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THRALL - Thom > Chapter 39 - Peritoneal Space > Flashcards

Chapter 39 - Peritoneal Space Flashcards

1
Q

Which of these structures are intraperitoneal (covered by peritoneum)?

Scrotum

Rectum

Vagina

Ovaries

A

Scrotum, majority of rectum (caudal portion retroperitoneal), cranial portion of vagina, Ovaries

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2
Q

The liver is connected to diaphragm craniodorsally at the level of the VC by which three ligaments?

A

Coronary, triangular and falciform

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3
Q

The duodenocolic ligament attaches which structures?

A

Ascending duodenum to descending colon

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4
Q

At what level is the mesenteric root usually found (using vertebrae)?

A

L2

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5
Q

Name 6 retroperitoneal structures

A

Adrenals, ureters, major vessels, lymph nodes, kidneys, VENTRAL aspect of prostate

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6
Q

Why do young animals have reduced serosal detail?

A

Reduced amount of fat

More brown fat, which contains more water and is thus closer to soft tissue.

+- peritoneal fluid

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7
Q

What radiographic and ultrasonographic features may be seen with sclerosing encapsulating peritonitis?

A

Increased, assymmetrically positioned soft tissue opacity, obscuring organ visualisation

Large volume peritoneal effusion and small bands covering organ surfaces

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8
Q

How quickly are the below fluids absorbed from the peritoneum?

1) water, containing electrolytes or low mol weight substances
2) Proteinaceous fluids (serum, blood, and lymph)

A

1) 24 hrs
2) 1-2 weeks

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9
Q

Metastatic spread to the peritoneum is associated withi which tumours?

A

Various carcinomas inc liver, pancreas and GI (carcinomatosis), haemangiosarcoma

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10
Q

Which is the most common primary tumour occuring in the retroperitoneal space?

A

Lipoma

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11
Q

List 5 causes of steatitis

A

Pancreatitis / other inflammatory process

Pancreatic neoplasia (both proteolytic enzyme release)

Vit. E deficiency (Cats)

Excessive polyunsaturated fatty acids in diet (Cats)

=> Both result in “Ceroid” formation

Severe Hypocalcaemia (Rare)

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12
Q

Which parasite causes peritoneal granulomas in NW America and Europe?

A

Mesocestoides

Varying size, cavitary, septated structures with echogenic particles within fluid

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13
Q

What are the 3 most common causes of retroperitoneal streaking?

A

Haemorrhage (e.g. rodenticide, trauma); urine leakage; inflammation (e.g. migrating grass FB, experimetally has also been observed with pancreatitis)

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14
Q

Experimentally, how long does peritoneal gas persist?

A

25 days

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15
Q

Which projection is most sensitive for detecting pneumoperitoneum?

A

Dorsal recumbency, horizontal beam with cranial abdomen lifted slightly

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16
Q

What volume of peritoneal gas can be detected with US?

A

0.4ml

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17
Q

List 5 causes of pneumoretroperitoneum

A

Penetrating trauma

Migrating FB

Iatrogenic (inc spinal sx)

Progression of pneumomediastinum

Rupture of viscus (vagina, rectum)

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18
Q

List two common causes of metastatic calcification (hypercalcaemia)

List three common site of metastatic calcification

A

Renal hypercalcaemia, hypothyroidism

Kidneys, vessels, gastric mucosa

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19
Q

Which muscles of the abdominal wall are continuous with the rib cage?

A

Internal oblique and transversus.

(External oblique can be identiifed seperatelay as it is surrounded by fat)

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20
Q

List the 3 lymph centres forming the parietal abdominal group

Peritoneal vs retro?

Drainage?

A

Lumbar, iliosacral inc. MILN (retroperintoeal)

Iliofemoral (peritoneal) - single node in distal part of femoral triangle, only present in 10% dogs.

Drain spine, adrenals, kidneys, genitals, caudodorsal abdomen, pelvis and pelvic limbs

Empty into lumbar trunk, then cysterna chyli (or directly into CC)

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21
Q

What structures surround the medial iliac LNs?

A

Vertebrae (L5-7)

External iliac arteries; Deep circumflex iliac arteries

22
Q

Name the 3 visceral lymph centres

Drainage?

A

Celiac, cranial mesenteric and caudal mesenteric centres

Celiac: Structures supplied by C art. Gastric, hepatic, splenic, pancreatioduodenal

Cr Mes: Jejunal and colic nodes - drain jejunum, ileum and panc

Ca mes: = Caudal mesenteric nodes. Drain caudal descending colon and rectum

All drain into CC via intestinal trunk. Ca may drain to MILN / lumbar trunk

23
Q

Which vessels occasioanlly seen end on in the retroperitoneal space may be confused with lymph nodes?

