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Correlative Anatomy of Abdomen (trans)

Dr. James Taclin Banez


ABDOMINAL WALL
Usual abdominal lesions
Disease
Description
Plain Inflammation
Tumors

Seldom malignancy
at abdominal wall
Fascia
liposarcoma
Muscle
rhabdomyosarcoma
Connective tissue
fibrosarcoma
(rare in abd wall)

**Inguinal Hernia
a. Direct
b. Indirect
c. Femoral

Bulging mass at
inguinal ligament:
Above: direct and
indirect
Below: femoral

Cause

S/Sx

Usually caused by
Bacterial infection
Considering it has
epithelium, carcinoma,
seldomly squamous
cell or basal cell
carcinoma head and
neck and exteremities,
seldom in abd wall

Rubor, Dolor, Calor,


Tumor
(most common) Lipoma
hyperplasia of a fat cell,
encapsulated it does not
invade adjacent
structures, it will not
metz, but it can cause
pressure, abd is
distensible so no problem

Cause: anything that increases intraabdominal


pressure
Weakening of the wall (common among elderly)
Differentiate direct and indirect.
Indirect inguinal hernia, enters the internal
inguinal ring passes through the inguinal canal and
exits through external inguinal ring to go to
scrotum. Hernia sac

Management/Tr
eatment
Hygiene
Topical Antibiotics
If the tumor is big,
there is a need to
use a general
anesthesia.

Notes

Surgical defect
in the wall

Most common:
indirect inguinal
hernia (male and
female) more
common in females

No need tablets
Most common tumors
are benign

Usual organ that


herniates, omentum
and small bowel

Direct, bulging in hasselbachs triangle. Does not


enter the canal. Outside the canal
HERNIA
(a) Reducible
(b) Non-reducible
(c) Encarcinated
(d) strangulated

(a) It appears when


a person is in erect
positon or straining
(c) if the patient is
lying down, supine
position,

(c) pain, erythema,


sepsis, intestinal
obstruction, patient looks
toxic, very painful

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encarcenated (call
the encarcinated.
No pain
(d) blood vessel is
compromised
indirect and femoral

STOMACH
ACID PEPTIC DISEASE: most common problem
Peptic Ulcer
Description:
If the erosion of the mucosa is greater than 0.5 cm, usually
acidic and extremely painful
80% associated w/ helicobacter pylori, due to drugs
(NSAIDs)
[ Gastrititis - Inflammation of the erythema of the partition mucosa
of the stomach ]

Effect of HCl acid. The secretion of HCl is more than normal


OR Normal secretion, HCl secretes in between meals.
Secretion beats the mucus secretion of goblet cell resulting
to erosion of mucosa
Mucus neck cells protect the mucosa.

***** most common location of gastric ulcer 1st part of the


duodenal bulb
Signs & Symptoms
Abdominal pain
Abdominal fullness (bloated)
Nausea / vomiting
Loss of appetite and loss of weight
Hematemesis
Melena
Extreme pain if with rupture

Difference between duodenal ulcer to gastric ulcer.


Usual symptom would be adominal pain:
- Burning type of pain of HCl acid
- Colicky pain any hollow viscous structure (stomach) pain
relief pain relief, pain is present during when smooth
muscle is contracting.
- Stabbing pain
- Lacerating pain
- If its Burning pain: think of the stomach
- If its colicky: think of biliary
Location of pain
Stomach epigastric
Biliary right hypochondriac
Appendix right iliac
Intestine umbilical
Sigmoid left iliac
The location will guide you on identifying the disease
Migration
Epigastric to hypogastric aneurysm
Epi to right iliac appendicitis
Epi to shoulder to back biliary
Relation to food intake
Pain before eating then (+) FOOD intake = relief: duodenal ulcer
Pain is precipitated when you eat something and swallow it: gastric
ulcer
Abdominal Fullness
Inflammation of the stomach

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Motility of the stomach is altered


