ABD Board-Retroperitoneum

Question 1

the serous membrane that forms the lining of the abd cavity and covers most of the abd organs

Answer 1

peritoneum

Question 2

two layers of peritoneum

Answer 2

parietal-outer layer lines the abd cavity

visceral peritoneum-inner layer cover the abd organs

Question 3

space between the two peritoneum layers is the

Answer 3

peritoneal cavity

Question 4

two compartments of the peritoneal cavity

Answer 4

lesser sac

greater sac

Question 5

space that is situated between the liver, pancreas, and stomach. The entrance to this is the epiploic foramen

Answer 5

lesser sac

Question 6

the rest of the peritoneal cavity . Where ascites and floating bowel are

Answer 6

greater sac

Question 7

a peritoneal recess extending between the rectum and the uterus. In men the correcspoinding space is the __________

Answer 7

pouch of douglas (rectouterine pouch)

rectovesical pouch

Question 8

intraperitoneal structures (12 of them)

Answer 8

stomach

jejunum

1st part of juedenum

appendix

spleen

cecum

transcerse and sigmoid colon

rectum (part of)

liver

uterus

fallopian tubes

ovaries

Question 9

posteriorly located compartment that lies between the transversalis fascia and the posterior parietal peritoneum

Answer 9

retroperitoneum

Question 10

the ____ ______ divide the retroperitoneum coronally into three compartments

Answer 10

renal fascia (gerotas fascia)

Question 11

three compartments of the retroperitoneum

Answer 11

anterior pararenal space

perirenal space

posterior pararenal space

Question 12

kidneys and adreanal glands lie

Answer 12

within the perirenal space and are separated from the pararenal spaces by the anterior and posterior renal foascia (gerotas fascia)

Question 13

organs in the retroperitoneum

sad pucker

Answer 13

suprarenal (adrenal gland)

aorta/IVC

duodenum (2nd and 3rd part adn 4th)

pancreas (not tail)

ureters

colon (ascending and desending)

kidneys

(o)esophagus

rectum

Also:

prostate

lymphatics

gonadal vessels

superior meseteric vessels

renal vessels

Question 14

the quadratus lumborum and psoas muscles lie posterior to the posterior pararenal space and are separated from this space by

Answer 14

their own fascia (transversalis fascia)

Question 15

the Aorta enters the abd cavity in a ______ location

Answer 15

posterior

becomes more anterior as is travels caudally

Question 16

The IVC maintains ______ as it courses throughout the retroperitoneum

Answer 16

horizontal

doesn’t go more anterior or posterior

Question 17

1st major branch of aorta

Answer 17

celiac axis

Question 18

the celiac axis is ____ to the pancreas

Answer 18

superior

Question 19

celiac axis branches into

Answer 19

common hepatic artery

left gastric artery

splenic artery

Question 20

celiac axis terminates with the

Answer 20

bifurcation of the common hepatic artery and the splenic artery

sea gull or dove sign

Question 21

what artery extends cranially from the celiac axis

Answer 21

left gastric artery

Question 22

2nd branch off aorta about 1cm inferior to celiac axis

Answer 22

superior mesenteric artery

parallels the aorta and is posterior/inferior to the body of the pancreas

Question 23

SMA doppler waveforms

Answer 23

fasting state - high resistance

postparandial(after eating) - low resistance, increased velocity

Question 24

the renal arteries arise from the _____ walls of the aorta just below the origin of the _______

Answer 24

lateral

superior mesenteric artery

Question 25

the right renal artery passes ____ to the IVC

Answer 25

posterior

Question 26

the inferior mesenteric artery arises from the ____ aspect of the aorta

Answer 26

anterior

Question 27

the IVC lies ______ to the pancreatic head and liver

Answer 27

posterior

Question 28

the IVC _____ with cardeiac failure and fluid overload

Answer 28

dilates

Question 29

most common tumor to involve the IVC

Answer 29

renal cell carcinoma

Question 30

reasons the IVC could be displaced

Answer 30

liver mass(posterior/medial) right renal artery aneurysm (superior/anterior) lymphadenopathy (anterior) toruous aorta (lateral) right renal / adrenal mass (medial/anterior)

