Gross Anatomy Unit 3 FAL
Uncal herniation
Medially displaced medial temporal lobe over free margin of tentorium. Focal effacement of ambient cistern and lateral suprasellar cistern. Rarely compresses contralateral cerebral peduncle (Kernohan's notch) against tentorial margin. (eye that is drooped and pupil is blown wide)
subarachnoid hemorrhage
Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.
After receiving health insurance through the affordable care act, a 55-year-old man is encouraged by his wife to see a family physician for a check-up for the first time in over a decade. The physician assistant noted that the man spent several minutes taking deep breaths and expiring through pursed lips while sitting in a tripod position when he came in the room, but that this subsided over time. During the physical, the physician notices a barrel chested appearance and that his fingernails have a distinct rounded appearance to them. The physician also notices a bluish tinge to the patient's lips. Body temperature is 980C Blood pressure is 138/85, Heart rate is 90 BPM and respiratory rate is 25 breaths per minute. Auscultation is relatively normal, except for Rhonchi in the vicinity of the secondary bronchi. The physician inquires into the patients medical history. He describes a 60 pack-year history of smoking and a "smoker's cough" that is typically worse when he first wakes up in the morning. Aside from the normal problems that happen with aging, the patients describes himself as being in "pretty good health, all things considered".
COPD (chronic obstructive pulmonary disease)
chronic subdural hematoma
CT scan through the brain of an elderly patient demonstrates a subdural haemorrhage with acute and chronic components. Note how the acute blood sinks inferiorly (haematocrit effect). A similar appearance can rarely be seen in acute haemorrhage in patients on anticoagulants, where the blood separates into serum and haematocrit rather than clotting.
Abducens nerve palsy
Deficit of Lateral Rectus muscle Unopposed medial rectus action Eye deviates medially (when the bad eye is covered the other eye moves too far medially to compensate)
absent P wave
SA node abnormal
The patient in the accompanying image has been diagnosed with a neural infection. Which specific nerve branch has been affected? (looks like herpes)
trigeminal nerve
first rib fractures
•Relatively Rare •Most commonly found in subclavian groove (structurally weak) •Suggests significant blunt force trauma or avulsion (scalene contraction during whiplash) •Indicators of increased morbitity/mortality in trauma situations, when present •Associated with cervical spine trauma, other fractures, neurovascular injuries
hematocrit effect
With mixed-density hematomas, the denser acute blood settles to the bottom
epidural hematoma
a hematoma located on top of the dura (lemon shape, hyperdense)
While standing on the sidelines, Drew Bledsoe demonstrated untypical restlessness and agitation, and was assessed further in the locker room. As he was packing his belongings, he kept complaining about a painful shoulder. The doctors felt something was not quit right, and so sent him for a consultation with an internist at Mass General.
accumulation of blood in pleural space
A patient makes an appointment with his family physician searching for a treatment for laryngitis. The physician uses a laryngoscope to view the vocal folds, and is surprised to note that there is no discernable inflammation. The physician asks the patient to alternate between saying "aaah" and taking deep breaths and notes that the left vocal fold does not move properly with the right (see video). Among other tests, the doctor refers the patient for angiography. What artery is the doctor interested in viewing?
aortic arch (impinges on left recurrent laryngeal nerve)
A 48 year old woman reports to the ER complaining of severe pain in her shoulder that is beginning to radiate down her arm. During the physical examination the physician notices a firm mass in her right anterior neck and dilation of the external jugular vein (see video). Palpation of the mass creates a pins and needles sensation down her arm. The physician also notices that the patient's right eyelid is drooping. Shining a penlight in the patient's eyes, she notices that the right pupil is fixed and constricted. A plain film radiograph is ordered.
apical lung cancer
coronary artery disease
atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle
impingement of what structure causes radiating pain and pins and needles (happens after pancoast tumor)
brachial plexus
A teenager presents to the emergency room with orbital swelling. About a week ago the patient reported experiencing frequent headaches in the "back of his eyes" and yesterday developed blurred vision. He woke up this morning with a fullness in his left orbit. After seeing his reflection in a mirror, he called down to his mother, who rushed him into the hospital. The patient does not recall having suffered any significant head trauma. The physician does note that the patient's skin is noticeably pock marked (acne). What is the most likely diagnosis?
