Peritoneum, Chest and Invasive Procedures - Part 2 Flashcards
Where does the subhepatic space extend from?
From the inferior border of the liver to a deep recess anterior to the right kidney.
What is the most common site for fluid collection?
Subhepatic space
What is the subphrenic space divided by?
Falciform ligament
Where is the left subphrenic space located? (2)
- Inferior to the diaphragm
2. Superior to the spleen
What does the left subphrenic space include? (4)
- Left diaphragm
- Left lobe of the
liver - Stomach
- Spleen
Where is the right subphrenic space located? (2)
- Inferior to the diaphragm
2. Superior to the liver
Where does the right subphrenic space extend over?
Several rib spaces to the right coronary
ligament (bare area)
Where does the peritoneum extend? (2)
- From the anterior abdominal wall to the retroperitoneum and paraspinal tissues
- From the diaphragm to the deep pelvic spaces around the bladder.
Pleura
A delicate serous membrane composed of a visceral and parietal layer
What is the sensitivity to pain for the visceral layer of the pleura?
Low
What is the sensitivity to pain for the parietal layer of the pleura?
High
What does the visceral layer of the pleura cover?
The lungs
What does the parietal layer of the pleura cover?
The chest wall
What does the pleural fluid do?
Lubricates the pleural surfaces
What position are patents typically when evaluating the peritoneal cavity?
Supine
What position are patents typically when evaluating the thoracic cavity?
Sitting
What are indications for a peritoneal cavity exam? (5)
- Increase in abdominal girth
- Chronic liver disease
- Congestive heart failure
- US guided paracentesis or biopsy
- Evaluate pathology demonstrated on a previous medical imaging study
- eg) CT
What are indications for a pleural cavity exam? (3)
- Shortness of breath
- US guided thoracentesis
- Evaluate fluid collection demonstrated on previous medical imaging study
- eg) chest x-ray exam
What is a decrease of hematocrit suspicious for?
Internal bleeding
What is leukocytosis suspicious for?
Infection
What is an abscess caused by?
Infection
What are the clinical findings of a peritoneal abscess? (5)
- Abdominal pain
- Fever
- Leukocytosis
- Fatigue
- Nausea/vomiting
What are the US appearance of a peritoneal abscess? (5)
- Complex mass
- most common - Thick, irregular wall margins
- Displacement of adjacent structures
- Non-vascular mass
- May demonstrate septations, shadowing (air), or mild acoustic enhancement
What are 3 differential diagnosis for a peritoneal abscess?
- Hematoma
- Complex ascites
- Lymphadenopathy
What is the cause of benign ascites in the peritoneum? (7)
- Congestive heart failure
- Cirrhosis
- Hypoalbuminemia 4. Infection
- Inflammation
- Portal venous obstruction
- Postoperative
complication
What are the clinical findings for benign ascites in the peritoneum? (2)
- Abdominal distention
2. Abdominal pain
What is the US appearance for benign ascites in the peritoneum? (4)
- Anechoic fluid accumulation in the peritoneal cavity
- Mobility of fluid with patient
position change - Bowel may appear “floating”
within the fluid - Thick-appearing GB wall with adjacent ascites
What are 5 differential diagnosis for benign ascites in the peritoneum?
- Fluid-filled loops of bowel
- Abscess
- Hemoperitoneum
- Lymphocele
- Cystic neoplasm
Where is benign ascites of the peritoneum most commonly located?
Subhepatic space
- followed
by the paracolic gutters
What is hemoperitoneum caused by? (5)
- Surgery
- Ruptured blood vessel
- Trauma
- Fistulas
- Necrotic neoplasm
What are the clinical findings of a hemoperitoneum? (3)
- Abdominal pain
- Decrease in
hematocrit - Shock
What is the US appearance of a hemoperitoneum? (3)
- Hypo echoic fluid collection(s) 2. Swirling low-level echoes
- Hyper echoic mass(es) within
the fluid representing clot formation
What are 2 differential diagnosis of a hemoperitoneum?
- Ascites
2. Pseudomyxoma peritonei
