1 / 31

Omental and Mesenteric Conditions

Omental and Mesenteric Conditions. Omentum. I. Anatomy - double sheet of flattened endothelium - epiploic vessels, lymphatics, nerves, and fatty areolar tissue pass in between

scot
Download Presentation

Omental and Mesenteric Conditions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Omental and Mesenteric Conditions

  2. Omentum I. Anatomy - double sheet of flattened endothelium - epiploic vessels, lymphatics, nerves, and fatty areolar tissue pass in between - hangs as a double fold between the greater curve of the stomach to the transverse colon, with the right side usually longer and larger

  3. - size depends on the amount of fat - usually underdeveloped in innfants II. Physiology - “Policeman of the abdomen”; helps in walling of inflammatory conditions - areolar tissue is rich in inflammatory conditions

  4. III. Pathology A. Torsion – twisting along its long axis causing vascular compromise * requirements for torsion - redundant segment - a fixed point

  5. 1. Etiology a. Primary - with predisposing factors such as projections from the edge of the omentum, obesity, and venous redundancy

  6. b. secondary - associated with another pathology such as omental cysts, tumors, inflammatory conditions or hernias 2. Pathology a. twists in a clockwise direction b. right side twists more frequently

  7. 3. Clinical manifestations a. pain - sudden, constant, increasing in intensity b. nausea and vomiting c. peritonitis d. mass

  8. 4. Diagnosis - laparotomy 5. Treatment - resection B. Idiopathic Segmental Infarction – acute vascular occlusion not accompanid by torsion, intraabdominal conditions, trauma, or cardiac disease 1. Etiology – thrombosis of the omental veins secondary to endothelia injury

  9. - usually involves the right side 2. Clinical manifestions – pain which is gradual in onset, usually on the right side 3. Diagnosis – CT scan which will show a “smudged” appearance

  10. 4. Treatment – excision C. Cysts 1. Pathology a. obstructed lymphatic channels b. growth of congenitally misplaced lymphatic tissue

  11. 2. Clinical manifestations – palpable mass 3. Diagnosis a. x- ray – can diagnose dermoid cyst b. ultrasound c. CT scan

  12. 4. Treatment – excision D. Solid tumors 1. Pathology a. metastatic carcinoma – most common b. hemangiopericytoma and leiomyosarcoma – most common primary tumors

  13. 2. Diagnosis a. ultrasound b. CT scan 3. Treatment – excision of the primary tumor if possible and omentum

  14. Mesentery I. Anatomy - a reflection of the posterior peritoneum - connects the intestines to the posterior abdominal wall and carries blood vessel and nerves - root of the mesentery extends from the ligament of Treitz at the level of L2 and is approximately 6 inches

  15. - Mesocolon – suspensory ligament of the transverse and sigmoid colon - Space of Riolan – avascular space to the left of the middle colic artery - Mesenteric circulation

  16. B. Pathology 1. Acute Occlusion of the SMA a. embolism - sudden occlusion of the main branch of the SMA - produces ischemia of the entire small bowel distal to the ligament of Treitz and proximal half of the colon

  17. b. thrombosis - occurs in an artery partially occluded by atherosclerosis - slowly developing stenosis may allow time for collaterals to develop

  18. 2. Pathology - sudden complete occlusion first causing an ischemic infarct in which the bowel is pale - later stages will show hemorrhagic infarction

  19. 3. Clinical Manifestations - surgical emergency with extreme abdominal pain - P.E. is not proportional to the pain the patient perceives - unresponsive to narcotics - mottled, cyanotic abdomen - absent bowel sounds

  20. 4. Diagnosis a. arteriogram b. WBC – leukocytosis c. hct – hemoconcentration d. metabolic acidosis e. FPA – dilated bowel loops

  21. 5. Treatment a. embolectomy b. resection c. antibiotics d. anticoagulation e. NGT

  22. B. Non- occlusive Mesenteric Infarction 1. Etiology – low cardiac output from CHF, MI, septic shock, arrythmia 2. Diagnosis – arteriography 3. Treatment a. correct hypotension b. vasodilators c. antibiotics

  23. C. Chronic Occlusion of Visceral Arteries 1. Etiology – “intestinal angina” - ischemia without infarction - food pain sequence 2. Pathology – occlusion secondary to atherosclerosis

  24. 3. Clinical Manifestation – crampy abdominal pain when eating with weight loss 4. Diagnosis – arteriogram

  25. 5. Treatment a. arterial reconstruction b. thromboendarterectomy c. synthetic vein graft d. resection

  26. D. Occlusion of Mesenteric Veins 1. Etiology – usually secondary to thrombosis 2. Pathology – hyperemia, edema, subserosal hemorrhage 3. Clinical Manifestations – vague discomfort, severe abdominal pain 4. Treatment – resection, antibiotics, anticoagulant

More Related