Ch. 39 Peritoneal Space Flashcards
What connects the stomach and the spleen?
Gastrosplenic ligament
What connects the colon to the duodenum?
Duodenocolic ligament - descending colon to proximal part of ascending duodenum
What and where is the mesenteric root?
site of the attachment of the mesentery to the dorsal abdominal wall, which commonly is located ventral to the second lumbar vertebra
Where is the prostate gland
A) peritoneal
B) retroperitoneal
C) neither
D) both
B - the ventral aspect is covered by peritoneum, therefore it is retroperitoneal
Are the adrenal glands peritoneal or retroperitoneal?
retroperitoneal
In the _________ dog, the peritoneal cavity is _______.
Male/Female
Open/Closed
If open - where is it open
male - completely closed
female - open, via the cranial aspect of the uterine horns
b) Through the cranial aspect of the uterine horns
b) Mainly ventral, very movable, and contains variable amounts of fat
b) Higher water content and opacity closer to that of soft tissue
which is which in the images?
normal and mature cat / dog
young patient
obese/emaciated patient
Causes of decreased serosal detail
What could gas-filled bowel loops in a non-central location in patients with a large amount of peritoneal fluid suggest?
The presence of an abdominal mass or adhesions (which prevent free movement), or a large amount of peritoneal fat (esp. in cats)
What additional finding might be observed on ultrasound in patients with sclerosing encapsulating peritonitis?
a) No fluid present
b) Large quantities of peritoneal fluid and small bands covering organ surfaces
c) Gas bubbles
d) Bone fragments
b) Large quantities of peritoneal fluid and small bands covering organ surfaces
What is the echogenicity of fluid with moderate to high cellular content, such as exudate, blood, or chyle?
a) Hyperechoic
b) Hypoechoic
c) Isoechoic
d) Anechoic
a) Hyperechoic
What is the echogenicity of fluid with low cellular content, such as urine or a transudate?
a) Hyperechoic
b) Hypoechoic
c) Isoechoic
d) Anechoic
d) Anechoic
How long might proteinaceous fluids like serum, blood, and lymph be present in the peritoneal cavity after laparotomy?
a) 1 to 2 days
b) 3 to 4 days
c) 5 to 7 days
d) 1 to 2 weeks
d) 1 to 2 weeks
How long does it take for solutions containing water, electrolytes, and low molecular weight components to be absorbed by the peritoneal membrane?
a) 6 hours
b) 12 hours
c) 24 hours
d) 48 hours
c) 24 hours
What pigment is deposited in fat during steatitis, causing increased radiopacity on radiographs?
a) Melanin
b) Bilirubin
c) Ceroid
d) Hemoglobin
c) Ceroid
What condition can result in steatitis in cats due to dietary issues?
a) Vitamin B deficiency
b) Vitamin E deficiency and/or excessive polyunsaturated fatty acids
c) Excessive protein intake
d) High carbohydrate diet
b) Vitamin E deficiency and/or excessive polyunsaturated fatty acids
Primary de novo peritoneal neoplasia in companion animals encompasses which of the following types of tumors, particularly considering those where the primary origin remains unidentified?
a) Lipoma, fibroma, hemangioma
b) Osteosarcoma, chondrosarcoma, rhabdomyosarcoma
c) Mesothelioma, leiomyoma, carcinomas with primary origin not identified
d) Melanoma, lymphoma, mastocytoma
e) Hemangioma, liposarcoma, adenocarcinoma
c) Mesothelioma, leiomyoma, carcinomas with primary origin not identified
What is a potential manifestation of peritoneal infection by Mesocestoides species tapeworms on imaging?
a) Solitary, solid mass
b) Multiple, fluid-filled cavities
c) Diffuse peritoneal thickening
d) Cavitary, septated structures with echogenic particles
d) Cavitary, septated structures with echogenic particles
What imaging appearance is characteristic of peritoneal infection by Mesocestoides species tapeworms?
a) Homogeneous solid masses
b) Cavitary, septated structures with echogenic particles
c) Linear calcified structures
d) Diffuse hyperechoic regions
b) Cavitary, septated structures with echogenic particles
Most common primary tumour of the retroperitoneal space
Lipoma
How long will pneumoperitoneum persist following laparotomy?
