412.As a general surgeon specializing in oncological cases you do a fair
number of bowel resections. A 55-year-old man is referred to your office by
his gasteroentrogist who recently removed two polyps from his splenic flexure
of the colon during an endoscopic exam. The pathology report has confirmed
that they are both cancerous and recommends surgical resection of a portion
of the bowel from where the polyps were removed. Lymph nodes that receive
lymph from this region are removed for sampling to stage the cancer growth.
The 55-year-old patient comes to your office to learn what is involved in the
surgical procedure. You describe that you are probably going to remove about
a foot long section of large intestine, which includes part of the transverse and
descending colon and then reattach the cut ends to each other and reconnect
a major artery and collect numerous lymph nodes. Which of the following
major arteries is going to be reconnected and where are you going to collect
lymph nodes from to stage the potential spread of the colon cancer?
a. aorta; splenic and suprarenal lymph nodes
b. splenic artery; splenic and suprarenal lymph nodes
c. marginal artery; splenic and superior mesenteric lymph nodes
d. marginal artery; superior and inferior mesenteric lymph nodes
e. sigmoid artery; left colic and sigmoidal nodes
413.When examining a 48-year-old woman for the first time at a free clinic
you note that she is quite slender and tanned. During the physical exam you
note that she has prominent veins both on her anterior abdominal wall and
also about her nose. During the physical exam you can palpate a fairly large
firm organ that extends well below the right costal margin during both inspi-
ration and expiration. There is noabdominal tenderness. Which of the fol-
lowing is the most likely explanation for your physical findings?
a. Splenomegaly
b. Hepatomegaly
c. Appendicitis
d. Cholecystitis
e. Abdominal aortic aneurysm
Abdomen 513