cavernous sinus thrombosis
A 64-year-old female with severe depression had become dehydrated after a prolonged period of self-starvation and refusal to drink. In order to rehydrate the woman, a central line was place in the subclavian vein for administration of a rehydration solution. The patient showed improvement over a period of 2 days, then suddenly developed tachypnea, cyanosis, tachycardia, and hypotension. Blood work and a chest film was ordered. What caused the sudden onset of the above symptoms?
collapse of apicoposterior bronchopulmonary segment
A 46-year-old man was referred to a neurology clinic with a 2-year history of recurrent vertigo. During the first attack, an initial period of acute severe vertigo lasting several minutes was immediately followed by sensorineural hearing loss and imbalance. The patient was treated with intravenous infusions and symptoms resolved completely. The second episode of severe vertigo occurred 18 months later, accompanied by right-sided aural fullness and high-frequency nonpulsatile tinnitus, this time without hearing impairment. Six months after the second episode, the patient started to suffer from recurrent episodes of severe vertigo lasting from several minutes to hours, which were incapacitating and significantly impaired the patient's ability to work or carry on with his regular activities. Symptoms were lessened with bed rest. Both frequency and intensity of the vertigo attacks increased over the following months. Two months ago the attacks occurred at least several times a week, sometimes daily. The patient is also contending with persistent fluctuating high-frequency tinnitus and increasing aural fullness on the right side. All other aspects of his neurological examination was normal. Audiometric testing showed no significant hearing impairment and vestibular testing was normal, what nerve is affected?
cranial nerve 8 (vestibulococlear)
Frey's syndrome is a unique condition that follows a parotidectomy. Residual parasympathetics establish connections with sweat glands that cause the person to perspire when they eat. What nerve does this stimulation originate from?
cranial nerve 9 (glossopharengeal)
A 32-year-old man was referred to a rehabilitation clinic with left shoulder dysfunction. The physical therapist identifies weakness with shoulder elevation and develops a rehabilitation program for the patient. Two weeks into treatment, the patient calls to reschedule a session due to a conflicting doctor's appointment. The patient explains in the following session that he was also referred to an ENT specialist, due to sore throat, left earache, hoarseness, and swallowing difficulty, which developed three weeks prior to the left shoulder issues. The PT consults with the ENT physician about his own assessment and learns that the patient's left vocal cord was hypomobile, that he showed an impaired gag reflex on the left side and deviation of the uvula to the right side. There was no impairment of facial sensation and motion, no tongue deviation or nystagmus. The PT begins to believe that the patient's diverse medical complaints can all be attributed to a single medical condition affecting 3 different cranial nerves, what three nerves are involved?
cranial nerves 9,10,11 (glossopharyngeal, vagus, accessory)
A 53-year-old man appeared in the ER complaining of pain and distension in his abdomen that had progressed over the past several days. He had originally attributed the pain to indigestion and bloating, but has become concerned that the bloating has continued to increase, despite not eating. During the patient history, the man admits to eating fast foot takeout almost every day, and to smoking a pack of cigarettes and drinking a liter of burbon on an almost daily basis going on 20 years. Inspection of the abdomen reveals distension and the prominence of the superficial veins.
destruction and scarring of the liver
Imagine that the person in the accompanying photo were to suffer an injury to her left oculomotor nerve. In which direction would you expect the eye to deviate in a resting position?
down and out (D)
A 7-month pregnant female comes goes to her OBGYN for a routine check up, the doctor notices that there appears to be more blood in the lungs than normal. Which structure is there a potential problem with?
ductus arteriosus
•Four days following a two-vessel coronary artery bypass graft (CABG) procedure and replacement of a mitral valve, a 69-year-old woman presented with a chief complaint of shortness of breath, inability to lie supine, oliguria, and overt weakness. Her pulse is 120 beats/min, respirations are 30 breaths/min, and blood pressure is 70/40 mm Hg. Jugular venous distention is noted. Breath sounds are normal. Heart sounds are not audible. The ER physicians order an ultrasound of the mediastinum...
