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ARDMS Abdominal Review > Retroperitoneum > Flashcards

Retroperitoneum Flashcards

1
Q

What is the serous membrane that forms the lining of the abdominal cavity and covers most of the abdominal organs

A

Peritoneum

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2
Q

The peritoneum consists of what 2 layers

A

1) parietal peritoneum- outer layer that lines the abdominal wall
2) visceral layer- inner layer that covers the abdominal organs

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3
Q

The peritoneal cavity contain what 2 separate compartments

A

1) less sac

2) greater sac

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4
Q

What space is situated between the liver, pancreas, and stomach

A

Lesser sac

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5
Q

The entrance to the lesser sac is the

A

epiploic foramen

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6
Q

Name the 13 intraperitoneal structures * NEED TO KNOW`

A

1) stomach
2) jejunum
3) 1st part of duodenum
4) appendix
5) spleen
6) cecum
7) transverse colon
8) sigmoid colon
9) rectum
10) liver
11) uterus
12) fallopian tubes
13) ovaries

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7
Q

What is a posteriorly located compartment that lies between the transversalis fascia and the parietal peritoneum

A

Retroperitoneum

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8
Q

2 layers of renal fascia dived the retroperitoneum coronally into 3 compartments

A

1) anterior pararenal space
2) perirenal space (gerotas fascia)
3) posterior pararenal space (potential space)

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9
Q

The following structures are located in the retroperitoneum *NEED TO KNOW

A

1) kidneys
2) adrenal glands
3) ascending and descending colon
4) 2nd, 3rd, and 4th parts of the duodenum
5) pancreas
6) aorta and IVC
7) urters
8) renal vessels
9) superior meseteric vessels
10) gonadal vessels
11) lymphatics
12) prostate

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10
Q

What 2 muscles lie posterior to the posterior pararenal space and are separated from this space by their own fascia

A

1) Quadratus lumborum

2) psoas muscles

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11
Q

What is the 1st major branch as the aorta descends through the diaphragm

A

celiac axis

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12
Q

Where is the celiac axis located in relation to the pancreas

A

superior

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13
Q

The celiac axis branches into what 3 arteries

A

1) common hepatic artery
2) left gastric artery
3) splenic artery

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14
Q

The celiac terminates with the bifurcation of the _____ artery and the _____ artery also called a “seagull or “dove sign”

A

1) common hepatic artery

2) splenic artery

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15
Q

As the common hepatic artery courses toward the liver it bifurcates into the ____ artery and the ____ artery

A

1) proper hepatic artery

2) gastroduodenal artery (GDA)

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16
Q

What artery branches off the aorta about 1 cm inferior to the celiac axis

A

SMA

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17
Q

What artery parallels the aorta and is seen posterior/inferior to the body of the pancreas

A

SMA

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18
Q

Name the SMA doppler waveforms for a fasting state and a postparandial

A

Fasting state- high resistance

Postparandial- low resistance, increased velocity

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19
Q

What arteries arise from the lateral walls of the aorta just below the origin of the SMA

A

Renal arteries

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20
Q

Which renal artery passes posterior to the IVC to enter the renal hilum

A

Right

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21
Q

Which renal artery is shorter as the aorta lies to the left of the midline

A

Left

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22
Q

What arteries arise from the distal aorta and are rarely imaged

A

Right and left gonadal arteries

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23
Q

What artery arises from the anterior aspect of the distal aorta

A

IMA

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24
Q

What lies to the right of the aorta and posterior to the pancreatic head and liver

A

IVC

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25
Q

What vessel dilates with cardiac failure and fluid overload

A

IVC

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26
Q

What is the most common tumor to involve the IVC

A

Renal cell carcinoma

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27
Q

Name 6 reasons as to why the IVC would be displaced

A

1) liver mass
2) right renal artery aneurysm-( moves IVC anterior)
3) Lymphadenopathy - (arch IVC anterior)
4) Tortuous aorta- ( to the right)
5) Right renal/ adrenal mass - (lateral)
6) Retroperitoneal tumor- (anterior)

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28
Q

IVC filters are used to prevent the ascent of lower extremity vein thrombus. The most common filter is the

A

Greenfield filter

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29
Q

Proper location for an IVC filter is ___ to the renal veins

A

Inferior

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30
Q

What veins drain into the IVC

A

Hepatic veins

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31
Q

Which renal vein is short, draining directly into the IVC

A

Right renal vein

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32
Q

Which renal vein is longer passing between the SMA and aorta as it travels from the left kidney to the IVC

A

Left renal vein

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33
Q

What is the engorgement of the left renal vein due to its compression by the SMA and Aorta

A

Nutcracker syndrome

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34
Q

Which gonadal vein drains into the IVC

A

Right gonadal vein

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35
Q

Which gonadal vein drains into the left renal vein

A

Left gonadal vein

36
Q

The _____ and _____ veins provide an alternative pathway for venous return in the case of caval obstruction. The connect the proximal abdominal IVC to the SVC.

