100 Concepts (31 - 40)

What is an open pneumothorax

Entry of air into pleural cavity causing lung collapse. Wound pierces the parietal pleural so the pleural cavity is open to the outside air

In an open pneumothorax, during inspiration air enters the chest wall and the mediastinum will shift _____

toward the other side and compress the opposite lung

In an open pneumothorax, during expiration air exits the wound and moves the mediastinum _____

toward the affected side

What can be damaged in the case of improper subclavian venipuncture resulting in a pneumothorax

Cervical pleura

Deepest place in the pleural cavity

Costodiaphragmatic recess

Where is the midclavicular line

Between ribs 6-8

Where is the midaxillary line

Between ribs 8-10

Where is the paravertebral line

Between ribs 10-12

Parietal pleura is sensitive to

General senses (pain, temperature, touch, and pressure)

Somatic sensory innervation to the costal pleura

Intercostal nerves

An _____ nerve block may be used to decrease thoracic pain

intercostal

What gives somatic sensory innervation to the mediastinal pleura

Phrenic nerve

What gives somatic sensory innervation to the diaphragmatic pleura

Phrenic nerve

What is the visceral pleura sensitive to

Stretch but not general sensibilities

What does the visceral pleura receive autonomic nerve supply from

Pulmonary plexus

Common site for bone marrow biopsy

Sternum

An improperly done sternal puncture may affect structures related to the posterior surface of the manubrium including

Left brachiocephalic vein

Aortic arch

Which structure conveys to the blood al lymph from the lower limbs, pelvic cavity, abdominal cavity, left side of the thorax, left side of the head and neck, and left upper limb (3/4 of the total body)

Thoracic duct

Which structure drains the right head and neck, and left upper limb

Right lymphatic duct

Tributaries of the thoracic duct

Left jugular lymph trunk

Left subclavian lymph trunk

Left bronchomediastinal lymph trunk

Sites that are common for development of strictures or esophageal carcinomas

C6

T4-T5

T10

What is the location of where the pharynx joins the upper end

C6

What is the location where the aortic arch and left main bronchus cross the anterior surface of the esophagus

T4-T5

What is the location where the esophagus passes through the diaphragm into the stomach

T10

Organs in RUQ

Liver

Gallbladder

Organs in LUQ

Stomach

Spleen

Organs in RLQ

Cecum

Appendix

Organs in LLQ

Sigmoid colon

End of descending colon

Pain from the foregut derived structures are commonly referred to the

Epigastric region

Pain from the midgut derived structures are commonly referred to the

Umbilical region

Pain from the hindgut derived structures are commonly referred to the

Hypogastric region

Nerve supply to the anterior abdominal wall

5 lower intercostals

1 subcostal

L1 (iliohyogastric & ilioinguinal)

Where can you anesthetize L1

Injecting 1 inch superior to the anteiror superior iliac spine

Where is the neurovascular plane

Between internal oblique and transversus muscles

Important superficial arteries of the anterior abdominal wall

Superficial epigastric

Superficial circumflex iliac

Important deep arteries of the anterior abdominal wall that also lie in the neurovascular plane

Superior epigastric

Posterior intercostal arteries

Lumbar arteries

Deep circumflex iliac artery

Inferior epigastric

_____ involves herniation of abdominal viscera through an enlarged umbilical ring. Viscera are covered by amnion

Omphalocele

_____ is a herniation of abdominal contents through the body wall directly into the amniotic cavity. Viscera are NOT covered by peritoneum or amnion.

Gastroschisis

3 parts of hernia

Hernial sac

Hernial contents

Hernial coverings

A pouch (diverticulum) of peritoneal and has a neck and a body

Hernial sac

May consist of any structure found in the abdominal cavity (more often - loops of small bowel and pieces of omentum major)

Hernial contents

Formed from the layers of the abdominal wall through which the hernial sac passes

Hernial coverings

_____ is the FIRST STRUCTURE which is crossed by ANY abdominal hernia

Transversalis fascia

Most common form of hernia, is believed to be congenital in origin

Indirect inguinal hernia

Indirect inguinal hernias pass through the _____ and _____ to the inferior epigastric vessels, inguinal canal, superficial inguinal ring, and descends into the scrotum

deep inguinal ring, and lateral

Indirect inguinal hernias are more common on which side

Right due to the right testis descending later than the left

_____, the abdominal contents will protrude through the weak area of the posterior wall of the inguinal canal medial to the inferior epigastric vessels in the inguinal [Hesselbach's] triangle then through the superficial inguinal ring