Question 31

used to prevent the ascent of lower extremity vein thrombus

Answer 31

IVC filters

Question 32

most common IVC filter

Answer 32

greenfield filter

Question 33

proper location for an IVC filter

Answer 33

inferior to the renal veins

Question 34

IVC filters are placed by

Answer 34

catheters with entry at the femoral vein or internal jugular vein

Question 35

the left renal vein passses

Answer 35

anterior to the aorta and posterior to the SMA

Question 36

nutcracker syndrome

Answer 36

engorgement of the left renal vein due to its compression by the SMA and sorta

Question 37

the right gonadal vein drains into the ___ and the left gonadal vein drains into the ____ _____ ____

Answer 37

IVC left renal vein

Question 38

a dense fibrous tissue proliferation confined to the paravertebral region

Answer 38

``` retroperitoneal bibrosis AKA ormonds disease AKA inflammatory aneurysm ```

Question 39

retroperitoneal fibrosis extends

Answer 39

rarely superior to the level of L-2 and may extend inferiorly to the dome of the bladder generally centered at the aortic bifurcation

Question 40

retroperitoneal fobrosis appears

Answer 40

usually as a hypoechoic midline mass

Question 41

retroperitoneal fobrosis is associated with

Answer 41

bilateral ureteral obstruction as it envelopes structures rather than displacing them*** progression will cause loss of renal function IVC and lymphatic compression leads to lower extremity edema and gonal vein involvement will cause scrotal swelling

Question 42

bibrosis develops as an

Answer 42

immunologic response to antigens within altherosclerotic plaques usually begins around a severely atherosclerotic aorta

Question 43

veins that provide an alternate pathway for venous return in the case the IVC gets obstructed

Answer 43

azygos and hemiazygos veins unpaired hemiazygos is considered tributary connect the proximal IVC to the superior vena cava can't see them until they dilate to be used

Question 44

azygos vein in located on the

Answer 44

right

Question 45

hemiazygos vein in located on the

Answer 45

left

Question 46

branches of the common iliac veins couterparts of the azygos/hemiazygos system travel lateral to the spine and posterior to the psoas muscle

Answer 46

ascending lumbar veins

Question 47

the right ascending lumbar vein at the level of the diaphragm joins the

Answer 47

right subcostal vein

Question 48

the right ascending lumbar vein and the right subcostal vein join to form the

Answer 48

azygos vein

Question 49

left ascending lumbar vein at the level of the diaphragm joins the

Answer 49

left subcostal vein

Question 50

the left ascending lumbar vein and the left subcostal vein join to form the

Answer 50

hemiazygos vein

Question 51

the adreanal glands and kidneys are in the

Answer 51

perirenal space

Question 52

the crus of the diaphragm lies ____ and ____ to the right adrenal gland

Answer 52

medial and posterior

Question 53

the right adrenal gland is shaped like a

Answer 53

triangle

Question 54

right adrenal gland is located

Answer 54

on the superior, anterior, and medial aspect of the upper pole of the right kidney portions of the gland extend postior to the IVC

Question 55

the left adrenal gland is shaped like a

Answer 55

cresent

Question 56

left adrenal gland is located

Answer 56

anteriomedial to the upper pole of the left kidney

Question 57

the aorta and the crus of the diaphragm are located ____ to the left adrenal gland

Answer 57

medial

Question 58

the tail of the pancreas is located _____ to the left adreanal gland

Answer 58

anterior

Question 59

the crus of the diaphragm is located

Answer 59

anterior to the aorta superior to the celiac axis posterior to the IVC medial and posterior to all structures except the aorta

Question 60

three arterys that support the adrenal gland

Answer 60

suprarenal branch of the inferior phrenic artery suprarenal branch of the aorta suprarenal branch of the renal artery

Question 61

vein that drains the right adrenal gland

Answer 61

right suprarenal vein drains into the IVC

