GL 8 and CA 14

Q2

cleft lip

Developmental anomalies in the form of “hare-lip” or “cleft lip”; common in newborns

cleft palate

cleft lip may extend into the oral cavity in the form of

Cheiloplasty

* Surgical procedure done to correct this cleft lip
* Usually done before the age of 2 (when the child begins to vocalize)

Uranoplasty

surgical correction for cleft palate

mucous or mucocele

Most common benign tumor of the lip

vermilion border

frequent site of cancer of the lips

ludwig’s angina

Inflammation of the floor of the mouth

scurvy

* a vitamin C deficiency frequently found on the **LIPS**
* Could show signs of other systemic diseases and poisoning

teeth

important to gauge the development of the child

Dental Caries

Results from disintegration of one or more components of the tooth

Dental Calculus or Tartar

Formed by the accumulation of calcium salts in the saliva within the crevices between the teeth or between teeth and gum

Dental Abscesses

Infection of roots may lead to the formation of

Waldeyer’s Ring

The **FAUCIAL**, **NASOPHARYNGEAL** and **LINGUAL** tonsils form the ______ around the posterior apertures of the nose and oral cavity. \n

tonsillitis

inflammation of the **faucial tonsils**

Tonsillectomy

operation to remove the faucial tonsils

adenoids

Inflammation of the nasopharyngeal tonsils

Adenoidectomy

operation to remove the nasopharyngeal tonsils

tongue

Common site of benign as well as malignant tumors

Carcinoma of the Tongue

Most common malignant lesion in the oral cavity

pharynx

Most common site of abscesses, such as **retropharyngeal abscess**

nasopharynx

* most common site of cancer
* **Opening of the eustachian tube** is located here, so that inflammations may reach the **middle ear** through this passageway

greater omentum

* **abdominal policeman**


* Lower, right, and left margins are free
* buttress an intestinal anastomosis or in the closure of a perforated gastric or duodenal ulcer

torsion of greater omentum

* May present as a vague abdominal pain and diagnosis may be difficult
* If extensive, the blood supply to a part of it may be cut off → necrosis.
* would require excision of the **ischemic omental segment**

Acute abdominal pain

One of the most common symptoms referable to the upper GI tract which is loosely defined as pain present for less than 6 hours in the abdomen

Heartburn

Substernal burning sensation that has the tendency to radiate to the mouth

Dysphagia

Difficulty in swallowing

Dyspepsia

Postprandial complaint that includes epigastric distress, nausea, fullness and bloating

Anorexia

Clinical syndrome characterized by the absence of hunger or appetite

Flatulence

Excessive gas

Constipation

Clinically, a movement that is soft and easy to pass with a frequency ranging from three per day to one every three days is normal

Diarrhea

Increase in volume, frequency, or fluidity of stool output

Intestinal obstruction

interference with the aboral transit of intestinal contents

Mechanical bowel obstruction

used to describe an actual physical barrier

ileus

denotes a functional failure of progressive intestinal transit

Hematemesis

* Vomiting of blood
* Usually represents UGI bleeding proximal to the

ligament of Treitz

Melena

* Passage of black tarry stools
* Only 50mL of blood is necessary to produce

melena

Hematochezia

Passage of fresh blood or clots per rectum

constrictions of the esophagus

* Sites where swallowed foreign bodies can be lodged or through which it may be difficult to pass an esophagoscope


* Common sites of carcinoma in the esophagus

* Where the pharynx joins the upper end
* Where the aortic arch and the left bronchus cross its anterior surface
* Where the esophagus passes through the diaphragm into the stomach

where are the **3 anatomic and physiologic constrictions of the** esophagus?

6 in (15 cm)

commencement of the esophagus from the upper incisor teeth

10 in (25 cm)

the point at which it is crossed by the left bronchus from the upper incisor teeth

16 in. (41cm)

termination from the upper incisor teeth

esophageal atresia

* Congenital anomaly of the esophagus
* Presents with **polyhydramnios** and acute **respiratory distress in newborns**

esophageal cancer

* Presents as a progressive dysphagia from liquids to solids
* An **apple core deformity** is usually observed
* On esophagoscopy: anular or fungating in appearance

Barrett's esophagus

**Chronic acid reflux** induces metaplasia of the lower lining epithelium known as

achlasia

* Benign condition secondary to inability of the lower esophageal sphincter (LES) to relax
* Maybe a differential diagnosis for esophageal carcinoma

vagus nerve

Innervation of the cardioesophageal sphincter

Balloon dilatation of LES

Palliative treatment for achlasia; less invasive

Distal esophagomyotomy

permanent relief for achlasia

Heller’s esophagomyotomy

entails circumferential dissection of the muscular layer from the mucosal layer of the esophagus from the cardia up to the mid-esophagus

Esophageal varices

Dilated submucosal varices in distal esophagus

L gastric vein

Lower third of the esophagus drained by esophageal veins drain to the portal system via the

azygos vein

Lower third of the esophagus drained by esophageal veins drains to the systemic circulation via

