruptures & cause svere hemorrhage

Paradudenal recess & fossa is large & to side of ascending part of dudenoum.if intestine strangulate inf mesenteric vesels/ascending branch es of left colic artery in danger.

46.

ISCHEMIA OF INTESTINES:

Occlusion of vasa recta due to emboli ,if sever obstruction of intestine occurs.vomiting,fever,dehydration,colicky pain,abdominal distension occurs.

47.

APPENDECITIS:

Inflamtion of appendix,due to hyperplasia of lymphatic follicles in appendix lumen occludesor due to conceration (n fecal matter) formed or clot in appendicular artery

48.

DIVERTICULOSIS:

External evaginations or outpo keting of mucosa of colon,common is in sigmoid colon,these are not true.

49. 50. 51. 52. 53.

VOLVULOS: RUPTURE OF SPLEEN: SPLENIC NEEDLE BIOPSY: PANCREATECTOMY: PANCREATIC CANCER:

Rotation& twisting of mobile loop of sigmoid colon& mesocolon results in obstruction,ischemiaconstipation,fecal impaction,necrosis 9th12th rib

10 rib in midaxilary line is pleural cavitys extension Imposible to remove complete head of pancrease to preserve deudenal blood supply. Heads cancer obstruct bile duct & result retention of bile pigment,dilation of

Gall bladder & obstructive jaundice.Neck or bodys cancer cause compression of hepatic portal system,IVC & metastasis to liver by portal vein.

54.

SUBPHRENIC ABCESS:

Pus formation,more common on right side.due to ruptures appendix & duodenal ulcers& may drain in hepatorenal pouch (supine position) and aspirated by 12th rib.

55. 56.

HEPATIC SEGMENTECTOMY: ABERRANT HEPATIC ARTERY:

Liver injuries involve right lobe,in segmentectomy,veins provide map guide. Accessory/replaced artery, source of right hepatic artery is SMA & for left is left gastric artery.

57.

HEPATOMEGALY:

Liver enlargement,due to congestive heart failure,bacteria,hepatitis,viral diseases,tumors examination.inf border becomes palpable below costal margins.

58. 59. 60.

LIVER CHIROSIS: LIVER BIOPSY: GALLSTONE:

Progressive destruction of hepatocytes & replacement with fat & fibrous tissue,it acuse portal hypertension,its due to alchol,ccl4, Directed through right 10th intercostal space in midaxilary line in full expiration. Concentration in gallbladder ,cystic duct composed of cholesterol crystals.common site is hepatogastric ampula,can cause inflamtion of gallbladder & hartmans pouch(junction of neck of gallbladder &

cystic duct).it may pass to duodenum if there is deoudnal ulcer.pain goes to epigastrium & 9th costal cartilage level & to shoulders due to irritation to diaphragm,cause jaundice if bile goes to blood.

61.

GALLSTONES IN DEUODENUM:

If inflamtion of gallbladder,it makes adhesion with viscera,further inflmation erodes duodenum & makes false pathway.

62. CALOTS TRIANGLE/VYSTOHEPATIC TRIANGLE:

Inf: cystic duct, medialy: common bile duct, superiorly: inf surface of liver

63. 64. 65. 66. 67.

CHOLESCYSTECTOMY: PORTAL HYPERTENSION: PORTOSYSTEMIC SHUNTS: PERINEPHRIC ABCESS: NEPHROTOSIS:

Right hepatic artery is in danger It causes varices in lower esophagus,umblical region(caput medusa),hemorrhoid To reduce portal hypertension another way is splenorenal shunt. Due to renal fascia adherent to ureter & vessels so prevent from going on contralateral side but provide pathway to pelvis. Droped kidenyes,can be distinguishes from ectopic kidneys, by length of ureter. Due to lack of inf support to kidneys,major blood vesls,convenient access to blader,transplanted kidneys are placed in iliac fosa.

68.

PAIN IN PARARENAL REGION:

Close relationship to psoas major to kidney,extension of hip joint cause pain.

69. RENAL VEIN ENTRAPMENT SYNDROME/NUTCRAKER SYNDROME:

Left renal vein (larger) while reaching IVC makes acute angle when anteriorly SMA and abdominal aorta posteriorly, may compress by them or 3rd part of deuodenum and symptoms are testicular pain,left sided varicoecele,vomiting,nausea,flank pain,hematuria,proteinuria.

70.

RENAL & URETERIC CALCULI:

Pebbels are composed of salt & inorganic/organic acids,if stoen is sharp or larger thn normal lumen of ureter it cause excesive stretching of ureter & cause intermittent pain.T11-L2 pain level,thigh by genitofemoral nerve (L1L2),labia majora,scrotum,cause nausea,vomiting,cramping,diarrhea.

71.

HICCUPS:

Involantry spansmodic contractions of diphargm causing sudden inhalation & rapidly interepted by spasmodic closure of glottis,irritation of affrents & effrents nerve endings ,medullary centre in brain stem.alcholisim,cerebral lesions,diaphragm irritation,disturbing phrenic nerve.

72.

REFERED PAIN FROM DIPHHRAGM:

2 sites: irritation to diaphragmatic pleura & diaphragmatic peritoneum refers to C3,4,5 shoulder. And from intercostal nerves to skin & lateral abdominal wall.

73.

PSOAS ABCESS:

t.b is common in vertebral column,& from here it spreads to psaos sheath & produces psoas abcess.pus can also reach to posterior mediastinum.it reaches deep to inguinal ligament.

74.

POSITIVE PSOAS SIGN:

Because ofvarious relation with psaos,when any of those structure si diseased,psoas movements cause problems,so patient is asked to lay on unaffected side,& extend thigh on afftected side,pain present +ve psaos sign.

75. 76.

PARTIAL LUMBAR SYMPTHACTOMY: ABDOMINOPELVIC VENOUS BLOOD:

During this care is taken for genitofemoral nerve,lumbar sympthatic & ureter. 3 routes when IVC is blocked: Sup & inf epigastric vein, thoracoepigastric vein with ant abdominal wall. Epidural venous peluxes. Lumbar veins of IVC system & azygous system of veins.

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