Clinical Correlations

Fundal subserosal, subserosal, intramural, pedunculated submucosal, and submucosal

Where can uterine fibroids occur?

No

Are uterine fibroids cancerous?

Myometrium

What do uterine fibroids typically develop from?

Estrogen and progesterone

What hormones affect the production of uterine fibroids?

70%

What percentage of Caucasian women over the age of 50 have uterine fibroids?

80+%

What percentage of black women over the age of 50 have uterine fibroids?

Heavy menstrual bleeding, longer + more frequent periods, pelvic pressure/pain, pain during sex, and urinary frequency or difficulty urinating

What symptoms are associated with uterine fibroids?

Hepatic portal vein

What do paraumbilical veins drain into?

Dilation of paraumbilical veins due to portal hypertension

What causes caput medusae?

No

Is dilation of paraumbilical veins (caput medusae) typically problematic by itself ?

Late liver disease or sometimes blockage of IVC

What does caput medusae indicate?

Excess fluid present in persistent process vaginalis

What is hydrocele of the testis?

Injury or inflammation to epididymis

What can cause hydrocele (excess fluid present) of the spermatic cord?

Blood collecting in tunica vaginalis after injury

What is hematocele?

Parietal peritoneum and viscera

In a direct (acquired) inguinal hernia, what protrudes?

Normal or abnormal opening medial to inferior epigastric vessels

In a direct (acquired) inguinal hernia, what is the parietal peritoneum and viscera protruding through?

wall of the inguinal canal; superficial inguinal ring

In a direct (acquired) inguinal hernia, herniation can occur directly through the _____________ via the ________________

Increased abdominal pressure and/or weakened abdominal muscles

What typically causes a direct (acquired) inguinal hernia?

Protrusion of parietal peritoneum and viscera through the deep and superficial inguinal rings lateral to the inferior epigastric vessels

What is an indirect (congenital) inguinal hernia?

Spermatic cord

In a male, the abdominal contents protrude into what with an indirect (congenital) hernia?

10-20 times as likely

How much more likely is an indirect (congenital) hernia in a male?

more

Indirect (congenital) hernias are more/less likely to strangulate

Open lesions of stomach mucosa

What are gastric ulcers?

Lesions of mucosa of pyloric canal (of stomach) or duodenum

What are peptic ulcers?

Duodenum

Are peptic ulcers more common in the pyloric canal of the stomach or the duodenum?

Helicobacter pylori

Bacteria associated with gastric and peptic ulcers

Erode mucosal lining of stomach

What does Helicobacter pylori do to contribute to the development of gastric or peptic ulcers?

increases (parasympathetic = rest and digest)

The vagus nerve increases/decreases acid production of the stomach

Cutting of vagus nerve branches (decrease secretion of acid)

What is a treatment that may performed to prevent chronic ulceration of the stomach?

Posterior gastric ulcers

What type of gastric ulcers are especially dangerous?

pancreas; splenic artery

Posterior gastric ulcers are dangerous because they could erode into the _____________ and damage the _______________

Spinal levels autonomics came from

Visceral afferent (sensory) nerves go back to what?

Anterior and posterior right shoulder, right hypochondriac region, and right lower back

Where might one feel referred pain from the liver?

Anterior and posterior right shoulder, right anterior lower thoracic region, and right middle back

Where might one feel referred pain from the gallbladder?

Anterior and posterior right shoulder and epigastric region

Where might one feel referred pain from the duodenum?

Epigastric, left hypochondriac, and upper left lumbar abdominal regions and between medial borders of scapula posteriorly

Where might one feel referred pain from the stomach?

Left hypochondriac region wrapping around posteriorly to left back

Where might one feel referred pain from the spleen?

Umbilical region of abdomen

Where might one feel referred pain from the small intestine?

Left inguinal abdominal region

Where might one feel referred pain from the sigmoid colon?

Right inguinal and hypogastric abdominal regions

Where might one feel referred pain from the ascending colon and cecum?

Left inguinal region in band wrapping superolaterally around left side and up left back

Where might one feel referred pain from the kidney and ureter?

Umbilical and right inguinal abdominal regions

Where might one feel referred pain from the appendix?

Epigastric abdominal region

Where might one feel referred pain from the head of the pancreas?

Sudden increases in intra-thoracic or intra-abdominal pressure

What can cause a ruptured diaphragm or herniation of viscera?

Motor vehicle accident (MVA)

What can commonly cause rupture of the diaphragm?

Left side (95% of time)

Which side of the diaphragm is more likely to rupture?

Liver

What somewhat prevents the rupture of the right side of the diaphragm?

Herniation of the GI tract viscera and/or mesentery through lumbocostal triangle region of diaphragm

What is a traumatic diaphragmatic hernia?

Herniation of stomach through esophageal hiatus

What is a hiatal hernia?

