Samenvatting Abdomen

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Samenvatting - Abdomen

  • 1.1 Anatomy abdomen

  • Abdominal regions:
    1. Regio hypochondriaca dextra
    2. Regio epigastrica
    3. Regio hypochondriaca sinistra
    4. Regio lateralis (lumbalis) dextra
    5. Regio umbilicalis
    6. Regio lateralis (lumbalis sinistra
    7. Regio inguinalis (iliaca) dextra
    8. Regio pubica (hypogastrica)
    9. Regio inguinalis (iliaca) sinistra
  • Transpyoric plane (L1) (Addison's plane)
    --> horizontal line half way between suprasternal notch (T2/3)  & pubic symphysis

    Structures approx. on this line
           - L1 vertebra --> termination spinal cord
           - Origin of superior mesenteric artery
           - Origin of portal vein
           - Pancreatic neck
           - Pylorus
           - 2nd part of duodenum
           - Sphincter of Oddi
           - Hila of kidney
           - Duodenojujenual flexure
           - Fundus of gall bladder
           - 9th costal cartilage
           - Hilum of spleen
           - Transverse mesocolon
  • Subcostal plane
    At the level of the 10th costal cartilages and the 3rd lumbar vertebra (L3)
  • Intertubercular plane
    Joins tubercles on iliac crests & lies at the level of the 5th lumbar vertebra
  • Intercristal plane
    Passes across highest points on iliac crests & lies on the level of L4
             --> Lumbar spinal tap
  • McBurney's point
    Point over the right side of the abdomen that is 1/3 of the distance from the anterior superior iliac spine (ASIS) to the umbilicus. This point roughly corresponds to the most common location of the base of the appendix where it is attached to the caecum.
          --> point of surgical incision for appendectomy
  • 1.1.3.1.1 Uterus

  • Anatomy
    .
  • Physiology

    - The role of the uterus is to nurture the fetus until parturition.
    - Functionally it consists of a lower cervix (which acts at different times as a passageway, a barrier and a reservoir) and an upper body in which the fetus develops.
  • Three layers

    •Serosa - peritoneum
    •Myometrium – smooth muscle with areolar tissue, blood & lymph vessels and nerves
    •Endometrium -  lined by columnar epithelium. It contains many tube-like glands → mucus
  • Nerves

    Nerve supply to uterus via autonomic pathways:
    •Body: sympathethicfibres from T10-L1
    •Cervix: parasympathetic pathways from S2-S4

    Sympathetic activation → uterine contraction and vasoconstriction
    Parasympathetic activity → uterine inhibition and vasodilatation
  • 1.1.3.1.2 Bladder

  • The bladder
    The bladder is a hollow organ whose walls contain well-developed layers of smooth muscle, consisting of a body and a neck. In the body, urine is stored until released in the process known as urination, voiding, or micturition. The bladder can expand to hold a volume of about 500 ml. The neck is a funnel-shaped extension of the body, passing into the urogenital triangle and connecting with the urethra, a single tube through which urine passes to reach the external environment. The opening between the bladder and urethra s closed by two rings of muscular sphincters; the internal and external sphincter. 
  • 1.1.3.2.1 Gall bladder

  • Anatomy
    .
  • 1.1.3.2.2 Liver

  • Anatomy
    .
  • Enterohepatic circulation
    .
  • Portal system
    .
  • 1.1.3.2.3 Pancreas

  • .
    .
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Laatst toegevoegde flashcards

Epidemiology
Incidence in the Netherlands:
                   – 1100 / year
                   – Lifetime risk: 1.5% or 1/65 ♀
Mortality: – 900 / year   

Mean age: 65 y. 70-80% occur in postmenopausal women
In postmenopausal women: 30% of ovarian tumours = malignant
In premenopausal women: 7% of ovarian tumours = malignant
Late effects in healthy tissue
From three to several months after the treatment
- In general slow-dividing tissues
- Often irreversible
- Examples: skin (teleangiectasia, fibrosis), lungs(pneumonitis, fibrosis), intestines (stricture, perforation), eye (cataract), salivary glands(xerostomia)
Early effects in healthy tissue
From 1-2 weeks after the start of radiotherapy (depending on e.g. the fraction dose)
- In general fast-dividing tissues
- Usually reversible
- Examples: skin (erythema and desquamation), mucosa (mucositis, proctitis)
Effect in healthy tissue
Damage to healthy tissues results from cell death in the tissues that are essential for the functioning
The damage may increase by the tissue’s response to the damage (e.g. fibroblast proliferation leading to fibrozation)
A tissue may contain several target cells each with a different sensitivity
Factors influencing the effect
- Division activity of the cells/cell cycle
- Oxygen concentration
- Ionization density (radiation type)
- Dose rate
- Other factors
             - Temperature
             - Other substances (e.g. chemo, smoking)
Biological effect of radiation
1. Atom level:
             - Ionizations
2. Molecule level :
             - Radical formation
3. Cell level:
             - Main effect is DNA damage
Diagnostics vs. therapy
In radiodiagnostics: keV
In radiotherapy: MeV 


Doses in radiotherapy:
               - expressed in Gray (Gy) = J/kg

In radiodiagnostics:
               - usually the effective dose is given
               - unit (milli)Sievert (Sv)
               - effective dose is calculated by correcting for radiation type and organs
                  radiated
High energetic X-rays
- Advantages:
              - High penetration power
              - Skin-sparing effect
- Disadvantages:
              - Not suitable for good imaging
              - Superficial tumours not well-radiated
              - Difficult to shield
Types of radiation
- Ionising radiation
           - minimal energy 124 eV (wave length ~100nm and smaller)
- Electromagnetic radiation
                 - γ-ray or X-ray
                             --> indirect ionisation
- Particle radiation
                 - e.g. electrons, α-radiation, protons, neutrons
                             --> direct ionisation
Brachytherapy
- Brachy = close
- Internal radiation
            - via existing body orifice
            - implant
- Implant
            - temporary
            - permanent
- Using radioactive isotopes
            - Very common: 125I and192Ir