-Which is located to the right? Which is located to the left?

A

Azygos and hemiazygos veins

Azygos to the right
Hemiazygos to the left

37
Q

What veins are branches of the common iliac veins

A

Ascending lumbar veins

38
Q

What veins travel in a path lateral to the spine and posterior to the psoas muscle

A

Ascending lumbar veins

39
Q

What is another name for Retroperitoneal fibrosis

A

1) Ormonds disease

2) inflammatory aneurysm

40
Q

What is a dense fibrous tissue proliferation confined to the paravertebral region

A

Retroperitoneal fibrosis

41
Q

Sonographically, what is the appearance of a Retroperitoneal fibrosis

A

Hypoechoic midline mass

42
Q

What is associated with bilateral ureteral obstruction as it envelopes structures rather than displacing them

A

Retroperitoneal Fibrosis

43
Q

Name 7 causes of retroperitoneal fibrosis

A

1) malignancies
2) various drugs and chemicals
3) crohns disease
4) sclerosing cholangitis
5) radiation therapy
6) chemotherapy
7) aortic aneurysm

44
Q

Which adrenal gland is shaped like a triangle or pyramid. It is located on the superior, anterior, and medial aspect of the upper pole of the right kidney

A

Right adrenal gland

45
Q

What part of the diaphragm lies medial and posterior to the right adrenal gland

A

Crus of diaphragm

46
Q

Which adrenal gland is crescent shaped and is located anteriomedial to the upper pole of the left kidney

A

Left adrenal gland

47
Q

The ____ and ___ of the diaphragm are located medial to the left adrenal gland

A

Aorta and crus

48
Q

Where is the tail of the pancreas located in relation to the left adrenal gland

A

Anterior

49
Q

The crus of the diaphragm is located:

1) _____ to the aorta
2) _____ to the celiac axis
3) _____ to the IVC

A

1) Anterior the aorta
2) superior to celiac axis
3) Posterior to IVC

50
Q

The _____ cortex is hypoechoic and typically is less echogenic than the surrounding retroperitoenal fat

A

Adrenal

51
Q

The _____ medulla is seen as an echogenic linear structure within the adrenal gland

A

Adrenal

52
Q

What 3 arteries supply each adrenal gland

A

1) suprarenal branch of the inferior phrenic artery. (1st branch of AO)
2) suprarenal branch of the AO
3) suprarenal branch of the renal artery

53
Q

A single vein drains each adrenal gland

A

1) right suprarenal vein drains IVC

2) Left suprarenal vein drains into left renal vein

54
Q

The adrenal cortex produces what 3 steroid hormones

A

1) mineralocorticoids (Aldosterone)
2) Glucocorticoids (Cortisol)
3) Androgens

55
Q

The _____ gland and the ____ gland function together to regulate hormone production

A

Adrenal gland and anterior pituitary gland

56
Q

Tumors of the adrenal gland and pituitary gland may overproduce or underproduce _____ and _____

A

ACTH and ACH

57
Q

The adrenal medulla produces catecholamines

A

1) epinephrine (adrenalin)

2) norepinephrine

58
Q

What is excessive cortisol secretion associated with adrenal adenomas

A

Cushing syndrome

59
Q

What is excessive cortisol secretion due to increase in ACTH from a pituitary adenoma

A

Cushing’s syndrome

60
Q

What is excessive aldosterone secretion associated with adrenal adenoma

A

Conn’s disease

61
Q

What is excessive androgen secretion producing symptoms such as hirsutism, baldness, acne, and amenorrhea

A

Adrenal virilism (adrenogenital syndrome)