Vagal trunks, left inferior phrenic vessels, and esophageal branches of left gastric artery

What can a hiatal hernia damage?

Iliopsoas

What muscle is important clinically and is close to the abdominal viscera and posterior wall nerves?

Disease in abdominal viscera near it (when moved, muscle exacerbates pain in organs)

What can cause posterior abdominal pain with movement of iliopsoas?

Placing of patient on unaffected side and the extension of hip of afflicted side against resistance from the examiner

What is the iliopsoas test?

positive psoas sign

If pain is experienced during a iliopsoas test, the result is a...

Aneurysm

Localized enlargement of a blood vessel

Severe back pain and death (90%) to heavy blood loss if unrecognized

What can occur with rupture of an abdominal aortic aneurysm?

Surgical repair via sewing on a prosthetic graft or endovascular catheterization

What are possible treatments for an abdominal aortic aneurysm rupture?

1. Bifid renal pelvis and ureter

2. Supernumerary kidney

3. Horseshoe kidney

4. Ectopic pelvic kidney

What are some common developmental abnormalities of the kidneys?

bifid renal pelvis and ureter

Incomplete division of the metanephric diverticulum in an embryo leads to...

supernumerary kidney

Complete abnormal division of the metanephric diverticulum in an embryo leads to a...

Kidneys being close together in embryonic development and the inferior poles fusing

What can cause a horseshoe kidney?

At level of L3-L5

Where is a horseshoe kidney (U-shaped kidney) normally located?

Inferior mesenteric artery

What prevents the superior movement of a horseshoe kidney?

When an embryonic kidney does not ascend to the abdomen

What causes an ectopic pelvic kidney?

Renal calculi

What can cause severe pain as they pass through the ureters?

intermittently; completely

Renal calculi can _______________ or ______________ obstruct urinary flow

T11-T12

The ureters are innervated by what spinal levels?

Lumbar or inguinal regions, anterior proximal thigh, or external genitalia

Due to the spinal levels of the kidney and different locations in which a stone can become lodged, where might one experience referred pain?

Removal with nephroscope or broken up via lithotripsy (shock wave)

How can renal calculi be treated?

Vasculature changes to more superior vessels and inferior vessels degenerate

What typically occurs as the kidneys ascend during development?

Accessory renal vessels

Vessels of the kidney that fail to degenerate as the kidneys move superiorly

25%

What percentage of people have accessory renal vessels?

Levator ani muscle, pelvic fascia, and/or perineum

What can childbirth injure?

Pubococcygeus

What levator ani muscle is most likely to be injured during childbirth?

Urethra, vagina, and anal canal

What does pubococcygeus encircle and support?

Alteration in position of neck of bladder and urethra

What can occur following weakening of the levator ani muscles or pelvic fascia following childbirth?

urinary stress incontinence

Alterations of the neck of the bladder or urethra following weaking of the levator ani muscles and/or pelvic fascia can cause...

"Piles"

What are internal hemorrhoids also referred to as?

Prolapse of rectal mucosa containing normally dilated internal rectal venous plexus

What causes internal hemorrhoids?

It can get caught in sphincters, strangulate, and ulcerate

Following prolapse of the rectal mucosa, what can occur to the normally dilated internal rectal venous plexus?

bright red

Blood from internal hemorrhoids is usually...

Blood clots in veins of external rectal venous plexus

What causes external hemorrhoids?

Pregnancy, chronic constipation, and increased abdominal pressure

What are some predisposing factors for external hemorrhoids?

Portal hypertension

What can increase the likelihood of internal hemorrhoids?

inferior mesenteric vein

Superior rectal veins drain into the...

internal iliac vein

Middle and inferior rectal veins drain into the...

Dorsal abdominal wall superior to lumbar region

Where are the fetal testes typically located?

deep inguinal ring; 9-12

The fetal testes descend to the _____________ at ______________ fetal weeks

Gubernaculum

Ligament that guides the descent of the testes

Peritoneum, blood vessels, lymphatics, and nerves

What is dragged with the testes during their descent?

Tunica vaginalis

What is a remnant of the fetal peritoneum in the scrotum?

Before or shortly after birth

When do the testes reach the scrotum?

After middle age

When can benign hypertrophy of the prostate occur?

distort and impede the prostatic urethra

Benign hypertrophy of the prostate can...

55

Prostate cancer is most common in individuals over the age of...

Posterolateral region

Where does prostate cancer usually develop?

palpation in rectal exam

Prostate cancer can usually be detected by...

iliac and sacral lymph nodes

Prostate cancer can metastasize to...

Loss of erection

What can a prostatectomy potentially cause?

The prostatic plexus is close to the prostate and provides parasympathetic fibers that supply cavernous nerves leading to an erection

Why can a prostatectomy lead to a loss of erection?