Bleeding esophageal varices

* Varicose esophageal veins may rupture causing sever vomiting of blood (hematemesis)
* Secondary to prolonged portal hypertension in the coronary vein and left gastric vein

Nasogastric Tube

A **small caliber plastic or silicone** **catheter** inserted into the nostril and threaded to the pharynx and into the esophagus and stomach for decompression, drainage, feeding, sampling of gastric juice

Deviated nasal septum and 3 anatomical sites of constrictions

Anatomic structures that impedes passage of NGT

wall of esophagus and posterior wall of L atrium

transesophageal ultrasound utilizes proximity of _____ to assess and evaluate the pre and post-op cardiac and valvular functions, and integrity during and after open heart surgery

tympanic

The percussion note over the **fundus** of the stomach that usually contains air

perotinitis

spillage of gastric contents into peritoneal cavity

stomach, diaphragm, and thoracic organs

The close relationship of these organs explain partly the shortness of breath due to a distended stomach after a full meal

ulcer pain

typical pain produces a burning sensation in the epigastric area

gastric ulcer

Peptic ulcer in the stomach

ulcer

from imbalance between acid **(body & fundus)** and mucous secretion **(antrum & pylorus)**

vagus (nervous) and gastrin (hormonal)

Secretion of acid and pepsin is controlled by

duodenal ulcer

consequence of the secretion of acid in excess of the amount that can be efficiently disposed of by the duodenum

splenic artery (branch of gastroduodenal artery)

gastric ulcer may cause **torrential bleeding** if it erodes what artery

endoscopic sclerotherapy or laser cauterization

treatment for peptic ulcer bleeding

generalized peritonitis

Ulcers may **perforate anteriorly** into the **greater peritoneal cavity** leading to

abscess formation

Ulcers may perforate **posteriorly** into the **lesser peritoneal cavity** causing ______

gastric outlet obstruction

When **ulcers heal by fibrosis**, it may lead to obstruction, especially in the **first part of the duodenum** called _____

vagotomy

surgical treatment of chronic gastric and duodenal ulcers that **reduce the amount of acid secretion**

antrectomy

surgical treatment of chronic gastric and duodenal ulcers that remove the gastrin-bearing area of mucosa

Truncal Vagotomy with Pyloroplasty

**Decrease acid secretion** and **promote increased transit time of gastric contents** into the duodenum

carcinoma of the stomach

Polypoid or fungating lesion; Scirrhous or diffuse infiltrating lesion

total gastrectomy

Malignant disease of the stomach is treated by

subpyloric

zone I lymphatic drainage of the stomach

pancreaticolineal

zone II lymphatic drainage of the stomach

superior gastric

zone III lymphatic drainage of the stomach

subpyloric

zone IV lymphatic drainage of the stomach

vagus nerve

constitutes the motor and secretory nerve supply for the

stomach

Laparoscopic Pyloroplasty

increase gastric emptying that is usually done in combination with vagotomy

small branch from the hepatic or gastroduodenal

artery

The 1st part of the duodenum is supplied by

gastroduodenal artery

**Erosion of the posterior perforation** of the duodenal ulcer into the **____** can produce massive GI bleeding

endoscopy and sclerotherapy

bleeding duodenal ulcer is addressed by _______

lesser sac hemorrhage

**3rd part/portion of the duodenum** and the **body of the pancreas** may be crushed against the **3rd lumbar vertebrae** posterior to them resulting in that may be difficult that may result to _____

proton-pump inhibitor therapy

Vagotomy with pyloroplasty to treat peptic ulcer disease is replaced by

gallstone ileus

Gallstone can erode into the duodenum and produce an intestinal obstruction, a condition called _____

percutaneous nephrostomy tube insertion

Common minimally invasive urologic procedure that drain a hydronephrotic kidney or crush a kidney stone

duodenum

this can be punctured during percutaneous nephrostomy tube insertion and cause peritonitis

abdominal cavity

also referred to as the **“abdomino-pelvic cavity”**

**Respiratory diaphragm**, fibromuscular walls, and lower

ribs

superior border of the abdominal cavity

Pelvic diaphragm

inferior border of the abdominal cavity

L1-L5 and posterior wall muscles

posterior border of the abdominal cavity

* Diaphragm
* Musculomembranous tissues and lower ribs
* Lumbar vertebra and iliac fossa

Abdominal wall and cavity proper is bounded by:

Peritoneal Cavity

* potential space between the parietal peritoneum and visceral peritoneum
* In males – closed cavity; In females – with communication with exterior via the uterine tubes, uterus, & vagina

peritoneum

thin serous membrane that lines the walls of the abdominal cavity; providing either a complete or partial covering

Parietal Peritoneum

Lines the wall of the abdominal and pelvic cavities

Visceral Peritoneum

Covers the organ or the viscera; May provide complete or partial covering of the organ

lower part of the thoracic cage and abdominal muscles

anterior boundary of the abdominal cavity

* 12th rib
* upper part of the pelvis
* psoas muscle
* quadrates lumborum
* aponeurosis of the transversus abdominis muscle

lateral boundary of the abdominal cavity