Mesentery/Peritoneum

Question 1

dependent portion of peritoneal cavity

Answer 1

pouch of douglas (women)
retrovesical space (men)

Question 2

peritoneum cells

Answer 2

single layer of mesothelial cells

Question 3

3 true mesenteries

Answer 3

connect to posterior abdominal wall;

small bowel mesentery, transverse mesocolon, sigmoid mesentery

Question 4

greater and lesser omentum

Answer 4

attach to the stomach; do not connect to posterior abdominal wall

Question 5

flow of peritoneal fluid

Answer 5

circulated and drains into thoracic duct around diaphragm

Question 6

misty mesentery

Answer 6

infiltration of mesentery by fluid, inflammatory cell, tumor, fibrosis

Question 7

mesenteric edema

Answer 7

CHF, low protein states, third spaces

focal mesenteric edema may be due to mesenteric vessel thrombosis, Budd-Chiari, IVC obstruction

Question 8

mesenteric inflammation

Answer 8

pancreatitis is the most common cause

other inflammatory causes: appendicitis, IBD, diverticulitis, mesenteric panniculitis

Question 9

neoplastic infiltration

Answer 9

most commonly NHL with bulky adenopathy

pancreas, colon, breast, GIST, mesothelioma may also cause infiltration

Question 10

mesenteric masses

Answer 10

carcinoid, desmoid, sclerosing mesenteritis , mesenteric mets/lymphoma

Question 11

GI carcinoid

Answer 11

commonly in the distal ileum

usually intraluminal mass > mesentery

enhancing soft tissue mass with radiating linear bands extending into mesenteric fat; calcifications (desmoplastic reaction)

Question 12

desmoid tumor

Answer 12

benign locally aggressive mass of proliferating tissue

associated with Gardner syndrome

isoattenuating to muscles, may have central necrosis

Question 13

sclerosing mesenteritis

Answer 13

rae inflammatory condition causing fatty necrosis/fibrosis of mesenteric root

calcifications possible

Question 14

GI metastases and lymphoma

Answer 14

gastric, ovarian, breast, lung, pancreatic, biliary, colon, melanoma

Question 15

sandwich sign

Answer 15

mesenteric lymphoma; fat/vessels engulf bulky lymphomatous masss (breast of sandwich)

Question 16

peritoneal carcinomatosis

Answer 16

omental caking; replacement of fat by tumor and fibrosis

commonly mucinous adenocarcinoma

Question 17

pseudomyxoma peritonei

Answer 17

low grade malignancy with copious mucus in peritoneal cavity; jelly bell

may be due to mucin producing adenocarcinoma of appendix, ovary, or colon

slightly higher attenuating lobular ascites than fluid; scalloping of hepatic margin

Question 18

treatment for pseudomyxoma peritonei

Answer 18

surgical management

hyperthermic intraperitoneal chemotherapy lavage