GI Perit Cav Suprcolic Infrcol MCQ's

The correct answer is "Splenic vein to the left renal vein." In portal hypertension, there is increased pressure in the portal vein, which carries blood from the gastrointestinal tract and spleen to the liver. Shunting portal blood around the liver can help alleviate this pressure. The splenic vein drains blood from the spleen, while the left renal vein drains blood from the left kidney. Connecting the splenic vein to the left renal vein allows portal blood to bypass the liver and reduce the accumulation of fluid in the abdomen.

The correct answer is splenic vein to the left renal vein. This surgical connection, known as a splenorenal shunt, is used to redirect portal blood flow from the spleen to the left kidney. This helps to reduce portal hypertension by bypassing the liver and allowing blood to flow directly into the systemic circulation. This procedure is commonly performed in patients with cirrhosis and portal hypertension to relieve symptoms and prevent complications such as variceal bleeding.

During a splenectomy, the lienorenal ligament is important to consider because it contains the tail of the pancreas. The lienorenal ligament is a connective tissue structure that attaches the spleen to the left kidney. It also contains other structures such as the splenic artery and vein, but in this case, the correct answer is the tail of the pancreas. This is important to remember during the procedure to avoid any damage or complications to the pancreas.

The splenic artery is likely injured in this case because it runs along the superior border of the pancreas. This artery is responsible for supplying blood to the spleen, and if it is eroded due to a retroperitoneal infection, it can cause abdominal pain in the epigastric region. The other arteries listed do not run along the superior border of the pancreas, making them less likely to be injured in this scenario.

When neoplastic tumors metastasize via the blood stream, they often get caught in the first capillary bed downstream, which acts as a filter. In this case, assuming the metastasis occurred in the inferior mesenteric vein, the blood would flow directly into the portal vein, which carries blood from the gastrointestinal tract to the liver. Therefore, the liver would be the first organ where metastases are expected to be found.

The surgeon would most likely find the abscess in the right paracolic gutter. The paracolic gutters are spaces along the sides of the abdominal cavity where fluid can accumulate. In cases of peritonitis, such as a ruptured appendix, infection and inflammation can spread to these spaces. The right paracolic gutter specifically is located along the right side of the abdomen, adjacent to the ascending colon. Therefore, when the surgeon makes an incision at McBurney's point (which is located in the right lower quadrant of the abdomen), they would be closest to the right paracolic gutter and would likely find the abscess there.

The change in location and quality of the patient's pain symptoms can be explained by the involvement of somatic afferents from the parietal peritoneum. Appendicitis causes inflammation of the appendix, which can irritate the parietal peritoneum, the outer lining of the abdominal cavity. The parietal peritoneum is richly innervated by somatic afferent nerves, which can transmit sharp, localized pain sensations. As the inflammation progresses, the pain may shift from a dull, generalized pain around the umbilicus to a sharp pain specifically in the right lower quadrant, where the appendix is located.

The extruded pancreatic fluid first enters the omental bursa, also known as the lesser sac. The omental bursa is a potential space located behind the stomach and in front of the lesser omentum. It is connected to the greater sac, which is the main space within the peritoneal cavity. When the pancreas ruptures through its anterior wall, the pancreatic contents are released into the omental bursa, leading to peritonitis.

The lymph nodes at the venous angle near the entrance of the thoracic duct receive drainage from the lymphatics that supply the fundus of the stomach. This means that the lymphatic vessels from the fundus of the stomach drain into these lymph nodes, causing the enlargement to be noted in this area.

The correct answer is Right subphrenic space. The patient's complaint of discomfort over his right shoulder suggests that the lesion is in the right subphrenic space. The subphrenic space is located between the diaphragm and the liver, and irritation or inflammation in this area can cause referred pain to the right shoulder due to the shared nerve supply between the diaphragm and the shoulder. This is known as Kehr's sign and is commonly seen in cases of subphrenic abscess or perforation of a gastric ulcer.

The correct answer is Splenic vein to the left renal vein. In portal hypertension, there is increased pressure in the portal vein, which carries blood from the digestive organs to the liver. Shunting portal blood around the liver is done to relieve this pressure. The splenic vein carries blood from the spleen and is connected to the left renal vein, which carries blood from the left kidney. This connection allows blood to bypass the liver and reduces portal hypertension.

The Lesser Splanchnic Nerve contains pre-ganglionic sympathetic fibers. These fibers are responsible for transmitting signals from the central nervous system to the ganglia, which are clusters of nerve cell bodies located outside the central nervous system. The pre-ganglionic sympathetic fibers play a role in the sympathetic division of the autonomic nervous system, which is responsible for the "fight or flight" response.

The pelvic splanchnic nerve is responsible for peristalsis of the descending colon.

The left gastric vein is the most likely source of bleeding in this scenario. The patient's symptoms of altered mental status, jaundice, and distended veins radiating from the umbilicus are consistent with liver cirrhosis, which can cause portal hypertension. Portal hypertension can lead to the development of portosystemic collaterals, including the left gastric vein. Rupture of these collaterals can result in severe upper gastrointestinal bleeding, which is evident from the patient vomiting massive amounts of blood.