fluid accumulation in pericardial sac
A few minutes after the first patient is brought in, the driver and passenger of the second car, an elderly couple, are also brought in. The passenger, a 78 year old woman, is complaining about pain along her left side, and also shortness of breath. Plain film radiographs are once again ordered...
fracture of multiple rib segments
A 25 year old patient is brought to the ER following a MVA. While waiting at a stop light, the car was rear ended from a distracted driver who failed to see the stopped car. He is complaining of significant pain in his left chest and shortness of breath. A plain film radiograph is ordered.
fracture of the first rib
anesthetism of facial nerve
half of face paralyzed
A 45 year old woman presents to her family physician. An avid runner, she has been noticing a progressive decrease in exercise performance over the past year. She originally attributed this to the effects of aging. During a group run earlier in the week, however, she was forced to pull back, and one of her running mates who chose to stay with her became alarmed to notice a blue tinge develop around the patient's lips. A thorough history reveals that the patient has also become susceptible to dizzy spells, and recalls several moments of almost passing out, particularly after coughing spells. Among other things, the physician orders cardiac ultrasonography...
hole in atrial septum
what causes bulge near scrotum of infant
intestinal tissue in inguinal canal
A man visits the dentist in order to have a root canal performed on his left lower molar. Where should the needle be inserted?
just to the left of the wooden stick
A 52 year old male presented to the emergency department with severe left flank pain radiating to the right lower quadrant. His blood pressure was 154/96, pulse rate was 79 bpm, respiratory rate was 24 breadths per minute and temperature was 36.7° C. The pain was insidious in onset and had an intensity of 10/10 on verbal analog scale which decreased to 8/10 after administration of Toradol and Morphine medications provided in the emergency department. The pain was constant, lasting 3 hours in duration, and he had two episodes of vomiting since its onset. He did not report experiencing any chest pain, dyspnea, fever or bowel and bladder dysfunction. His heart rate and respiration were within normal limits. He did not display any signs of edema or nausea, abdominal discomfort or indigestion. His abdomen was soft with diffuse tenderness, which increased over the right lower quadrant. Urinalysis revealed a moderate increase in specific gravity (1.030), significant hematuria (3+) and a trace of protein.
kidney stones in the left renal ureter
a lesion to the cordae tempani
loss of taste sensation to the anterior 2/3rds of the tongue
cranial bleeds: layers
meninges: dura mater, arachnoid mater, pia mater
An 83-year-old male is brought to the emergency room by his distraught daughter. The patient is a widow, having lost his wife of 55 years to an acute MI 3 years earlier. He speaks with his daughter, who lives several hours away, over the phone every few days. In recent months, the patient has complained to his daughter about feeling constantly nauseated, especially after eating. While the daughter expressed concern, the patient said it was likely nothing serious, as he was not running a temperature. Two weeks ago the symptoms progress to a complete loss of appetite and vomiting when he did attempt to eat. The daughter became increasing concerned at the lack of improvement and decided to come out to see him. Upon her arrival, she is alarmed by her father's appearance and immediately (yellowing skin) rushes him to the ER for assessment. An MRI and CBC are ordered.
metastatic pancreatic cancer
A young girl is seen in the ER after sustaining a serious head injury from a fall. While closing down their backyard pool for the fall season, the parents became distracted and did not see the young girl inch her way closer to the pool's edge. They turned in time to see her fall in and land on her head. The girl lost consciousness and was rushed to the ER, regaining consciousness on the way. Head CT images were negative for fracture or cranial bleeds. The family is released and instructed on concussion protocol. Two weeks after the incident, the wife follows up with a check-up with her family doctor. She has noticed abnormal movement of the child's eyes. During the examination, the doctor notices that the girl keeps her head tilted towards the right shoulder. She is referred to an opthamologist, who does a series of tests. Cover/uncover tests are normal when the child's head is tilted to the right, but abnormal when the head is held in a neutral position. Which cranial nerve is affected?