Days to weeks, depending on size of patient and amount of gas
How can small volumes of peritoneal gas be made more detectable on a radiograph?
a) By using a vertical x-ray beam
b) By using a horizontal x-ray beam and positioning the patient for 10 minutes before exposure
c) By increasing the radiation dose
d) By keeping the patient in a standing position
b) By using a horizontal x-ray beam and positioning the patient for 10 minutes before exposure
Free peritoneal gas usually floats to the highest point within the abdomen. In lateral recumbency, this is usually _______________ or _________.
- under the caudal aspect of the ribs
- in the mid abdomen.
How can digital images be adjusted to make peritoneal gas more visible?
a) Increase the brightness
b) Decrease the brightness
c) Increase the contrast
d) Decrease the contrast
a) Increase the brightness
Which projection is most sensitive for detecting small volumes of peritoneal gas?
a) Oblique view with the patient in standing position
b) Lateral view with a horizontally directed x-ray beam and the patient in dorsal recumbency
c) Ventrodorsal view with the patient in right recumbency
d) Anteroposterior view with the patient in left recumbency
b) Lateral view with a horizontally directed x-ray beam and the patient in dorsal recumbency
c - VD view also, but in LL because in RL the fundus will be where gas would accumulate and may be gas filled
What sonographic artifact is commonly noted at the soft tissue to air interface in cases of free gas in the peritoneal cavity?
a) Ring-down artifact
b) Mirror image artifact
c) Reverberation artifact
d) Acoustic shadowing
c) Reverberation artifact
(dirty shadowing)
Incorrect Options:
a) Ring-down artifact: While similar to reverberation artifacts, ring-down artifacts occur due to resonance within a fluid collection trapped between gas bubbles, often producing a continuous band of echoes below the gas bubble. It is not the primary artifact seen at the soft tissue to air interface in free peritoneal gas cases.
b) Mirror image artifact: This occurs when an ultrasound wave reflects off a strong reflector, such as the diaphragm or a large vessel, creating a duplicate image on the opposite side of the reflector. It is not typically associated with free gas detection in the peritoneal cavity.
d) Acoustic shadowing: This artifact occurs when an ultrasound wave is blocked by a dense structure (such as bone or a calcified object), creating a shadow behind it. Acoustic shadowing is not specific to the soft tissue to air interface and is not the primary indicator of free gas in the peritoneal cavity.
What is the minimum volume of air in the peritoneal space detectable by ultrasound in dogs?
a) 0.1 mL
b) 0.2 mL
c) 0.3 mL
d) 0.4 mL
d) 0.4 mL
What adjustment should be made to film radiography factors to make peritoneal gas more conspicuous?
a) Increase the exposure time
b) Intentionally underexpose the abdomen
c) Increase the radiation dose
d) Reduce the focal spot size
b) Intentionally underexpose the abdomen
In which species are Bates bodies more commonly found?
a) Dogs
b) Cats
c) Horses
d) Birds
Answer: b) Cats
can also occur in dogs
What could result in a mineralized fetus in the peritoneal space?
a) Chronic renal disease
b) Ectopic pregnancy
c) Ovarian cyst rupture
d) Uterine fibroids
b) Ectopic pregnancy
C) Lipoma
Which lymph centers are included in the parietal group?
A) Lumbar, iliosacral, and iliofemoral lymph centers
B) Cervical, thoracic, and axillary lymph centers
C) Mesenteric, hepatic, and splenic lymph centers
D) Inguinal, popliteal, and axillary lymph centers
A) Lumbar, iliosacral, and iliofemoral lymph centers
Where are all parietal lymph nodes, except the iliofemoral lymph nodes, located?
A) In the thoracic cavity
B) In the abdominal cavity
C) In the retroperitoneal space
D) In the mediastinum
C) In the retroperitoneal space
Which structures do parietal lymph nodes receive afferent lymphatics from?
A) Spine, adrenal glands, kidneys, genital organs
B) Heart, lungs, liver, pancreas
C) Muscles, bones, skin, joints
D) Brain, eyes, ears, nose
A) Spine, adrenal glands, kidneys, genital organs
What is the iliofemoral lymph center?
A) A group of multiple lymph nodes
B) Consists of only one distal femoral lymph node
C) Located in the thoracic cavity
D) Found in all dogs
B) Consists of only one distal femoral lymph node - in about 10% of dogs
Where does the efferent vessels from the parietal lymph nodes drain into?
A) Thoracic duct
B) Jugular trunk
C) Lumbar trunk
D) Mesenteric trunk
C) Lumbar trunk > cisterna chyli
Cranial parietal lnn may bypass lumbar trunk and go directly into cisterna chyli
Where are the medial iliac lymph nodes typically located?
