peritoneal cavity and abd wall power point

Question 1

}Consists of multiple peritoneal ligaments and folds that connect the viscera to each other and to the abdominopelvic walls

Answer 1

Peritoneal Cavity

Question 2

◦Lesser and greater omentum
◦Mesenteries
◦Ligaments
◦Multiple fluid spaces (lesser sac, perihepatic and subphrenic spaces)

Answer 2

Peritoneal Cavity
}Within the cavity

Question 3

}help determine the way abnormal collections of fluid within the peritoneal cavity can collect or move.
}When the patient lying supine, the lowest part of the body is the pelvis.
}On a transverse view, the flanks are lower than the midabdomen.
}Fluid will accumulate in the lowest parts of the body.
Pelvis and lateral flanks (gutters) should be examined for pathologic collections of fluid

Answer 3

Attachments of the peritoneum to the abdominal walls and organs

Question 4

}Subcapsular liver and splenic collections are seen when they are inferior to the diaphragm unilaterally and they conform to the shape of an organ capsule.
}May extend medially to the attachment of the superior coronary ligament

Answer 4

Subcapsular versus Intraperitoneal

Question 5

◦Left lateral extension of the greater omentum
◦Connects the gastric greater curvature to the superior splenic hilum
◦Forms a portion of the left lateral border of the lesser sac

Answer 5

}Gastrosplenic ligament

Question 6

Formed by the posterior reflection of the peritoneum of the spleen
Passes inferiorly to overlie the left kidney
Forms the posterior portion of the left lateral border of the lesser sac
Separates the lesser sac from the renosplenic recess

Answer 6

Splenorenal Ligament

Question 7

Subdivided into a larger lateroinferior recess and a smaller mediosuperior recess by the gastropancreatic folds, which are produced by the left gastric and hepatic arteries
Lesser sac extends to the diaphragm.
Superior recess of the bursa surrounds the anterior, medial, and posterior surfaces of the caudate lobe, making the caudate a lesser sac structure.

Answer 7

Lesser Omental Bursa

Question 8

may extend a considerable distance below the plane of the pancreas by inferiorly displacing the transverse mesocolon or extending into the inferior recess of the greater omentum

Answer 8

Lesser sac collections

Question 9

}Look for findings in the ascitic fluid that would suggest an inflammatory or malignant process
◦Fine or coarse internal echoes
◦Loculation
◦Unusual distribution, matting, or clumping of bowel loops
◦Thickening of interfaces between the fluid and neighboring structures

Answer 9

Inflammatory or Malignant Ascites

Question 10

}Abscess is a cavity formed by necrosis within
a solid tissue or a circumscribed collection of purulent material.
}Sonographers are frequently asked to evaluate patients to rule out abscess formation.
}Patient may have a fever of unknown origin or tenderness and swelling from a postoperative procedure.

Answer 10

Abscess Formation and Pockets
in the Abdomen and Pelvis

Question 11

◦Texture varies, depending on the length of time the abscess has been forming and the space available for the abscess to localize.
◦Many appear predominantly fluid-filled with irregular borders; they can also be complex with debris floating within the cystic mass, or they may show a more solid pattern.
If the collection is in pelvis, careful analysis of bowel patterns and peristalsis should be made in an attempt to separate the bowel from the abscess collection

Answer 11

}Sonographic findings for abscess collections

Question 12

}Epiploic foramen usually seals off the lesser sac from inflammatory processes extrinsic to it.
}If the process begins within the lesser sac, such as with a pancreatic abscess, the sac may be involved, along with other secondarily affected peritoneal and retroperitoneal spaces.

Answer 12

Lesser-Sac Abscess

Question 13

} should include pseudocyst, pancreatic abscess, gastric outlet obstruction, and fluid-filled stomach.

Answer 13

Lesser-Sac Abscess Differential diagnoses

Question 14

}Air interference may make it difficult to examine the left upper quadrant.
}Alter the patient’s position to a right lateral decubitus position to scan along the coronal plane of the body, or prone, to use the spleen as a window.
}Be careful of pleural effusions that appear above the diaphragm.
}You may perform the scan with the patient upright to better demonstrate the pleural and sub-diaphragmatic areas.

Answer 14

Subphrenic Abscess

Question 15

}Are extrahepatic loculated collections of bile.
}May develop because of iatrogenic, traumatic, or spontaneous rupture of the biliary tree

Answer 15

Biloma Abscess

Question 16

◦Cystic with weak internal echoes or a fluid-fluid level if clots or debris are not present
◦Sharp margins
Extrahepatic biloma abscesses are usually crescentric, surrounding and compressing structures with which they come in contact

Answer 16

Biloma Abscess Sonographic findings

Question 17

}Incomplete regression of the urachus during development
◦Apex of the bladder continuous with the allantois becomes obliterated and forms a fibrous core, the urachus.
Urachus persists throughout life as a ligament that runs from the apex of the bladder to the umbilicus and is called the median umbilical ligament

Answer 17

Urachal Cyst

Question 18

◦Cystic mass is found between the umbilicus and the bladder; the mass may be small or giant, multiseptated, and extend into the upper abdomen.

Answer 18

Urachal Cyst
}Sonographic findings

Question 19

}Renal abscesses classified according to their locations

Answer 19

Kidney Abscess

Question 20

}Abscess that forms within the renal parenchyma
◦Clinical symptoms vary from none to fever, leukocytosis, and flank pain.
Sonography may show a discrete mass in the kidney, which may be cystic, cystic with debris, or solid

Answer 20

Renal carbuncle

Question 21

Usually the result of a perforated renal abscess that leaks purulent material into the tissue adjacent to the kidney

Answer 21

Perinephric abscess

Question 22

◦Demonstration of an abdominal wall defect
◦Presence of bowel loops or mesenteric fat in a lesion
◦Exaggeration of the lesion with strain (Valsalva maneuver)
◦Reducibility of the lesion by gentle pressure

Answer 22

}Sonographic criteria for a hernia

Question 23

}Complications may arise if edema develops or
if the opening constricts to the extent that the protrusion cannot be placed back into position.
}Strangulation (interruption of the blood supply)
of the bowel can also occur in an incarcerated hernia that is not surgically repaired in a timely manner.
}Bowel can become necrotic and require resection.

Answer 23

Abdominal Hernia

Question 24

Collection of fluid that occurs after surgery in the pelvis, retroperitoneum, or recess cavities

Answer 24

Lymphoceles

Question 25

◦Generally look like loculated, simple fluid collections.
◦May have a more complex, usually septated, morphology.

Answer 25

Lymphoceles
}Sonographic findings

Question 26

}from loculated ascites is usually possible because the mass effect of a lymphocele that is under tension displaces the surrounding organs.
from other fluid collections is mainly made by aspiration.

Answer 26

Lymphoceles differentiation

Question 27

}Develop from cellular implantation across the peritoneal cavity
Most common primary sites are the ovaries, stomach, and colon

Answer 27

Peritoneal Metastases

Question 28

◦Metastases form a nodular, sheetlike, irregular configuration.
◦Multiple small nodules are found along the peritoneal line.
Larger masses obliterate the line and cause adhesion to bowel loops

Answer 28

Peritoneal Metastases
}Sonographic findings