trochlear nerve palsy
A woman experiences difficulty during a vaginal childbirth in the maternity ward of a local hospital. During delivery, the child's left shoulder becomes caught at the level of the symphysis pubis. After much manipulation, the obstetrician is able to clear the shoulder through the birth canal, and the delivery progresses normally. APGAR scores are within normal levels, and the baby appears healthy, with the exception of a slight cyanotic appearance. A ultrasound is ordered, and no abnormalities are found in heart wall structures. The cyanotic appearance persists in the weeks following delivery, and during a follow up visit, the physician notes diminished breath sounds over the entire left lung. A fluoroscopic analysis is performed...
paralysis of the left side of the diaphragm
subdural hematoma
pertaining to below the dura mater, tumor of blood (banana shape, isodense or hypodense)
referred pain patterns
places that show pain when certain organs are affected
COPD
•Airflow obstruction that is not fully reversible •May involve 1 or more of the following... •Chronic bronchitis •Productive cough 3+ months over 2+ consecutive years •Emphysema •Damage, fibrosis of alveolar sacs; breakdown of endothelial wall •Sac-like spaces evident on gross inspection •Asthma •Airway restriction from constriction of smooth muscles •Characterized by chronic cough (worse in mornings), sputum production, dyspnea and weight loss •May also notice clubbed fingers and barrel chested appearance •Smoking history has strong direct relationship with COPD •Chronic condition that is worsened by exacerbations/comorbidities •Infections, inflammation •Treated with supplemental oxygen, respiratory therapy, home modifications
aortic arch aneurysm
•Aneurysmal dilatation of the arch of the aorta(>50% normal diameter) •Likely to impinge on left recurrent laryngeal nerve •Hemiparalysis of left vocal fold •Red flag for aneurysm, left lung tumor
location of heart
•Aortic valve disease •May be congenital or acquired •Includes •Aortic valve stenosis •Aortic valve regurgitation
A 59-year-old man with a history of hypertension presents for an elective subtotal colectomy for colon cancer. The procedure is successful, without any signs of complication. His immediate postoperative state is stable, but on postoperative day 4 he develops sudden-onset shortness of breath. He denies having any chest pain, palpitations, nausea, or diaphoresis (excessive sweating). On physical examination, his blood pressure is 138/68 mm Hg; his pulse is regular, with a rate of 110 beats/min, and his respiratory rate is 30 breaths/min. His temperature is 97.7°F and his oxygen saturation is 92% on room air, which improves to 98% on 2 L of oxygen via nasal cannula. He is in mild respiratory distress but is able to speak in full sentences. He is not recruiting the accessory muscles of respiration. The examination of his head and neck is normal. He has mildly decreased breath sounds at his right lung base. His heart sounds are normal. His abdomen is soft, nontender, and mildly distended with good bowel sounds; a midline incision scar is clean and nontender. He has palpable peripheral arterial pulses in his upper and lower extremities. The patient did not have edema or tenderness in the lower extremities. Laboratory blood tests are normal. An arterial blood gas on room air demonstrates a pH of 7.45, a pCO2 of 32 mm Hg, and a pO2 of 62 mm Hg, with an oxygen saturation of 93%. A chest x-ray reveals bibasilar subsegmental atelectasis. He receives a treatment session with a respiratory therapist, but his condition continues to deteriorate. On postoperative day 5 his oxygen saturation declines despite supplemental oxygen and he is intubated for hypoxemic respiratory distress. He is transferred to the ICU.
pulmonary artery obstruction from blood clot
upside down QRS complex
purkinje fibers abnormal
Frank, a 59-year-old man is brought to the ER by his wife, Erma. The couple had been sitting out on the front porch of their home enjoying the sunset (after dinner) when the man started to experience the gradual onset of chest pain. Fearing a heart attack, the wife insisted they visit the local emergency room. The patient describes a burning sensation in the midthoracic region. The doctor also notes that couple has been arguing about the husband sitting in the chair; Erma wants the husband to lie down, but Frank insists that this makes the pain worse.
regurgitation of stomach contents into the esophagus
A patient comes in for his yearly physical, which involves listening to the heart sounds with a stethescope. At which location are you most likely to hear a "lub-duff" sound?