A) Ventral to L1 and L2
B) Ventral to L3 and L4
C) Ventral to L5 and L6
D) Ventral to L6 and L7
D) Ventral to L6 and L7
Which lymph centers make up the visceral lymph group?
A) Cervical, axillary, and inguinal lymph centers
B) Celiac, cranial mesenteric, and caudal mesenteric lymph centers
C) Thoracic, abdominal, and pelvic lymph centers
D) Superficial, deep, and intermediate lymph centers
B) Celiac, cranial mesenteric, and caudal mesenteric lymph centers
The celiac lymph center includes lymph nodes serving which organs?
A) Lungs and heart
B) Liver, spleen, stomach, and pancreas
C) Kidneys and adrenal glands
D) Brain and eyes
B) Liver, spleen, stomach, and pancreas
What is the relationship between the gas dilation of the duodenum and pancreatitis?
A) It confirms pancreatitis
B) It rules out pancreatitis
C) It suggests but does not confirm pancreatitis
D) It has no relation to pancreatitis
Answer C: The gas dilation, referred to as the sentinel loop sign, is not definitive evidence for pancreatitis.
How does an abnormal pancreas appear on MRI in cats?
A) T1 pre-contrast isointense and T2 hypointense
B) T1 pre-contrast hypointense and T2 hyperintense
C) T1 pre-contrast hyperintense and T2 hypointense
D) T1 pre-contrast isointense and T2 hyperintense
B: T1 pre-contrast hypointense and T2 hyperintense
What were the characteristics of the pancreas in dogs with suspected pancreatitis on the three-phase contrast enhanced CT?
A) The pancreas was shrunken and well-defined
B) The pancreas was normal-sized and homogeneously enhancing
C) The pancreas was enlarged, homogenously or heterogeneously contrast enhancing, and had ill-defined borders
D) The pancreas was small and heterogeneously enhancing
B : The pancreas was enlarged, homogenously or heterogeneously contrast enhancing, and had ill-defined borders.
heterogeneously - worse prognosis clinically
What is the most common primary pancreatic tumour in dogs?
islet cell carcinoma compatible with insulinoma, followed by pancreatic adenocarcinoma
Where do exocrine pancreatic carcinoma is tend to invade and metastasise?
They tend to invade the duodenum and often metastasise to regional lymph nodes liver, and the peritoneum
What is the sensitivity of ultrasound for detecting pancreatic tumours?
28 to 75%
Non-neoplastic differentials for a pancreatic tumour
Nodular hyperplasia, ectopic, splenic tissue, enlarged hypoechoic, lymph nodes
In cats, there was overlap in the radiographic and sonographic appearance of neoplasia and nodular hyperplasia; however, if __________________ was present, neoplasia was more likely.
a solitary pancreatic nodule 2 cm in diameter or larger
Adrenal gland width of less than _____ is highly suggestive of hypoadrenocorticism.
A) 1.8mm
B) 2.3mm
C) 2.8mm
D) 3.2mm
D) 3.2mm
In cats which of the following can represent an initial sign of pancreatitis?
A) Pancreatic enlargement
B) Sentinel loop sign
C) Dilation of the pancreatic duct
D) Heterogeneity of the pancreas on ultrasound
C) Dilation of the pancreatic duct
What percentage of dog with Cushings syndrome have functional adrenocortical carcinomas or adenomas?
5-8%
8-10%
10-20%
20-30-%
10-20%
In dogs, what is the generally accepted minimal amount of air that can be seen in the peritoneal space using ultrasound?
0.2ml
0.4ml
0.6ml
0.8ml
0.4ml
Medial iliac lymph nodes with a resistive index greater than__ are more likely to be neoplastic.
0.475
0.675
0.857
0.957
0.675
Which of the following statements is false regarding canine pancreatitis?
A) Dogs with pancreatitis that underwent CT which showed homogenous contrast enhancement and poorly- defined borders of the pancreas had an overall poorer outcome
B) Ultrasonographicaly, the pancreas can be enlarged, hypoechoic with hyperechoic surrounding mesentery
C) The pancreas can appear normal on ultrasound
D) Radiographically, it can cause the sentinel loop sign, but this is not definitive for pancreatitis
A) Dogs with pancreatitis that underwent CT which showed homogenous contrast enhancement and poorly- defined borders of the pancreas had an overall poorer outcome
—- heterogenous has poorer outcome
Horizontal beam radiographs to look for free peritoneal gas are not recommended with the animal in which recumbency?