Nausea and Vomiting
Constitutional symptom
Any intra-abdominal organ can cause nausea and vomiting
Hematemesis associated with gastric ulcer bleeding is too much
Hemoptysis coughing out of blood
Hematochesia bleeding is in the colon, if bleeding comes from the
stomach considering hemorrhagic shock
Melena black tarry stool, foul odor. Blood is exposed to acid
medium
MOST COMMON PART of the DIGESTRIVE TREE that bleeds:
Stomach
E.G.
The patient comes in complaining of extreme unrelieved pain
s/s: direct abdominal tenderness, board like rigidity
dx: stomach is perforated location: @duodenum
complication: chemical peritonitis (effect of HCl acid)
Most of the acid peptic disease are treated chemically if there will
be complications (answer sa test: ALL OF THE ABOVE!)
Complication
GIT bleeding
Perforation peritonitis
Gastric outlet obstruction pyloric stenosis
Gastric Outlet obstruction
Chronic on/off acid peptic disease
Chronic smoking
Scarring at pylorus
Food cannot enter
Treatment of Peptic Ulcer
Medical:

Antacids / H2 antagonist / Proton pump inhibitor / prostaglandin


analogue
Diet modification
Stop Smoking, Drinking
Others
Surgical: if with complications
Cancer of the Stomach
GASTRIC MALIGNANCY
Most common type is malignancy is carcinoma usually arises to
gastric blood
**** most common type: Adenocarcinoma
**** most common malignancy of the digestive tree COLON
because it has the longest exposure to carcinogen
**** seconded by stomach located at greater curvature
**** seldom: small bowel
Diagnosis is late for symptoms occurs late
Risk factors:
Family hx
H. pylori infection risk factor for malignancy
Blood type A
Smoking
Hx of anemia, chronic atrophic gastritis
Adenomatous gastric polyp
Symptoms:
Abdominal pain vague abd pain
Foul Breath odor because of dead stomach cells
Difficulty of swallowing location of cancer is at the cardiac
sphincter
excessive belching and flatus
Loss of appetite - N/V
Unexplained weight loss, weakness or fatigue anorexia
early satiety because of the tumor

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Vague abdominal fullness

* best diagnostic for gastric tumor: gastroscopy EGD


Examination & test
CBC check anemia
Esophagogastroduodenoscopy wit biopsy
Stool test for occult blood check for microscopic bleeding
evaluate the entire digestive tree gold screening
Upper GI series use of barium (contrast material)
If there is obstruction, do not use barium. Use water
contrast
Ulcer in tumor: malignancy
Outpouching: benign
Treatment:
Gastrestomy
Radiation therapy
Chemothrapy
GASTROENTERITIS
Inflammation of GIT involving both the stomach and small
bowel resulting to diarrhea
Caused most often by an infection from viruses less often by
bacteria, parasites or adverse reaction to diet or
medications
Inadequate tx can kill & a leading cause of death among
infants and children under 5.
Foodborne illness:
Viruses novovirus, rotavirus, adenovirus
Bacteria salmonella, shigella, staphylococcus, E. coli,
Closridium
Lab results (CBC):
o WBC differential count
o Viral lymphocytosis
No need for antibiotics, increase fluid intake
o Bacterial neutrophils/segmenters
antibiotics

Symptoms & Signs:


Nausea / vomiting
Diarrhea
Loss of appetite
Abdominal pain / cramps (colicky abd pain)
abnormal flatulence
Signs of dehydration
Fever
Management:
Replace fluids and electrolyte loses
Pharmacologic therapy:
Antibiotics
Antimotility (give after 2-3 days)
Antiemetics
COLITIS
Types:

Ulcerative colitis / Crohns colitis


Ischemic colitis answer sa exam!
Infectious colitis
Chemical colitis
Lymphocytic colitis
Pseudomembranous colitis

Ulcerative/Crohns disease it is a chronic inflammation of the


bowel
Ulcerative Colitis
involves only colon and a part of
terminal ileum
affect mucosa and mucosa
pain and bleeding
development of malnutrition

