Peritoneum, Chest and Invasive Procedures - Part 2

Question 1

Where does the subhepatic space extend from?

Answer 1

From the inferior border of the liver to a deep recess anterior to the right kidney.

Question 2

What is the most common site for fluid collection?

Answer 2

Subhepatic space

Question 3

What is the subphrenic space divided by?

Answer 3

Falciform ligament

Question 4

Where is the left subphrenic space located? (2)

Answer 4

1. Inferior to the diaphragm

2. Superior to the spleen

Question 5

What does the left subphrenic space include? (4)

Answer 5

1. Left diaphragm
2. Left lobe of the
   liver
3. Stomach
4. Spleen

Question 6

Where is the right subphrenic space located? (2)

Answer 6

1. Inferior to the diaphragm

2. Superior to the liver

Question 7

Where does the right subphrenic space extend over?

Answer 7

Several rib spaces to the right coronary

ligament (bare area)

Question 8

Where does the peritoneum extend? (2)

Answer 8

1. From the anterior abdominal wall to the retroperitoneum and paraspinal tissues
2. From the diaphragm to the deep pelvic spaces around the bladder.

Question 9

Pleura

Answer 9

A delicate serous membrane composed of a visceral and parietal layer

Question 10

What is the sensitivity to pain for the visceral layer of the pleura?

Answer 10

Low

Question 11

What is the sensitivity to pain for the parietal layer of the pleura?

Answer 11

High

Question 12

What does the visceral layer of the pleura cover?

Answer 12

The lungs

Question 13

What does the parietal layer of the pleura cover?

Answer 13

The chest wall

Question 14

What does the pleural fluid do?

Answer 14

Lubricates the pleural surfaces

Question 15

What position are patents typically when evaluating the peritoneal cavity?

Answer 15

Supine

Question 16

What position are patents typically when evaluating the thoracic cavity?

Answer 16

Sitting

Question 17

What are indications for a peritoneal cavity exam? (5)

Answer 17

1. Increase in abdominal girth
2. Chronic liver disease
3. Congestive heart failure
4. US guided paracentesis or biopsy
5. Evaluate pathology demonstrated on a previous medical imaging study
   - eg) CT

Question 18

What are indications for a pleural cavity exam? (3)

Answer 18

1. Shortness of breath
2. US guided thoracentesis
3. Evaluate fluid collection demonstrated on previous medical imaging study
   - eg) chest x-ray exam

Question 19

What is a decrease of hematocrit suspicious for?

Answer 19

Internal bleeding

Question 20

What is leukocytosis suspicious for?

Answer 20

Infection

Question 21

What is an abscess caused by?

Answer 21

Infection

Question 22

What are the clinical findings of a peritoneal abscess? (5)

Answer 22

1. Abdominal pain
2. Fever
3. Leukocytosis
4. Fatigue
5. Nausea/vomiting

Question 23

What are the US appearance of a peritoneal abscess? (5)

Answer 23

1. Complex mass
   - most common
2. Thick, irregular wall margins
3. Displacement of adjacent structures
4. Non-vascular mass
5. May demonstrate septations, shadowing (air), or mild acoustic enhancement

Question 24

What are 3 differential diagnosis for a peritoneal abscess?

Answer 24

1. Hematoma
2. Complex ascites
3. Lymphadenopathy

Question 25

What is the cause of benign ascites in the peritoneum? (7)

Answer 25

1. Congestive heart failure
2. Cirrhosis
3. Hypoalbuminemia 4. Infection
4. Inflammation
5. Portal venous obstruction
6. Postoperative
   complication

Question 26

What are the clinical findings for benign ascites in the peritoneum? (2)

Answer 26

1. Abdominal distention

2. Abdominal pain

Question 27

What is the US appearance for benign ascites in the peritoneum? (4)

Answer 27

1. Anechoic fluid accumulation in the peritoneal cavity
2. Mobility of fluid with patient
   position change
3. Bowel may appear “floating”
   within the fluid
4. Thick-appearing GB wall with adjacent ascites

Question 28

What are 5 differential diagnosis for benign ascites in the peritoneum?

Answer 28

1. Fluid-filled loops of bowel
2. Abscess
3. Hemoperitoneum
4. Lymphocele
5. Cystic neoplasm

Question 29

Where is benign ascites of the peritoneum most commonly located?

Answer 29

Subhepatic space
- followed
by the paracolic gutters

Question 30

What is hemoperitoneum caused by? (5)

Answer 30

1. Surgery
2. Ruptured blood vessel
3. Trauma
4. Fistulas
5. Necrotic neoplasm

Question 31

What are the clinical findings of a hemoperitoneum? (3)

Answer 31

1. Abdominal pain
2. Decrease in
   hematocrit
3. Shock

Question 32

What is the US appearance of a hemoperitoneum? (3)

Answer 32

1. Hypo echoic fluid collection(s) 2. Swirling low-level echoes
2. Hyper echoic mass(es) within
   the fluid representing clot formation

Question 33

What are 2 differential diagnosis of a hemoperitoneum?

Answer 33

1. Ascites

2. Pseudomyxoma peritonei