Abdomen
lecture notes
4.*
Appendix .
epithelium : simple columnar
mucosa : goblet cells
-
shaped
-
lumen : star -
sub mucosa lymphoid follicles
•
:
-
confluent nodules ( specific for appendix)
↳ surrounds lumen of appendix
•
muscularis externa : inner circular , outer longitudinal ICOL
in adults POSTER 0 MEDIAL ileocecal valve
-
MC position :
,
below
MC location : RETRO CECAL ( 11:00)
others : sub cecal , pelvic , pre
-
ileal , post ileal
6:00 5:00 1 or 2:00 1 or 2:00
-
Taenia coli :
merges at base of appendix
.
meso colic taenia Anterior taenia used to locate
-
omental taenia Appendix
-
Free taenia / taenia libera
-
Blood supply
-
Artery :
append iceal
artery from post cecal branch of ileocolic .
artery
. .. .
.
.. . . .. . .
Appendicitis -
Dunphy 's
sign
neutrophilIc infiltration pain RLQ upon coughing
Histologic
on
dx
-
-
:
of muscularis
-
Psoas sign
propria hip w/
- paint extending the
knee in full extension
-
Mc cause : fecal ith
•
Rousing 's sign
others : lymphadenitis ,
tumor
-
palpation of LLQ → pain on RLQ
.
1st symptom anorexia : ( precedes pain) -
peritoneal irritation
-
Markle 's sign
<
MC bacteria : E. coli ,
B- fragilis -
heel
jarring + abdominal pain
Alvarado Score Appendectomy Argentattin Cells ( Kultchitz sky cells)
Migration of pain to RLQ .
MC surgical emergency : appendicitis
)"
-
specialized cells at base of
Anorexia I -
Mc surgical emergency in pregnancy
Nausea / vomiting
1
append icial crypts
2 MC site of rupture in appendicitis :
* Tenderness at RLQ
anti mesenteric border carcinoid tumors
Rebound tenderness 1 -
give rise to
Elevated temp 1 -
Amy and 's hernia :
when hernia sac contains ruptured appendix -
neuroendocrine cells
Leukocytes is 1>10,000
-
* WBC) 2 _
Mc site of Gt carcinoid :
shift to the L ( > 75% neutrophils) 1 pseudo myxoma peritonei
appendix at tip collection of fluid and mucinous
gelatinous
, -
5- 6 compatible w/ acute appendicitis Adenocarcinoma surface and omentum
:
+× : Rhemi colectomy implants on peritoneal
mucinous
7- 8 : probable appendicitis
-
rarest , lowest survival
probable appendicitis Signet ring :
•
9- 10 : very
, Abdomen
.es/. . . . .
lobe
Liver
- R
•
caudate lobe
quadrate lobe
-
•
L lobe
-
Porta Hepatis .
or hit us of the liver at postero interior surface
'
contents :
R and L hepatic ducts
'
-
R and L hepatic artery
.
portal vein
-
nerves
-
lymph vessels
.
. ..
-
between L lobe and quadrate lobe
-
remains of the umbilical vein
Venosvm
-
Fissure for Ligamentum
-
between L lobe and caudate lobe
•
remains of ductus venous
-
Groove for NC
-
between R lobe and caudate lobe ; hepatic veins join IVC
•
Fossa for the gallbladder
'
between R lobe and quadrate lobe
-
no peritoneum bet .
R lobe and gallbladder
lecture notes
4.*
Appendix .
epithelium : simple columnar
mucosa : goblet cells
-
shaped
-
lumen : star -
sub mucosa lymphoid follicles
•
:
-
confluent nodules ( specific for appendix)
↳ surrounds lumen of appendix
•
muscularis externa : inner circular , outer longitudinal ICOL
in adults POSTER 0 MEDIAL ileocecal valve
-
MC position :
,
below
MC location : RETRO CECAL ( 11:00)
others : sub cecal , pelvic , pre
-
ileal , post ileal
6:00 5:00 1 or 2:00 1 or 2:00
-
Taenia coli :
merges at base of appendix
.
meso colic taenia Anterior taenia used to locate
-
omental taenia Appendix
-
Free taenia / taenia libera
-
Blood supply
-
Artery :
append iceal
artery from post cecal branch of ileocolic .
artery
. .. .
.
.. . . .. . .
Appendicitis -
Dunphy 's
sign
neutrophilIc infiltration pain RLQ upon coughing
Histologic
on
dx
-
-
:
of muscularis
-
Psoas sign
propria hip w/
- paint extending the
knee in full extension
-
Mc cause : fecal ith
•
Rousing 's sign
others : lymphadenitis ,
tumor
-
palpation of LLQ → pain on RLQ
.
1st symptom anorexia : ( precedes pain) -
peritoneal irritation
-
Markle 's sign
<
MC bacteria : E. coli ,
B- fragilis -
heel
jarring + abdominal pain
Alvarado Score Appendectomy Argentattin Cells ( Kultchitz sky cells)
Migration of pain to RLQ .
MC surgical emergency : appendicitis
)"
-
specialized cells at base of
Anorexia I -
Mc surgical emergency in pregnancy
Nausea / vomiting
1
append icial crypts
2 MC site of rupture in appendicitis :
* Tenderness at RLQ
anti mesenteric border carcinoid tumors
Rebound tenderness 1 -
give rise to
Elevated temp 1 -
Amy and 's hernia :
when hernia sac contains ruptured appendix -
neuroendocrine cells
Leukocytes is 1>10,000
-
* WBC) 2 _
Mc site of Gt carcinoid :
shift to the L ( > 75% neutrophils) 1 pseudo myxoma peritonei
appendix at tip collection of fluid and mucinous
gelatinous
, -
5- 6 compatible w/ acute appendicitis Adenocarcinoma surface and omentum
:
+× : Rhemi colectomy implants on peritoneal
mucinous
7- 8 : probable appendicitis
-
rarest , lowest survival
probable appendicitis Signet ring :
•
9- 10 : very
, Abdomen
.es/. . . . .
lobe
Liver
- R
•
caudate lobe
quadrate lobe
-
•
L lobe
-
Porta Hepatis .
or hit us of the liver at postero interior surface
'
contents :
R and L hepatic ducts
'
-
R and L hepatic artery
.
portal vein
-
nerves
-
lymph vessels
.
. ..
-
between L lobe and quadrate lobe
-
remains of the umbilical vein
Venosvm
-
Fissure for Ligamentum
-
between L lobe and caudate lobe
•
remains of ductus venous
-
Groove for NC
-
between R lobe and caudate lobe ; hepatic veins join IVC
•
Fossa for the gallbladder
'
between R lobe and quadrate lobe
-
no peritoneum bet .
R lobe and gallbladder