62
Q

What is a rare tumor that have a tendency to invade the renal veins and IVC

A

Adrenal Cortical Carcinoma

63
Q

What originate in the adrenal medulla and are also benign

A

Pheochromocytoma

64
Q

Pheochromocytomas secrete catecholamines

A

1) norepinephrine

2) epinephrine

65
Q

Pheochromocytomas are associated with

A

1) MEN

2) Von Hippel-Lindau disease

66
Q

What is a malignant tumor that presents as a palpable abdominal mass in children

A

Adrenal Neuroblastoma

67
Q

What are benign, nonfunctioning adrenal masses that contain fate and bone elements

A

Myelolipoma

68
Q

What sonographically appears as a hyperechoic mass in the adrenal gland and is associated with propagation speed artifact

A

Myelolipomas

69
Q

What is the most common cell type of an adrenal lymphoma

A

Non-hodgkin disease

70
Q

What is the 4th most common metastatic site

A

Adrenal metastases

71
Q

What type of hemorrhage is the most common in the neonate

A

Adrenal

72
Q

The______ is a connective tissue that is connected to the large intestine that provides structure and support, along with encasing/protecting blood vessels

a) mesentery
b) mesocolon
c) lesser omentum
d) greater omentum

A

b) mesocolon

73
Q

The term “splachnic arteries” describes which of the following vessels

a) celiac, SMA, and IMA
b) hepatic, renal, splenic and celiac arteries
c) renal, suprarenal, splenic and gastric arteries
d) all arterial branches of the abdominal aorta from the diaphragm to the umbilicus

A

a) celiac, SMA, and IMA

74
Q

On an ultrasound exam, the normal adrenal cortex appears

a) isoechoic to the medulla
b) as a hypoechoic ring around the echogenic medulla
c) as a hyperechoic ring around the hypoechoic medulla
d) as an echogenic ring around the echogenic medulla

A

b) as a hypoechoic ring around the echogenic medulla

75
Q

The aorta bifurcates

a) at the level of the sacrum
b) at the level of the L4 vertebral body
c) 3-5 cm below the SMA origin
d) 3-5 cm below the umbilicus

A

b) at the level of the L4 vertebral body

76
Q

While imaging the long axis of the left renal vein, you identify an anterior, somewhat parallel vessel that demonstrates flow moving in the same direction. What vessel is this?

a) splenic artery
b) IVC
c) SMV
d) splenic vein

A

d) splenic vein

77
Q

Which of the following is true regarding the anatomic position of the left adrenal gland

a) anterior to the pancreas tail
b) lateral to the left diaphragm crura
c) anterior to the IVC
d) superolateral to the left kidney

A

b) lateral to the left diaphragm crura

78
Q

The left renal vein passes _______ to the aorta to enter the medial aspect of the IVC

a) anterior
b) posterior
c) superior
d) none of the above

A

a) anterior

79
Q

On a longitudinal scan, this vessel is seen in cross section posterior to the IVC

a) right renal artery
b) left renal artery
c) left renal vein
d) right renal vein

A

a) right renal artery

80
Q

When trying to distinguish free fluid in the abdomen from the IVC, which of the following is true?

a) color doppler is an effective tool in differentiating the IVC from free fluid
b) The IVC will not demonstrate respiratory changes in diameter, while fluid pocket size/shape will vary respiration
c) The intrabomdinal fluid is most commonly seen on the left side of the abdomen and the IVC is located on the right side of the abdomen
d) The IVC will demonstrate respiratory changes in diameter while fluid pocket size/ shape will not vary respiration

A

a) color doppler is an effective tool in differentiating the IVC from free fluid

81
Q

Which of the following vessels follow a retroaortic course in the abdomen

a) left renal artery
b) portal confluence
c) right renal artery
d) none of the above

A

d) none of the above

82
Q

Which of the following vessels follow a retrocaval course in the abdomen?

a) right renal artery
b) superior mesenteric artery
c) left renal artery
d) portal confluence

A

a) right renal artery

83
Q

Which of the following is not an excepted finding with adrenal myelolipoma

a) increased echogenicity compared to adrenal and renal corical tissue
b) attenuation artifacts
c) comet tail artifacts
d) propagation speed artifacts

A

c) comet tail artifacts

84
Q

What is another name for the posterior renal fascia

A

Zuckerkandl fascia

85
Q

What space contains no organs and only fat

A

Posterior pararenal space

ARDMS Abdominal Review (14 decks)

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