Direct inguinal hernia

A Direct inguinal hernia will NEVER _____

descend into the scrotum

A direct inguinal hernia is a disease of

Old men (after 60years old) most commonly bilateral

The lesser omentum consists of what 2 ligaments

Hepatogastric

Hepatoduodenal

Contents of the lesser omentum

Right & left gastric vessels

Connective and fatty tissue

Portal triad (proper hepatic a, portal v, common bile duct)

Anterior border of the epiploid (winslow's) foramen

free border of the hepatoduodenal ligament

Posterior border of the epiploid (winslow's) foramen

IVC

Superior border of the epiploid (winslow's) foramen

Caudate lobe of the liver

Inferior border of the epiploid (winslow's) foramen

1st part of the duodenum

Deeper point of peritoneal space in vertical position in a female body, between the rectum and cervix of the uterus

Douglas (rectouterine) pouch

Aspiration of fluid from the Douglas (rectouterine) pouch

Culdocentesis

How to perform a Culdocentesis

Needle puncture of the posterior vaginal fornix near the midline between the uterosacral ligaments

Derivatives of the primitive gut: FOREGUT

Esophagus

Stomach

Duodenum (1st & 2nd parts)

Liver

Pancreas

Biliary apparatus

Gallbladder

Derivatives of the primitive gut: MIDGUT

Duodenum (2nd, 3rd, & 4th parts)

Jejunum

ileum

Cecum (with appendix)

Ascending colon

Transverse colon (proximal 2/3)

Derivatives of the primitive gut: HINDGUT

Transverse colon (distal 1/3)

Descending colon

Sigmoid colon

Rectum (anal canal above pectinate line)

Foregut artery

Celiac trunk

Midgut artery

superior mesenteric artery

hindgut artery

inferior mesenteric artery

Foregut pre-ganglionic parasympathetic innervation

DMN of vagus

CNX

Foregut post-ganglionic parasympathetic innervation

Terminal ganglion

Foregut pre-ganglionic sympathetic innervation

IML T5-T9

Greater splanchnic n

Foregut sensory innervation

DRG T5-T9

Foregut referred pain location

epigastrum

Midgut pre-ganglionic parasympathetic innervation

DMN of vagus nerves

CNX

Midgut post-ganglionic parasympathetic innervation

Terminal ganglion

Midgut pre-ganglionic sympathetic innervation

IML T10-T11

Lesser splanchnic nerves

Midgut post-ganglionic sympathetic innervation

Superior mesenteric ganglion

Midgut sensory innervation

DRG T10-T11

Midgut referred pain to

Umbilical

Hindgut pre-ganglionic parasympathetic innervation

SPN S2-S4

Pelvic splanchnic nerve

Hindgut post-ganglionic parasympathetic innervation

Terminal ganglion

Hindgut pre-ganglionic sympathetic innervation

IML L1-L2

Lumbar splanchnic nerves

Hindgut post-ganglionic sympathetic innervation

Inferior mesenteric ganglion

Hindgut sensory innervation

DRG L1-L2

Hindgut referred pain to

Hypogastrium

Posterior gastric ulcer may erode through the posterior wall of the stomach and into the

Omental bursa (lesser peritoneal sac) and affect the pancreas

Erosion of the _____ is very common in posterior gastric ulcers because of the proximity of the artery to the wall

splanchnic artery

Congenital anomaly representing a persistent portion of the vitellointestinal duct

Meckel's diverticulum

Meckle's diverticulum is often asymptomatic but may occasionally become inflamed if it contains

Ectopic gastric, pancreatic, or endometrial tissue

Where is meckle's diverticulum located

2 feet before the iliocecal junction and is supplied by the SMA

Differential diagnosis for Meckle's diverticulum

Acute appendicitis

Features of the large intestine

Appendices epiploic

Sacculations (haustrations)

Taeniae coli

The ascending colon lies _____ and lacks a mesentary

retroperitoneally

Mesentery of the transverse colon

Transverse mesocolon (intraperitoneal position)

The sigmoid colon is suspended by the _____

sigmoid mesocolon (intraperitoneal position)

Where is appendicitis first pain located

umbilicus

Visceral pain in teh appendix is produced by

distention of the lumen or spasm of its muscle

The afferent pain fibers of appendix enter the spinal cord at the level of

T10

In appendicitis, if parietal peritoneum gets involved, and then the pain is shifted laterally to _____ where somatic pain is precise, sever, and localized

McBurney's point

Point indicating the surface of the base of the appendix

McBurney's point

Location of McBurney's point

junction of the lateral 1/3 and medial 2/3 of a line joining the right anterior superior iliac spine with the umbilicus