Ch. 39- Peritoneal Space Flashcards
What is your ultrasonographic findings?
Hypoechoic pancreas
hyperechoic sorrounding mesentery
Medial iliac lymph nodes are previously know as what?
external iliac lymph nodes
What do the visceral LNs drain?
What are some examples?
liver, spleen, intestines, pancreas, stomach
cranial mesenteric lymph center: jejunal and colic LNs
Describe your findings and the most likely ddx
Ill-defined miliary (nodular, mottled, granular) pattern is appreciated in the cranioventral peritoneal cavity.
Most likely ddx: carcinomatosis
Location of medial iliac LNs
ventral to L5-L6, however these LN often are located ventral to L6-L7
What is the echogenicity of adrenal glands in u/s?
Both adrenal glands of dogs and cats are hypoechoic
to the surrounding fat and hypoechoic or isoechoic when
compared with the renal cortex.
Explain how both adrenals are found when doing an abd u/s
Find cranial pole of the left kidney in a saggital plane, slide medially to the aorta. The left adrenal gland lies just ventrolateral to the aorta between the cranial mesenteric and renal arteries. Occasionally, the left adrenal gland may be located slightly cranial to the celiac and cranial mesenteric arteries. Usually is peanut shaped.
Find cranial pole of the right kidney in a saggital plane, slide medially to the caudal vena cava. The right adrenal gland lies dorsolateral to the caudal vena cava and cranial to the renal vein. Usually is comma shaped or bent-arrow shaped
What are the components of connecting peritoneum?
Splenorenal ligament
Gastrosplenic ligament
Falciform ligament
Omentum
What are the measurements of normal adrenal glands in u/s
The normal adrenal gland
has been reported from 0.91 to 5.02 cm in length, from 0.19
to 1.74 cm in width and from 0.17 to 1.07 cm in thick
ness. Depends on the size and age of the dog as well.
Radiographic findings and diagnosis
Rupture of the abdominal wall
Radiographic findings and diagnosis?
Tubular structures present in the inguinal area consistent with inguinal hernia
What is your dx?
Hyperechoic nodule in the cranial pole of the adrenal gland
Peritoneal effusion or not?
Yes
What is the ill-defined soft tissue opacitiy(ies) that the black arrows are pointing?
End-on projections of the deep circumflex arteries
Ddx for retroperitoneal fluid
Hemorrhage
Urine
What are the ultrasonographic signs of pancreatitis?
enlarged pancreas
hypoechoic pancreas
hyperechogenicity of sorrounding mesentery
possible cavitary lesions within the pancreas
possible dilation of the CBD
possible peritoneal fluid (pancreatitis can cause peritonitis hence decreased serosal marigination)
***pancreas may appear normal***
What is abnormal in this radiograph?
Medial iliac LN enlargment
True or False: Normal Lns are normally seen on radiographs.
False. DUH!
What could this mineral opacity in the mid ventral abd represent?
Dystrophic calcification of necrotic mesenteric fat, also known as Bates bodies
Where are the parietal lymph nodes located?
retroperitoneal space (lumbar, iliosacral- iliofemoral is not located in the retroperitoneal space)
What’s you dx?
What projection is this?
Pneumoperitoneum
Horizontal beam
What is the structure that the black arrow is pointing at?
Left limb of the pancreas in an obese cat
Most common bening primary tumor of the abdominal wall
lipoma
**** Fibrosacoma can occur in the abdominal wall of cats*** TCC might spread to the abdominal wall secondary to percutaneous tissue sampling or sx
What are you radiographic findings and dx?
There is a large mineralized mass caudal to the stomach just to the right of midline. Malignant functional adenocortical tumor.
The components of the peritoneum are:
Liver, Gallbladder, Stomach, Small and large intestines, Pancreas, Ovaries
Describe your findings. What is your diagnosis?
There is evidence of free gas in the retroperitoneal space and double population of small intestinal loops. (need more views to determine the bowel loop that is dilated)
Pneumoperitoneum
Components of abdominal wall
External oblique abdominis
Internal oblique abdominis
Transverse abdominis
What is your diagnosis?
Retroperitoneal fluid (this case is an example of a post HBC)
Primary peritoneal neoplasia includes:
mesothelioma
leiomyoma
carcinoma
Radiographic findings and dx
Mineral opacities located cranio-dorsal to the kidneys. Mineralization os adrenal glands (non-neoplastic adrenal glands)
What are the radiographic findings of pancreatitis?
Increased soft tissue opacity in the cranial right abd
soft tissue mass effect caudal to the stomach
focal decreased serosal margination in cranial right abd.
gast distended descending duodenum (sentinel loop sign)
displacement of adjacent intestinal structures
***radiographs may appear normal****
What does the adrenal cortex secretes? What about the medulla?
The cortex secrets steroid hormones, including cortisol, aldosterone, androgens, and estrogen. The medulla produces catecholamine.
Causes of medial iliac LN enlargement?
neoplasia (most common- lymphosarcom, metastatic)
inflammatory
Most common pancreatic tumors
insulinoma
pancreatic adenocarcinoma
Differential diagnoses for decreased serosal margination
lack of intraabdominal fat
brown fat (young patient)
peritoneal effusion
peritonitis
peritoneal neoplasia
mass effect crowding
superimposed external material (wet hair, u/s gel etc.)
underexposure
** smaller amounts of peritoneal fluid, peritonitis, or carcinomatosis may produce a mottled, hazy or irregular loss of contrast***
What’s your diagnosis?
What are the ddx?
Pneumoperitoneum
Ddx: gi perforation, recent abd sx, gas producing bacteria, penetrating wound in abd wall
Measurements of the canine and feline pancreas and CBD
The normal width (ventral to dorsal dimension)
of left lobe and body of the pancreas are approximately 0.25
to 1.0 cm, and the right lobe is commonly reported slightly
smaller at between approximately 0.3 and 0.6 cm. The
maximum dimension of the right lobe of the pancreas in healthy
dogs was reported up to range between 0.9 to 2.1 cm; however,
it is unclear if the measurement corresponded to the ventro
dorsal maximum dimension reported in other studies. The
feline pancreatic duct width should normally be less than
approximately 0.25 cm,
which is similar to the dog.
