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Anatomy Exam 2 Clinical Correlations

4 Pages

Course Code
BIOL 1300

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16: CLINICAL CORRELATIONS Name Description Trunk wall • Greatest significance of trunk wall: a barrier confining and protecting the viscera organization • Weak areas in the abdominal wall: umbilicus, above inguinal ligament (passage of the spermatic cord or round ligament), immediately behind the medial end of the inguinal ligament (between femoral vein and pubic tubercle) • The gut can protrude through weak areas, containing herniated bowel • Abdominal incisions should be planned carefully, splitting muscles parallel to the direction of their fibers, and sparing motor nerves; muscle and fat do not hold sutures well, connective tissue is poorly vascularized and does not heal well Direct hernia intestine with peritoneal covering is forced through the inguinal triangle into the external ring, leaves the abdominal cavity medial to inferior epigastric vessels Indirect hernia intestine herniates into sac formed by the persistent processus vaginalis, and into the deep ring, the inguinal canal, and superficial ring into the scrotum, leaves the abdominal cavity lateral to inferior epigastric vessels, intestines are covered by the same layers as the spermatic cord, more common in males 17: CLINICAL CORRELATIONS Name Description Omphalocele lack of union of the body folds at the umbilicus, due to lack of return of midgut from the physiological herniation of the gut Gastroshcisis opening lateral to umbilicus, associated with alpha-feto protein in amniotic fluid, abdominal contents come out into direct contact with amniotic fluid Congenital 1/2000 births, 80% L side, incomplete union of pleuroperitoneal membrane and diaphragmatic hernia septum transversum, no muscle from body wall to pleuroperitoneal membrane, abdominal organs enter thoracic cavity, causing pulmonary hypoplasia Esophageal hiatal due to shortness of esophagus, upper part of stomach may remain in thorax hernia Parasternal hernia due to lack of development of muscular tissue in anterior diaphragm, produces a gap between sternal and costal origin Cleft sternum (ectopic a defect in the ventral wall of the thorax and abdomen, due to failure of union between heart) head and lateral folds 18: CLINICAL CORRELATIONS Name Description Costodiaphragmatic blunting of recess visible radiographically with presence of pleural fluid accumulation recess Peripheral pain from irritation of pleura referred to lateral thoracic and anterior abdominal walls diaphragmatic pleural referred pain Central diaphragmatic pain referred by distribution of nerves3-5 + mediastinal pleural referred pain Inflammation of accompanied by pain increased by respiratory movement, rasping sound (friction rub) parietal pleura heard on auscultation (pleurisy) Pneumothorax air in the intrathoracic cavity, disrupts negative pressure, results in a collapsed lung, poorly oxygenated blood causes dyspnea and cyanosis, causes: • penetrating thoracic wound • spontaneous rupture of a pulmonary bulla • tear of abnormally fused pulmonary and parietal pleura • iatrogenic piercing of pleural cavity Open pneumothorax air enters and leaves pleural cavity through wound, hyper-expansion of chest wall on normal side, mediastinal flutter (mediastinum shifts to normal side on inspiration, toward injured side on expiration) Tension pneumothorax air drawn in on inspiration, no expiration, increase in intrathoracic pressure causes mediastinal shift to normal side Hemothorax blood in the intrathoracic cavity, blood in diaphragmatic recess on standing Hydrothorax fluid in the intrathoracic cavity, fluid in diaphragmatic recess on standing Thoracentesis (pleural performed posterior to midaxillary line with patient sitting, fluid level determined by tap) percussion, insert needle halfway between ribs below fluid level but not below 9 th intercostal space Pancoasts’s tumor tumor of the upper lobe of either lung, may compress: • subclavian or brachiocephalic v – venous engorgement and edema of face + arm on one side • subclavian a – diminished pulse in that extremity • phrenic n – paralysis of a hemidiaphragm • recurrent laryngeal n – vocal hoarseness • sympathetic chain – Horner’s syndrome Pulmonary embolus embolus (blocking body) from systemic venous circulation or R heart gets impacted in pulmonary arterial circulation, results in local ischemia and necrosis, large embolus in main stem bronchus or lobar artery may result in neurogenic shock and death, small embolus may cause mild pain, pleurisy, or hemoptysis (spitting blood) Reduction of vital reduces ventilation, results in dyspnea and cyanosis, caused by: capacity • flail chest • diaphragmatic paralysis • pneumothorax • pleural effusion • loss of intrinsic elasticity • obstruction (mucus, asthma, neoplasm) Alveolar-capillary increase in effective blood-air barrier, thickness increased by: block • pulmonary fibrosis • pulmonary edema • hyaline membrane disease Asthmatic syndrome
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