Crohns disease
esophagus to anus (segmental)
transmural affects the entire
wall
pain and obstruction
development of malnutrition
(severe) because SI is affected

Both can lead to malignancy

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Ischemic Colitis
*** lesser curvature will receive most amount of blood
*** splenic flexure --- farthest from the aorta common location of
ischemic colitis

Infectious Colitis
Infection from enterobac., parasite

Chemical colitis beverage has toxin


Pseudomembranous colitis
- Viral
- Antibiotics kill the normal bacteria
- No surgery needed
- Mgmt: better antibiotic
Aptus Ulcer creates combal? Stone ill get to see each oter
Entire wall - Will enter the muscular wall creating a fibrous wall
creating a stricture (obstruct) scrotum
Conservative MGMT
Ulcerative and Crohns Dse can be treated medically
- Bowel rest
- Give antibiotic
- Give steroids
- Gove salycyoate
Surgery
- Ilioproctoscopy
- Crohns cannot be treated
*****Pseudomembranous Colitis
No surgery needed
Antibiotics only improvement in 7 days
Manifestations are similar to early malignancy, they are
subjected to colonoscopy to rule out malignancy
Colonic Malignancy
Adenocarcinoma of the colon most common histological
type of malignancy and on the left side

****Cancer in the left side --- obstruction --- narrowest part


of the lumen of the colon is in the sigmoid = partial
intestinal obstruction
Cancer in the right side --- anemia --- widest lumen (cecum)
seldom presents obstruction ---- what present is erosion.
Treatment: Surgery

Appendicitis
Appendix is an end organ
Obstruction in the lumen
Increase in pressure no food and water
Lining epithelium simple columnar with goblet cells, the
goblet cells continuously produce mucus
Appendicitis takes several hours to rupture
E.coli increases pressure = increase pressure in the wall =
strangulated vein => congestion
1st stage: CONGESTION. 1st layer that will be destroyed when
there is a problem in intramural pressure: Mucosa
specifically Lining epithelium because it has direct blood
supply, food, oxygen goes in thru diffusion through
basement membrane
Bacteria will now enter, the appendix will have the fatty
follicle (WBC-Neutrophil) will do the kamikaze effect (eats
the bacteria and dies with it)
2nd stage: PUS
3rd Stage: increase partial pressure of the wall --- artery
obstruction = ischemia then eventually it will rupture
Treatment: surgery
**** Liver Cirrhosis
Failure of the liver
Most common cause: chronic alcohol intake, smoking,
hepatitis
There is transformation of hepatocytes to a fibrous tissue
there will be narrowing of canaliculi then some of the bile
that is formed by the retained heapatocyte cannot exit, and
it will now be converted to bilirubin to and will now go to
blood causing yellowish discoloration

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All the blood going in the alimentary canal will have to pass
the portal vein, since there is already scarring of the liver,
there is difficulty of bringing blood to the right side of the
heart,
Blood coming from the intestine will now look for another
way
o Stomach and esophagus, esophageal vein, the left
gastric vein connects to the esophageal vein one way
of bringing to azygous vein
o Periumbilical Vein because it is also connected to the
vein of the epigastric
o Middle internal iliac vein and Inferior rectal is
connected to the internal pudendal and is now
connected to the IVC
o The areas where you have varicosities
Complication will be hemorrhagic shock, most common
cause is esophageal varices

Cholecystitis
Due to obstruction; cholecystolithiasis (stone in the biliary
tree)
**** MOST COMMON LOCATION OF THE BILIARY TREE --ANSWER IS GALLBLADDER
Stone in the biliary tree secondary stone
Colicky abd pain, pain will be experienced when the patient
eats something fatty
Buscopan to relieve pain
If no operation:
Not to eat fatty food, handy buscopan in the pocket, if the
patient will feel pain during eating (lunch) omit supper then
buscopan every 4 hours
Should be standing position or Jump to dislodge the stone
Diagnostic procedure: Ultrasound
Stone caused by difference of the level

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