A) Right lateral
B) Left lateral
C) Sternal
A) RIGHT LATERAL as gas can be confused with gas in the fundus
What is the most common primary tumour in the retroperitoneal space?
Renal carcinoma
Renal lymphoma
Lipoma
Leiomyoma
Lipoma
Steatitis in cats can be caused by a disorder of which vitamin?
A
D
E
C
vit E deficiency
Which of the following is not a ligament that attaches the liver to the diaphragm?
Diaphragmatic-hepatic
Triangular
Coronary
Falciform
Diaphragmatic-hepatic
does not exist
The mesenteric root is usually below which lumbar vertebrae?
1
2
3
4
L2
What pulsatility index (PI) value indicates a suspicion of neoplasia in mesenteric lymph nodes?
a) Greater than 0.65
b) Greater than 0.675
c) Greater than 1.025
d) Greater than 1.23
d) Greater than 1.23
Which characteristic is associated with malignancy in enlarged lymph nodes of dogs but not predictive in cats?
a) Homogeneity
b) Heterogeneity
c) Hyperechogenicity
d) Hypoechogenicity
b) Heterogeneity
What is a pathognomonic imaging finding for metastatic lymphadenopathy?
a) Enlarged lymph nodes
b) Hypervascularity
c) There are no pathognomonic imaging findings
d) Presence of calcifications
c) There are no pathognomonic imaging findings
Which RI value indicates suspicion of neoplasia in mesenteric lymph nodes?
a) Greater than 0.65
b) Greater than 0.675
c) Greater than 0.76
d) Greater than 1.025
c) Greater than 0.76
The pancreaticoduodenal vein can be an anatomic landmark for __________ in dogs/cats.
- the right lobe of the pancreas
- dogs
Pancreatic hyperechogenicity can be seen in
A) healthy dogs
B) Hypothyroidism
C) Cushing’s disease
D) Addison’s disease
A) healthy dogs
C) Cushing’s disease
What should not be misinterpreted as a diseased pancreas in healthy dogs and dogs with hyperadrenocorticism?
a) Hypoechoic pancreas
b) Hyperechoic pancreas
c) Isoechoic pancreas
d) Anechoic pancreas
b) Hyperechoic pancreas
In cats, what is the echogenicity of a normal pancreas relative to the liver and surrounding mesentery?
a) Hyperechoic to the liver and mesentery
b) Isoechoic to the liver and hypoechoic to the mesentery
c) Hypoechoic to the liver and isoechoic to the mesentery
d) Isoechoic to both the liver and mesentery
b) Isoechoic to the liver and hypoechoic to the mesentery
What is the normal width (ventral to dorsal dimension) of the left lobe and body of the pancreas in cats?
a) 0.1 to 0.5 cm
b) 0.25 to 1.0 cm
c) 0.3 to 0.6 cm
d) 0.9 to 2.1 cm
b) 0.25 to 1.0 cm
What is the commonly reported width of the right lobe of the pancreas in cats?
a) 0.1 to 0.3 cm
b) 0.25 to 1.0 cm
c) 0.3 to 0.6 cm
d) 0.6 to 1.2 cm
c) 0.3 to 0.6 cm
What is the maximum dimension range of the right lobe of the pancreas in healthy dogs?
a) 0.25 to 1.0 cm
b) 0.3 to 0.6 cm
c) 0.9 to 2.1 cm
d) 1.5 to 3.0 cm
c) 0.9 to 2.1 cm
What should be the normal width of the feline pancreatic duct?
a) Less than 0.1 cm
b) Less than 0.25 cm
c) Less than 0.5 cm
d) Less than 0.75 cm
b) Less than 0.25 cm
What is one of the advantages of scintigraphy in pancreatic imaging?
a) It is less invasive
b) It provides detailed anatomical images
c) It can identify functional abnormalities, such as insulinomas
d) It is faster than other imaging techniques
c) It can identify functional abnormalities, such as insulinomas
In what scenario has scintigraphy shown promise for pancreatic evaluation?
a) Detecting pancreatic cysts
b) Identifying insulinomas when no abnormality is noted sonographically
c) Measuring pancreatic enzyme levels
d) Evaluating pancreatic ductal obstructions
b) Identifying insulinomas when no abnormality is noted sonographically
