Chapter 14- Peritoneum Flashcards
What is the mesentery?
the double fold of peritoneum that suspends the intestines from the posterior abdominal wall.
What is the greater sac
The general peritoneal cavity
Where is the lesser sac
Anterior to the pancreas and posterior to the stomach
What attaches the greater and lesser sacs?
The foramen of Winslow or Epiploic foramen
Where is the lesser omentum
from the liver to lesser curve of stomach
What is the greater omentum
Apronlike fold of peritoneum that hangs from the greater curvature of the stomach
When examining a patient for pathologic collectins of fluid, where should you look first? Why?
The pelvis and lateral flanks. The fluid will accumulate in the
lowest parts of the body due to gravity.
What is the other name for Morison’s pouch
The hepatorenal or right subhepatic space
What is a subcapsular fluid collection and how does it appear sonographically?
Subcapsular fluid collections are between the organ capsule and parenchyma. They conform to the shape of an organ capsule
What separates the right subhepatic from the subphrenic spaces?
The bare area of the liver
What is the paracolic gutter?
The peritoneal spaces lateral to the colon.
How might ascites appear if it is malignant or inflammatory?
Internal echoes, loculation, unusual bowel
What is an abscess?
A cavity within a solid tissue formed by necrosis or a collection of pus
What are some symptoms of an abscess?
An unexplained fever, tenderness at post-op site, leukocytosis, sepsis or bacterial cultures
What is leukocytosis?
An increase in white blood cell production
How does an abscess appear sonographically?
with varying texture, fluid filled with irregular borders
How might a gas filled abscess appear sonographically?
It varies but typically echogenic with a dirty shadow
How does fluid move between the pelvis and abdomen?
The paracolic gutters allow for the fluid to move
What divides the right and left subphrenic spaces?
The falciform ligament
What is paracentesis? What is thoracentesis
the drainage of abdominal fluid. The drainage of pleural fluid
What is an abscess? What is it caused by?
A large collection of pus usually caused by infection due to trauma/surgery
What are some symptoms of an abscess? How does it appear?
Fever without reason and Leukocytosis. It is complex and non-vascular with irregular walls.
Bacteria entering the liver might cause a hepatic abscess. How could the bacteria enter? What way is the most common?
The bacteria could enter through the portal system, hepatic artery, from an infection or implantation after trauma. the most common is through the CBD
What is peritonitis
Inflammation of the peritoneum that might be diffuse or localized
What is biloma and what causes it?
Loculated collections of bile outside of the liver. It is caused by GB disease, trauma, rupture of biliary tree, or iatrogenic
How are renal abscesses classified?
according to their locations.
What is renal carbuncle?
An abscess that forms in the renal parenchyma.
What is a perinephric abscess?
A perforated renal that leaks into the material around the tissue
1/3 of masses are malignant in the omentum. What kind is most frequent?
Secondary neoplasms are more frequent.
What kind of mesentery tumor is most common?
A benign, secondary neoplasm
What is the difference between a sac and an omentum?
A sac is a pouch or sac within the peritoneum whereas the omentum is a fold of the peritoneum.
What is the cause of an abdominal cyst?
They are embryologic, traumatic or aquired, and neoplastic, infective or degenerative organs.
How do abdominal cysts appear on ultrasound?
loculated, Internal echoes, smooth walls
what is the median umbilical ligament
formed by incomplete regreassion of the urachus, a fetal channel between the bladder and the umbilicus.
What are the symptoms of a urachal cyst and how does it appear sonographically?
Ab pain, pain with urination, umbilical discharge, fever, UTI. Mass found between umbilicus and bladder.
What is urinoma? How does it appear sonographically
encapsulated collection of urine caused by renal trauma. It appears as a subcapsular or perirenal fluid collection
What are the most common primary sites for peritoneal metastasis?
Ovaries, Stomach, Colon
How does lymphoma of the omentum/mesentery appear sonographically?
As a thick hypoechoic band that follows the abdominal wall. Lobulated surrounding an echogenic area and “sandwich sign”
What pathology occurs most often in middle-aged men with recent exposure to asbestos?
Mesothelioma
What are the symptoms of Mesothelioma? How does it appear sonographically?
Symptoms are ab pain, weight loss, and ascites. It appears as diffuse nodes and plaques over a large area of the peritoneum
What is Extraperitoneal Rectus sheath Hematoma? What are some causes
a collection of blood in the rectus muscle or between the muscle and sheath. It is caused by trauma, pregnancy, muscle disease, extreme exercise
What are symptoms of Rectus Sheath Hematoma?
Sharp acute pain, shock, decrease in hematocrit levels
What is a lymphocele?
A collection of fluid that occurs after trauma. Can be loculated or under tension and displacing organs
What is bladder flap hematoma and what is a cause?
Collection of blood between the bladder and lower uterine segment. Occurs after C-Section
Where are subfascial hematomas found? What is the cause
They are aterior to the bladder and caused by a disruption of the inferior epigastric vessels during C-section
What might cause an abscess of the abdominal wall? What are some symptoms?
They are caused by trauma. The patient might have leukocytosis or sepsis.
How might an abdominal wall abscess appear sonographically?
As an anechoic mass with internal echoes and irregular borders
What is a lipoma? How does it appear?
A growth of fat cells in a fibrous capsule. It appears superficial and ovular with smooth walls
What is a desmoid tumor?
A rare, benign, neoplasm that most commonly occurs in the rectus abdominis and its sheath
How does a desmoid tumor appear sonographically
Anechoic to hypoechoic with smooth walls
What is a hernia What is the most common area for it to occur?
A protrusion through the weakened abdominal wall. The most common location is the umbilical area and femoral and inguinal rings.
What is an incarcerated hernia?
When the blood supply of the bowel is interrupted. The bowel may become necrotic.
Where are indirect inguinal hernias located?
An indirect hernia is located lateral to the epigastric vessels and projects through the inguinal ring.
Where are direct inguinal hernias located?
A direct hernia is located medial to the epigastric vessels and projects through the abdominal wall.
What is the sonographic appearance of a hernia?
Which type of hernia is congenital?
Indirect hernias are often congenital
What is the valsalva maneuver
Using strain to exaggerate a lesion (hernia)
