396.The answer is a.(Moore and Dalley, pp 250, 252.)This patient has a
sliding hiatal hernia. Sliding hiatal hernias are more common than parae-
sophageal hiatal hernias (answer b).Sliding hiatal hernias are generally
acquired in middle age and lead to chest pain, difficulty swallowing food and
acid reflux. A congenital Bochdalek hernia (answer c)is unlikely since they
usually allow a portion of the small intestine to enter the left pleural cavity
and are a medical emergency in newborns. Neither pylorospasm (answer d)
nor congenital hypertrophic pyloric stenosis (answer e)is likely since bar-
ium is reaching the small intestine.
397.The answer is e.(Moore and Dalley, pp 284–285.)The spleen is one
of the most frequently injured organs in the abdomen. This is especially so
if the spleen was enlarged as a consequence of infectious mononucleosis
making it more susceptible to rupture. Because it has an extensive blood
supply, shock and death from bleeding into the peritoneal cavity can occur
if a ruptured spleen is left untreated. The symptoms described above are
consistent with blood loss most likely associated with a ruptured spleen.
None of the other abdominal organs, stomach (answer a),duodenum
(answer b),pancreas (answer c),and kidney (answer d)are likely to
cause the sudden drop in blood pressure.
- The answer is e.(Moore and Dalley, pp 277, 257–258.)Volvulus
(twisting of the GI tract on itself) which limits movement of material within
the lumen and may compromise blood flow occurs most frequently with
the jejunum and ileum and the sigmoid colon. These are intraperitoneal
segments of the GI tract. The jejunum and ileum are both midgut deriva-
tives and thus refer pain to the periumbilical region [thus not (answer b)].
The sigmoid colon is the most mobile portion of the large bowel and is
derived from the hindgut and tends to refer pain to the suprapubic region
(especially on the left side) [thus not answers candd)]. The duodenum
(answer a)is retroperitoneal and generally doesnotundergo volvulus.
399.The answer is d.(Moore and Dalley, pp 311–312.)The newly trans-
planted kidney will be placed in the iliac fossa in the greater pelvis, attached
to branched iliac vessels and the ureter connected directly to the bladder.
Generally unless the kidneys are infected the host kidneys are left in place
[thus not (answers a and b)]. The newly transplanted kidney is placed in the
greater pelvis and connected to the iliac vessels [thus not (answer c)]. Often
524 Anatomy, Histology, and Cell Biology