Retroperitoneam Flashcards
What is the peritoneum?
serous membrane that forms the lining of the abdominal cavity and covers most of the abdominal organs
What are the layers of the peritoneum?
- Parietal peritoneum: outer layer, lines abdominal cavity
2. Visceral Layer: inner layer, covers the abdominal organs
What is the space called between the two layers?
Peritoneal cavity
What are the compartments of the peritoneal cavity?
- Lesser Sac
- Greater Sac
- Pouch of Douglas
What is the Lesser Sac?
- Space between the liver. pancreas, and stomach
- entrance to lesser sac is epiploic foramen
What is the Greater Sac?
- rest of peritoneal cavity
- when imaging ascites with floating bowel, this is greater sacs
What is Pouch of Douglas?
- Rectouterine Pouch
- between uterus and rectum (females)
- rectovesical space (males)
What are the Intraperitoneal structures?
- stomach
- jejunum
- 1st part of duodenum
- appendix
- spleen
- cecum
- transverse sigmoid
- rectum
- liver
- uterus
- fallopian tubes
- ovaries
What is the Retroperitoneum?
Posteriorly located compartment that lies between the transversalis fascia and the posterior parietal peritoneum
How many layers does Gerotas Fascia have?
2
What do the two layers of gerotas fascia divide into?
- anterior pararenal space
- perirenal space
- posterior pararenal space
Where do the kidneys and adrenal glands lie?
Perirenal space
What muscles lie posterior pararenal space?
Quadratus Lumborum and Psoas Muscles
What is the first major branch off of the aorta?
Celiac axis
What are the branches off of the celiac axis?
- Common hepatic artery
- Left gastric artery
- splenic artery
What branches off of the common hepatic artery?
- proper hepatic artery
2. Gastroduodenal artery (GDA)
What are the two branches off of the celiac axis?
- common hepatic artery
2. splenic artery
What vessels travels parallel to the aorta?
SMA
What are the Doppler waveforms for the SMA?
- fasting state: High resistance
- Postprandial: Low resistance, increased velocity
Where do the renal arteries arise from aorta?
lateral walls of aorta just below the origin of the SMA
Where does the RRA pass posterior to?
IVC
What renal artery is shorter>
LRA
Where does the IMA arise from aorta?
Anterior aspect of distal aorta
- with SMA and CA stenosis or occlusion is becomes enlarged
Know about the IVC…..
- right of Aorta and posterior pancreatic head
- Dilates with cardiac failure and fluid overload
- Tumor: Renal cell carcinoma
What is the most common filter for the IVC?
Greenfield filter
- filters used to prevent ascent of lower extremity vein thrombus
How are IVC filters placed?
- catheters with entry at the femoral vein or internal jugular vein
Know about hepatic veins…
- right, middle, left
- drain into the IVC
What is the “Nutcracker Syndrome”?
engorgement of the left renal vein due to its compression by the SMA and aorta
Where do the gonadal veins drain into?
Left gonadal vein: LRV
Right gonadal vein: IVC
What is retroperitoneal fibrosis?
- Ormond’s disease or inflammatory aneurysm
- dense fibrous tissue proliferation confined to the paravertebral region
What would a retroperitoneal fibrosis look like?
- hypoechoic midline mass
- typically at aortic bifurcation
What is retroperitoneal fibrosis associated with?
- bilateral ureteral obstruction
- progressive loss of kidney function
Where are the adrenal glands?
- Right adrenal gland: triangle or pyramid. Superior, anterior and medial of upper pole of kidney
- Left adrenal gland: crescent shaped located anteriomedial to upper pole
What hormones does the adrenal cortex produce?
- Mineralocorticoids (Aldesterone)
- Glucocorticoids (Cortisol)
- Androgens
What are the adrenal cortical hormones regulated by?
Pituitary Gland
What might tumors of the adrenal gland and anterior pituitary gland produce?
- overproduce or underproduce ACTH and ACH
What does the adrenal medulla produce?
- epinephrine (Adrenalin)
- norepinephrine
What is Cushings Syndrome?
- excessive cortisol secretion
What is Conn Syndrome?
- primary aldosteronism
- excessive aldosterone secretion
What is Hirsutism?
- Overbundance hair
- caused by excessive androgen production
Know about Adrenal Cortical Carcinoma…
- Majority of patients produce with Cushings syndrome
- Rare tumor > Poor prognosis
- Invade Renal veins and IVC
What is a Pheochromocytoma?
- originate from adrenal medulla
- occur along nerve chain
- majority > benign
What do Pheochromocytoma secrete?
Norepinephrine
Epinephrine
Know about Adrenal Neuroblastoma…
- malignant tumor arising from sympathetic nervous system
- Palpable mass
- Most common adrenal mass in infancy and childhood
- increase in blood and urine catecholamines
- Metastatic disease
What is a Myelolipoma?
- benign, nonfunctioning adrenal masses that contain fat, bone elements
- hyperechoic masses in adrenal bed
- Artifact: Propagation speed artifact
What is Adrenal Lymphoma?
Adrenal involvement with lymphoma is common and frequently bilateral
- Diffuse, hyperplasia or mass like
- Non-Hodgkin disease is most common cell type
Know about Adrenal Mets…
- 4th common metastatic site after lungs, liver and bone
- most common sites: lung, breast, skin, kidney, thyroid, and colon cancers
What is a Adrenal Hemorrhage?
- most common in neonate
- large size of the neonatal adrenals and their high degree of vascularity which makes them vulnerable to birth trauma
What is the most common adrenal mass in newborn?
Adrenal Hemorrhage