right 2nd intercostal space by sternum
The subject in the diagram below is able to move her jaw to her left when asked to do so. This helps confirm normal function of which nerve branch?
right mandibular n
An 85-year-old man is presented to the emergency department (ED) by ambulance with severe abdominal pain that began suddenly 2 hours before presentation. The pain is mainly in his back and radiates toward his left inguinal region. The patient felt light-headed at the onset of the pain to the extent that he had to grip the sink to steady himself. He also reports significant nausea, although he has not vomited. He has no urinary symptoms. His medical history includes type 2 diabetes, hypertension, hyperlipidemia, ischemic heart disease, and intermittent claudication (cramping pain) of his lower extremities. He smoked 10-20 cigarettes a day for over 60 years but stopped 5 years ago. The physical examination reveals tenderness in the left iliac fossa and left costovertebral angle. His vital signs are remarkable for a heart rate of 105 beats/min and a blood pressure of 110/90 mm Hg. An abdominal CT is taken.
ruptured abdominal aortic aneurism
Following the treatment for his kidney stone, the same patient returns to the clinic 3 weeks later with a similar pain presentation. The patient explains that the pain had had a more gradual onset than before, and had suddenly worsened this morning, accompanied with feelings of lightheadedness and weakness. The patient's vital signs at presentation were: heart rate, 96 beats/minute; blood pressure, 133/76 mm Hg; respiratory rate, 20 breaths/minute; and temperature, 98.9˚F. Oxygen saturation was 98% on room air. On physical examination, the patient had left lower quadrant pain and left costovertebral angle tenderness. Plain film radiographs showed nothing of significance. Laboratory studies were remarkable for a hemoglobin level of 6.8 g/dL, and a hematocrit of 21.1%. Based on the patient's history and symptoms, axial and coronal computed tomography (CT) scans were ordered...
ruptured renal calyx
A 27 year old woman is seen by her obstetrician 6 months following the birth of a health baby boy for a routine check-up. An avid exercise enthusiast, she returned to running and weight training a few weeks following an uneventful vaginal delivery under epidural anesthesia, and jokes with her doctor at how jealous her friends are with how quickly she lost her "baby bulge". During the examination, however, the woman confides in her doctor about a protrusion along her midline, just above the belly button. She first noticed it mid-pregnancy, in particular while doing abdominal crunches, and assumed it was a natural progression of the developing uterus, but is now frustrated by the fact that it does not seem to be disappearing. She says it is not painful, but she is becoming concerned and frustrated by the lack of improvement.
stretching of linea alba
impingement of what structure is causing the constricted pupil and drooping eyelid
sympathetic trunk
ventricular fibrillation
the rapid, irregular, and useless contractions of the ventricles
what other neurological symptoms would you see
there should be no other neurological symptoms
Dilated/ruptured renal pelvis/calyx
•Back-up of fluid, pressure within the renal pelvis, which may ultimately progress to tissue rupture •Causes •Unresolved ureterolithiasis (>4wks) •Typically smaller stones •Narrowing, scarring of ureter due to previous ureterolithiasis •Compression from AAA, abdominal tumors •Results in extravasation of blood urine into peritoneal cavity •Typically confined to perirenal space •Treatment •Identification, treatment of cause •Ureteric stent •Conservative treatment as tissue heals •Monitor for infection
internal pacemaker unit
•Battery unit with electrical leads fed into the heart through the superior vena cava •Monitors cardiac rhythm •If fatal arrhythmia detected, give electrical stimulation •Less voltage (direct stimulation)
Bell's palsy
•Bell's palsy •Facial nerve paralysis •Acute onset; paralysis over period of 48 hours •Causes •Many cases idiopathic •Possibly due to complications involving herpes simplex virus •Also seen in pregnancy, diabetes •Presents with unilateral facial paralysis, dry eye, possibly hypersensitivity to sound •Little can be done for treatment •Partial/total recovery over several weeks
bilateral frontal acute epidural hematoma
•Bilateral frontal epidural hematomas in a 25 year old male. An associated brain edema with marked mass effect in the form of effacement of cerebral sulci, compression of the third and lateral ventricles with possible uncal herniation. Hemorrhagic foci seen at the right frontal grey white matter junction and right temporal region. Also noted few scattered intra cerebral petechial hemorrhage at left para-falcine area.
