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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
Q

What values of RI and PI support neoplasia

In MILN

In mesenteric LN

A

MILN:

RI 0.675

PI 1.025

Mes:

RI 0.76

PI 1.23

26
Q

What has been associated with hyperechoic pancreas in dogs?

A

Hyperadrenocorticism (also in healthy dogs)

27
Q

Pancreatic measurements (VD measurement)!

Cat R, L and body

Dog R

Panc duct (both)

A

Cat:
L / Body: 0.25-1cm

R: 0.3-0.6cm

Dog:

R: 0.9-2.1cm

Panc Duct: <0.25cm

28
Q

What is the most common exocrine pancreatic disorder in dogs and cats?

A

Pancreatitis!

29
Q

What is the “Sentinel loop sign”?

A

Gas in dilated duodenum adjacent to pancreatitis

30
Q

What US feature of the pancreas can be seen in pancreatitis in the cat?

A

Dilation of the pancreatic duct (>0.25cm). HOWEVER normal age variant.

31
Q

Features of CEUS in acute pancreatitis in dogs?

A

Compared to normal dogs:

Higher mean pixel intensity

Greater wash in rates

Steeper slope to peak

32
Q

CEUS in cats with pancreatitis

A

Increased vascularity and blood volume

33
Q

What CT feature has been associated with poorer prognosis in dogs with pancreatitis?

A

Heterogeneous contrast enhancement

34
Q

What is the sensitivity of US for detecting pancreatic tumours?

A

28-75%

35
Q

What features are more likely to be associated with pancreatic nodular hyperplasia cf: neoplasia on US?

A

Multiple nodules

<1cm

Only definitive characteristic in cats was single nodule >2cm

36
Q

What % of insulinomas can be detected on US?

A

Approx. 30%

37
Q

CEUS in pancreatic neoplasia. Features distinguishin insulioma from adenocarcinoma?

A

Adenocarcinoma hypoechoic pre contrast and hypovascular following contrast

Insulinoma hypervascular

38
Q

Main features to distinguish inflammatory vs neoplastic pancreatic disease in dogs?

A

Diffusely hypo panc in pancreatitis

Hypo nodules in neoplasia

39
Q

Which biochemical marker has been shown to increase with pancreatic sampling?

A

TLI

(Not cPLI)

40
Q

What is secreted by the adrenal cortex and medulla respectively?

A

Cortex: steroid hormones including androgens, oestrogens, aldosteroine, cortisol

Medulla: Catecholamines

41
Q

How large do canine adrenal tumours need to be to be radiographically visible?

A

>2cm

42
Q

List 4 facts about adrenal mineralisation in cats!

A

Normal variant, rarely seen with adrenalitis

Reported in normal kittens, not well correlated with age

Cortex usually affected

Has been associated with distemper

43
Q

Normal canine adrenal gland size!

W, L and THICKNESS

A

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
Q

How frequently are incidental adrenal gland masses observed in dogs undergoing CT?

A

9.3%, more common >8yrs

45
Q

Name 5 adrenal tumours

A

Adenoma

Adenocarcinoma

Phaeochromocytoma

Myelolipoma (RARE)

Haemangiosarcoma (RARE)

46
Q

What percentage of phaeos are invasive / metastasise?

A

Invasion: 20-93%

Mets: 40%

47
Q

What percentage of dogs with HyperA have functional adrenal tumours?

A

10-20%

48
Q

List 6 possible radiographic findings in cushingoid dogs

A

Hepatomegaly

Calcinosis cutis

Adrenomegaly

Adrenal calcification (more likely if primary adrenal tumour)

Bronchial mineralisation

(PTE)

49
Q

Atrophy of the contralateral adrenal gland in ADH is controversial. What adrenal thickness has been reported as supportive of ADH and gland atrophy?

A

<0.5cm in atrophied gland

50
Q

What adrenal US changes may be noted with trilostane and mitotane tx respectively?

A

Trilostane:

INCREASED 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
Q

ACTH and US have the same Sens and Spec for detecting PDH from ADH. What are they?

A

Sens: 100%; Spec: 95%

52
Q

What adrenal gland thickness on US has been suggested as supporting a dx of hypoA?

What 5 rx features have been associated with HypoA?

A

<0.32cm

Small heart

Small pulmonary vessels

Small cava

Small liver

+- oesophageal dilation

THRALL - Thom (40 decks)

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