A

Deep circumflex iliac arteries and veins

24
Q

List US features of neoplastic LNs, including Short:long; PI and RI. 8 in total!

A

S:I >1.2

Narrow or absent hilus

Hypoechoecoic

Sharp borders

RI >0.65

PI>1.45

Distal acoustic shadowing

Heterogeneity associated with malignancy IN DOG,. not cat

25
What values of RI and PI support neoplasia In MILN In mesenteric LN
MILN: RI 0.675 PI 1.025 Mes: RI 0.76 PI 1.23
26
What has been associated with hyperechoic pancreas in dogs?
Hyperadrenocorticism (also in healthy dogs)
27
Pancreatic measurements (VD measurement)! Cat R, L and body Dog R Panc duct (both)
Cat: L / Body: 0.25-1cm R: 0.3-0.6cm Dog: R: 0.9-2.1cm Panc Duct: \<0.25cm
28
What is the most common exocrine pancreatic disorder in dogs and cats?
Pancreatitis!
29
What is the "Sentinel loop sign"?
Gas in dilated duodenum adjacent to pancreatitis
30
What US feature of the pancreas can be seen in pancreatitis in the cat?
Dilation of the pancreatic duct (\>0.25cm). HOWEVER normal age variant.
31
Features of CEUS in acute pancreatitis in dogs?
Compared to normal dogs: ## Footnote **Higher mean pixel intensity** **Greater wash in rates** **Steeper slope to peak**
32
CEUS in cats with pancreatitis
Increased vascularity and blood volume
33
What CT feature has been associated with poorer prognosis in dogs with pancreatitis?
Heterogeneous contrast enhancement
34
What is the sensitivity of US for detecting pancreatic tumours?
28-75%
35
What features are more likely to be associated with pancreatic nodular hyperplasia cf: neoplasia on US?
Multiple nodules \<1cm Only definitive characteristic in cats was single nodule \>2cm
36
What % of insulinomas can be detected on US?
Approx. 30%
37
CEUS in pancreatic neoplasia. Features distinguishin insulioma from adenocarcinoma?
Adenocarcinoma hypoechoic pre contrast and hypovascular following contrast Insulinoma hypervascular
38
Main features to distinguish inflammatory vs neoplastic pancreatic disease in dogs?
Diffusely hypo panc in pancreatitis Hypo nodules in neoplasia
39
Which biochemical marker has been shown to increase with pancreatic sampling?
TLI | (Not cPLI)
40
What is secreted by the adrenal cortex and medulla respectively?
Cortex: steroid hormones including androgens, oestrogens, aldosteroine, cortisol Medulla: Catecholamines
41
How large do canine adrenal tumours need to be to be radiographically visible?
\>2cm
42
List 4 facts about adrenal mineralisation in cats!
Normal variant, rarely seen with adrenalitis Reported in normal kittens, not well correlated with age Cortex usually affected Has been associated with distemper
43
Normal canine adrenal gland size! W, L and THICKNESS
W: 0.19-1.74cm L: 0.91-5.02cm **Thickness (most important): 0.17-1.07cm** MAX Small dogs: 0.6cm MAX Large dogs: 0.74 L, 0.81 R Larger in older dog, length proportional to BW \*\*\*
44
How frequently are incidental adrenal gland masses observed in dogs undergoing CT?
9.3%, more common \>8yrs
45
Name 5 adrenal tumours
Adenoma Adenocarcinoma Phaeochromocytoma Myelolipoma (RARE) Haemangiosarcoma (RARE)
46
What percentage of phaeos are invasive / metastasise?
Invasion: 20-93% Mets: 40%
47
What percentage of dogs with HyperA have functional adrenal tumours?
10-20%
48
List 6 possible radiographic findings in cushingoid dogs
Hepatomegaly Calcinosis cutis Adrenomegaly Adrenal calcification (more likely if primary adrenal tumour) Bronchial mineralisation (PTE)
49
Atrophy of the contralateral adrenal gland in ADH is controversial. What adrenal thickness has been reported as supportive of ADH and gland atrophy?
\<0.5cm in atrophied gland
50
What adrenal US changes may be noted with trilostane and mitotane tx respectively?
Trilostane: I**NCREASED differentiation of layers:** Outer hypoechoic layer becomes hyper Inner hypereechoic layer becomes hypo ??WRONG - see pic **Enlarged (max at 6 weeks, and persistent), becoming irregular** Mitotane: **Heterogeneous** **Becomes smaller**
51
ACTH and US have the same Sens and Spec for detecting PDH from ADH. What are they?
Sens: 100%; Spec: 95%
52
What adrenal gland thickness on US has been suggested as supporting a dx of hypoA? What 5 rx features have been associated with HypoA?
\<0.32cm Small heart Small pulmonary vessels Small cava Small liver +- oesophageal dilation

THRALL - Thom (40 decks)

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