Vestibulocochlear nerve compression/ lesions
•Causes •Tumor •Ménière's disease (MD) •Microvascular compression •Temporal bone fracture •Symptoms •Hearing loss, tinnitus •Vertigo Loss of equilibrium - see it with a shakey eye
apical pnuemothorax
•Collapse of the apical/apicoposterior bronchiopulmonary segment 20 to pucture of the cervical pleura •Can be caused by puncture during central line placement/shifting •Presentation •Patient presents with shortness of breath, elevated heart rate, respiratory rate, agitation, pulse-ox > 92% •Radiograph confirms receding line of visceral pleura •Treated with needle throacocentesis, chest tube
hemothorax
•Collection of blood fluid in pleural cavity, between parietal, visceral pleural layers •Due to tearing of blood vessels in/around pleural cavity •e.g. intercostal a/v.s •Presentation similar to pneumothorax •May also present with referred pain •Irritation of diaphragm •Treated with thoracocentesis, chest tube, ligation of source of bleed
indirect vs. direct inguinal hernias
•Hesselbach's triangle •Theoretical space bordered by inferior epigastric vessels, lateral border of rectus abdominis, inguinal canal •Represents region of weakness for anterolatral abdominal wall •Direct hernias - push through Hesselbach's triangle •Indirect hernias - enter deep inguinal ring lateral to Hesselbach's triangle
pancreatic cancer
•High prevalence of metastasis •Liver commonly involved due to portal circulation •Presents as multiple liver mets •Very poor prognosis •Rarely caught early on •Extensive blood supply makes surgery difficult •Whipple procedure •<10% 5 year survival rate •Treatment often focuses on palliative care •Duodenal, bile stents to improve digestion •Pain medications •Chemotherapy to prolong life
indirect vs direct inguinal hernias
•Indirect •Most common •Tissue enters inguinal canal through deep inguinal ring, progresses through inguinal canal and through superficial inguinal ring •Direct •Tissue pushes through weakening
gastroesophageal reflux disease (GERD)
•Irritation of the lower esophageal lining due to reflux of stomach contents into esophagus •Causes •Weak/inactive cardiac sphincter •Hiatal herniation •Due to differences in endothelial lining of esophagus vs. stomach
patent foramen ovale
•Most common form of heart defect •Most commonly due to incomplete sealing of foramen ovale following birth. •Presentation •Exercise intolerance, syncope (fainting), arrhythmias •Exacerbated by rises in pulmonary pressure (e.g. coughing) •Symptoms increase with age •Risk factor for paradoxical embolism •Venous clots shunting to arterial system, resulting in stroke
flail chest
•Most common rib fractures occur between 5 to 9 •Multiple fractures common •Flail chest •Requires multiple fractures in at least 3 consecutive ribs •Isolated segment behaves independent of remainder of chest cavity •Paradoxical breathing •Fracture segment moves in opposite direction during breathing
pancreatic cancer
•Pancreatic adenocarcinoma •Affecting the exocrine cells (producing digestive enzymes) •>80% of cases •>60% found in pancreatic head •Tumor can impact other tissues •Duodenum - loss of appetite, vomiting •Common bile duct - jaundice •Pancreatic duct - acute pancreatitis
pulmonary embolism
•Partial/complete disruption of 1 or more bronchiopulmonary segments from a blood clot •Commonly result from venous stasis (e.g. bed rest) •Responsible for 10% to 15% of deaths in hospital •Also seen in some traumas, clotting disorders •Significant back-up of blood may result in cor pulmonale (right sided heart failure) and circulatory collapse •Saddle embolus - partial/complete obstruction of pulmonary trunk (R/L pulmonary arteries Medical emergency
pediatric inguinal hernia
•Protrusion of intestinal tissue into inguinal canal, scrotum •Common pediatric condition in boys •Due to "patent processus vaginalis" (path taken by descended testical fails to close completely) •Right side > left side (later descent) •Types •Reducible - herniated tissue can move back and forth •Progresses/recedes with expiration/inspiration •Incarcerated - tissue is fixed in place •Strangulated - incarcerated hernia in which blood flow is compromised •Medical emergency •Requires surgical repair to prevent progression to strangulation
