GI Perit Cav Suprcolic Infrcol MCQ's
Questions and Answers
- 1.
A 6-year-old boy who has complained of a "stomach ache" for two days is brought into the Emergency Dept. by his father. At first the pain was dull and located generally around the umbilicus, but this morning it was sharp and sited in the right lower quadrant of the abdomen. The physician diagnoses appendicitis. What explains the change in location and quality of the patient's pain symptoms?
- A.
Referred pain
- B.
Reflex abdominal rigidity
- C.
Involvement of somatic afferents from the parietal peritoneum
- D.
Involvement of pelvic splanchnic nerves as the infection spreads
- E.
Involvement of lumbar splanchnic nerves as the infection spreads
Correct Answer
C. Involvement of somatic afferents from the parietal peritoneumExplanation
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.Rate this question:
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- 2.
An impacted gallstone at the hepatopancreatic ampulla can block the pancreatic duct and Can lead to pancreatitis. This condition can cause a rupture of the pancreas through its anterior wall and result in a release of pancreatic contents into the peritoneal cavity, in turn causing peritonitis. What anatomical space does the extruded pancreatic fluid first enter?
- A.
Greater sac
- B.
Left subphrenic recess
- C.
Omental bursa (lesser sac)
- D.
Rectouterine pouch (Douglas's pouch)
- E.
Hepatorenal recess (Morrison's pouch)
Correct Answer
C. Omental bursa (lesser sac)Explanation
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.Rate this question:
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- 3.
Lymph node enlargement is noted in a patient at the venous angle near the entrance of the thoracic duct. Which anatomical area is supplied by lymphatics that drain to these nodes?
- A.
Fundus of the stomach
- B.
Right superficial cervical region
- C.
Right deep cervical region
- D.
Right axilla
- E.
Right digastric triangle
Correct Answer
A. Fundus of the stomachExplanation
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.Rate this question:
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- 4.
A 54-year-old alcoholic man is brought to the emergency department because of altered mental status. On examination he is jaundiced with distended veins radiating from his umbilicus. While in the hospital he begins to vomit massive amounts of blood and goes into hemorrhagic shock. Which vessels is the most likely source of bleeding?
- A.
Left gastro-omental vein
- B.
Left gastric vein
- C.
Portal vein
- D.
Superior rectal vein
- E.
Inferior mesenteric vein
Correct Answer
B. Left gastric veinExplanation
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.Rate this question:
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- 5.
Which one of these fibers can be found in the Lesser Spanchnic Nerve?
- A.
Pre-ganglionic sympathetic
- B.
Pre-ganglionic parasympathetic
- C.
Post-ganglionic sympathetic
- D.
Post-ganglionic parasympathetic
- E.
Branches of the vagus nerve
Correct Answer
A. Pre-ganglionic sympatheticExplanation
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.Rate this question:
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- 6.
A 34-year-old man is brought to the hospital with abdominal pain in the epigastric region. Investigations reveal that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which of the following arteries is likely injured?
- A.
Right gastric artery
- B.
Left gastro-epiploic artery
- C.
Gastroduodenal artery
- D.
Dorsal pancreatic artery
- E.
Splenic artery
Correct Answer
E. Splenic arteryExplanation
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.Rate this question:
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- 7.
When performing a splenectomy, it is important to remember that the lienorenal ligament contains which of the following structures?
- A.
Left gastro-omental artery
- B.
Left renal artery
- C.
Left ureter
- D.
Tail of the pancreas
- E.
Short gastric arteries
Correct Answer
D. Tail of the pancreasExplanation
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.Rate this question:
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- 8.
A 42-year-old man, chronic alcoholic, diagnosed with portal hypertension secondary to cirrhosis of liver. He underwent surgery. Which of the following surgical connections is involved in shunting portal blood around the liver?
- A.
Splenic vein to the left renal vein
- B.
Superior mesenteric vein to the inferior mesenteric vein
- C.
Portal vein to the superior vena cava
- D.
Portal vein to the left renal vein
- E.
Superior rectal vein to the left colic vein
Correct Answer
A. Splenic vein to the left renal veinExplanation
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.Rate this question:
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- 9.
53-year-old man presents to the emergency room with sudden onset of massive accumulation of fluid in the abdomen. He is diagnosed with portal hypertension secondary to cirrhosis of liver. He underwent surgery. Which of the following surgical connections is involved in shunting portal blood around the liver?
- A.
Superior mesenteric vein to the inferior mesenteric vein
- B.
Portal vein to the superior vena cava
- C.
Portal vein to the left renal vein
- D.
Splenic vein to the left renal vein
- E.
Superior rectal vein to the left colic vein
Correct Answer
D. Splenic vein to the left renal veinExplanation
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.Rate this question:
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- 10.
Patient diagnosed with a ruptured appendix and peritonitis is rushed into surgery. Upon incision at McBurney's point, the surgeon needs to lavage and evacuate the abscess. In a supine position, where would the surgeon most likely find the abscess?
- A.
Pelvic recess
- B.
Right paracolic gutter
- C.
Omental bursa
- D.
Left subphrenic recess
- E.
Right costodiaphragmatic recess
Correct Answer
B. Right paracolic gutterExplanation
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.Rate this question:
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- 11.
The gastroenterologist diagnosed your patient with decreased peristalsis of the descending colon of a neurogenic nature. Which one of the following nerves is responsible for peristalsis of the descending colon?
- A.
Lesser Splanchnic Nerve
- B.
Vagus Nerve
- C.
Greater Splanchnic Nerve
- D.
Pelvic Splanchnic Nerve
- E.
Inferior Mesenteric Nerve
Correct Answer
D. Pelvic Splanchnic NerveExplanation
The pelvic splanchnic nerve is responsible for peristalsis of the descending colon.Rate this question:
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- 12.
Neoplastic tumors sometimes metastasize via the blood stream and spread throughout the body. These cells usually get caught in the first capillary bed downstream, which works like a filter. Assuming this happened in the inferior mesenteric vein. Where would you expect to find metastases first?
- A.
Pancreas
- B.
Lungs
- C.
Liver
- D.
Brain
- E.
Gallbladder
Correct Answer
C. LiverExplanation
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.Rate this question:
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- 13.
53-year-old man presents to the emergency room with sudden onset of massive accumulation of fluid in the abdomen. He is diagnosed with portal hypertension secondary to cirrhosis of liver. He underwent surgery. Which of the following surgical connections is involved in shunting portal blood around the liver?
- A.
Superior mesenteric vein to the inferior mesenteric vein
- B.
Portal vein to the superior vena cava
- C.
Portal vein to the left renal vein
- D.
Splenic vein to the left renal vein
- E.
Superior rectal vein to the left colic vein
Correct Answer
D. Splenic vein to the left renal veinExplanation
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.Rate this question:
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- 14.
A 50-year-old man was admitted to the hospital following perforation of a gastric ulcer. He complained of severe pain, but also stated that he had discomfort over his right shoulder. Where is the lesion?
- A.
Right subhepatic space
- B.
Right subphrenic space
- C.
Right para-colic gutter
- D.
Morrison's pouch
- E.
Lesser sac
Correct Answer
B. Right subphrenic spaceExplanation
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.Rate this question:
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Mar 20, 2023Quiz Edited by
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Feb 26, 2012Quiz Created by
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