Question 62

vein that drains the left adrenal gland

Answer 62

left suprarenal vein drains into the left renal vein

Question 63

the adrenal cortex produces

Answer 63

mineralocorticoids (aldosterone) glucocorticoids (cortisol) androgens

Question 64

the adrenal gland and the _____ gland function together to regulate hormone production

Answer 64

pituitary gland

Question 65

the adrenal medulla produces

Answer 65

catecholamines: epinephrine (adrenalin) norepinephrine

Question 66

benign can be hyperfunctioning or nonhyperfunctioning

Answer 66

adrenal adenoma

Question 67

syndromes that can be a result of adrenal hyperfunctioning

Answer 67

cushings conn hirsutism

Question 68

rare tumor with poor prognosis majority of patients present with cushings syndrome and metastatic involvement hard to tell the difference from adenoma tendency to invade renal veins and IVC

Answer 68

adrenal cortical cacinoma rumor removal or biopsy is based on size (3-6cm)

Question 69

originate in the adrenal medulla but can be ectopic majority are benign secrete catecholamines (norpinephrine and epinephrine) assocaited with multiple endocrine neoplasia (MEN) and von hoppel lindau disease

Answer 69

pheochromocytoma

Question 70

malignant rumor arising from the sympathetic nervous system commonly in the adrenal medulla but may also occur in neck, chest, or pelvis palpable ABD mass most common adrenal mass iof infancy and early childhood 2 months - 2 years

Answer 70

adrenal neuroblastoma

Question 71

appearance of adrenal neuroblastoma

Answer 71

solid mass that dosplaces the ipsiliateral (same side as) kidney inferiorly into the pelvis increased blood and urine catecholamines: epinephrine norepinephrine dopamine

Question 72

benign, nonfunctioning adrenal masses that contain fat and bone elements seen as hyperechoic masses in the adrenal bed associated with propagation speed artifact due to fat

Answer 72

myelolipoma

Question 73

usually bilateral may be diffuse resembling hyperplasia or mass like non hodgkin disease is the most common cell type

Answer 73

adrenal lymphoma

Question 74

the adreanal glands are the ___ most common metastatic site after lungs, liver, and bone

Answer 74

4th

Question 75

most common in the neonate caused by the large size of the neonatal adrenals and high degree of vascularity making them vulnerable to birth trauma

Answer 75

adrenal hemorrhage

Question 76

appearance of adrenal hemorrhage

Answer 76

varies due to blood coagulation normal evolution of hematoma ends with pseudocyst formation decreasing hematocrit

Question 77

if a mass is identified adjacent to the adrenal glands of a newborn it is most likely

Answer 77

a hemorrhage adrenal hemorrhage is the most common adrenal mass in a newborn

Question 78

The IVC will be displaced ____ by a right liver mass

Answer 78

posterior

Question 79

the IVC will bedisplaced ___ by a right renal artery aneurysm

Answer 79

anterior

Question 80

the IVC wil be displaced ___ by a tortuous aorta

Answer 80

right

Question 81

the IVC will be displaced ____ by a right adrenal mass

Answer 81

medial / anterior

Question 82

the IVC will be displaced ____ by a right renal mass

Answer 82

medial / left

Question 83

although lymphadenophy typically surrounds longitudinal vessels in the ABD, it commonly displaces the vessels, such as the IVC and SMA ___

Answer 83

anteriorly

Question 84

what direction will the splenic vein be displaced by a left adrenal mass

Answer 84

anterior

Question 85

what direction will the bladder be displaced by a hematoma in the puch of Douglas

Answer 85

anterior

Question 86

with a gastric outlet obstruction and dilatation of the somach, what direction will the pancreatic tail be displaced

Answer 86

posterior

Question 87

what direction will a mass in the incinate process displace the SMV

Answer 87

anterior

Question 88

what direction will a neuroblastoma displace the ipsilateral kidney

Answer 88

inferior

Question 89

what direction wil a mass in the left lobe of the liver displace the gastroesophageal junction

Answer 89

posterior