apical lung cancer: pancoast tumer
•Pulmonary neoplasms at pleuropulmonary groove •Leads to compression of structures within neck, thoracic inlet •Presentation •Shoulder/axillary pain, ultimately radiating into the upper limb •Atrophy of upper limb musculature •Impingement of brachial plexus •Horner's syndrome (drooping eyelid, constricted pupil, hemianhidrosis) Impingement of sympathetic chain
abdominal aortic aneurysm
•Relatively common •Men > 65 at greatest risk •Presentation •Syncope (fainting) •Sudden, severe, constant back/flank/abdominal/groin pain •Pulsatile sensation in lower abdominal area •Diagnosis •Palpation sufficient, but angiography better characterizes •Treatment •Small sized aneurysms monitored for progression •Low rupture risk •Sufficiently large AAA require aortic stents to reinforce wall •AAA rupture represents medical emergency •~65% of ruptures result in cardiovascular collapse, death before patient arrives at hospital
phrenic nerve lesion
•Relatively uncommon condition •May be unilateral or bilateral •Causes •Surgical injury •Pressure from tumors, aneurysms, etct. •inflammatory •Unilateral lesion results in diaphragm hemiparalysis •Paradoxical breathing pattern •Paralyzed side moves up during inspiration, due to pressure from abdominal organs
liver cirrhosis
•Scarring of liver tissue due to chronic cycles of inflammation, tissue regeneration •Causes •Hepatitis B/C - 60% •Alcohol - 20% Many other causes
diastasis recti
•Separation of the rectus abdominis muscles due to stretching of the linea alba •Results in mild, painless protrusion of abdominal organs at sight of weakness, especially when trunk is flexed •May progress to umbilical herniation (tearing of linea alba with protrusion of abdominal organs) •Common in pregnancy, typically noticed during post-partum period •Due to elevated levels of relaxin hormone •Can also be seen in obesity (females > males) or developmentally •Usually resolves spontaneously, but may require surgical repair •Abdominal exercise contraindicated (exacerbate problem) Core training may be appropriate
cardiac tamponade
•Significant compression of the heart by accumulating pericardial contents. •Blood and clots (postcardiotomy, chamber perforation, dissecting aortic aneurysm, trauma, anticoagulant therapy), •Effusions (malignant states, infective pericarditis, idiopathic pericarditis), •Air •Can have gradual or rapid onset •Can be life threatening situation •Stiff fibrous pericardium prevents expansion; fluid compresses heart chambers, limiting cardiac output •Presentation •Increased HR - compensation for decreased SV •Decreased arterial blood pressure - reduced ventricular contractile strength •Distended SVC, jugular veins - venous back-up
liver cirrhosis
•Typically leads to portal hypertension •Acitis - accumulation of fluid in peritoneal cavity •Caput medusae - varicosities in campers fascia, due to redirection of blood through paraumbilical, superior rectal veins
jugular foramen syndrome
•a.k.a Vernet syndrome •Impingement of the jugular foramen •Paraganglioma tumors •Other forms of malignant/benign tumors •Trauma •Infection •Bone diseases •Presentation •Dysphonia (CNX) •Uvula deviation (CNX) •Loss of sense/taste over posterior 1/3rd of tongue (CNIX) •Loss of gag reflex (CNIX/CNX reflex loop) •Shoulder droop/weakness (CNXI)
ureterolithiasis
•a.k.a kidney stones •Presentation •Sudden onset of sever pain originating in flank •Pain related to dilation, stretching, spasm of ureter •"loin to groin" progression as kidney passes •Diagnosis •Can be made on clinical presentation along, although imaging commonly done •Treatment •Control pain while stone passes (>80%) •More serious cases (unrelenting pain, UTIs) may require drainage with a stent or percutaneous nephrostomy