Retroperitoneum Flashcards by Ysabella Hartnett

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

Peritoneum

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The peritoneum consists of what 2 layers

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

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The peritoneal cavity contain what 2 separate compartments

1) less sac

2) greater sac

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

Lesser sac

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The entrance to the lesser sac is the

epiploic foramen

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Name the 13 intraperitoneal structures * NEED TO KNOW`

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

Retroperitoneum

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

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

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

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

1) Quadratus lumborum

2) psoas muscles

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

celiac axis

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Where is the celiac axis located in relation to the pancreas

superior

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The celiac axis branches into what 3 arteries

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

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

1) common hepatic artery

2) splenic artery

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

1) proper hepatic artery

2) gastroduodenal artery (GDA)

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

SMA

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

SMA

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

Fasting state- high resistance

Postparandial- low resistance, increased velocity

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

Renal arteries

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

Right

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

Left

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What arteries arise from the distal aorta and are rarely imaged

Right and left gonadal arteries

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What artery arises from the anterior aspect of the distal aorta

IMA

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

IVC

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What vessel dilates with cardiac failure and fluid overload

IVC

What is the most common tumor to involve the IVC

Renal cell carcinoma

Name 6 reasons as to why the IVC would be displaced

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)

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

Greenfield filter

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

Inferior

What veins drain into the IVC

Hepatic veins

Which renal vein is short, draining directly into the IVC

Right renal vein

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

Left renal vein

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

Nutcracker syndrome

Which gonadal vein drains into the IVC

Right gonadal vein

Which gonadal vein drains into the left renal vein

Left gonadal vein

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?

Azygos and hemiazygos veins Azygos to the right Hemiazygos to the left

What veins are branches of the common iliac veins

Ascending lumbar veins

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

Ascending lumbar veins

What is another name for Retroperitoneal fibrosis

1) Ormonds disease | 2) inflammatory aneurysm

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

Retroperitoneal fibrosis

Sonographically, what is the appearance of a Retroperitoneal fibrosis

Hypoechoic midline mass

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

Retroperitoneal Fibrosis

Name 7 causes of retroperitoneal fibrosis

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

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

Right adrenal gland

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

Crus of diaphragm

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

Left adrenal gland

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

Aorta and crus

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

The crus of the diaphragm is located: 1) _____ to the aorta 2) _____ to the celiac axis 3) _____ to the IVC

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

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

Adrenal

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

Adrenal

What 3 arteries supply each adrenal gland

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

A single vein drains each adrenal gland

1) right suprarenal vein drains IVC | 2) Left suprarenal vein drains into left renal vein

The adrenal cortex produces what 3 steroid hormones

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

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

Adrenal gland and anterior pituitary gland

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

ACTH and ACH

The adrenal medulla produces catecholamines

1) epinephrine (adrenalin) | 2) norepinephrine

What is excessive cortisol secretion associated with adrenal adenomas

Cushing syndrome

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

Cushing's syndrome

What is excessive aldosterone secretion associated with adrenal adenoma

Conn's disease

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

Adrenal virilism (adrenogenital syndrome)

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

Adrenal Cortical Carcinoma

What originate in the adrenal medulla and are also benign

Pheochromocytoma

Pheochromocytomas secrete catecholamines

1) norepinephrine | 2) epinephrine

Pheochromocytomas are associated with

1) MEN | 2) Von Hippel-Lindau disease

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

Adrenal Neuroblastoma

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

Myelolipoma

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

Myelolipomas

What is the most common cell type of an adrenal lymphoma

Non-hodgkin disease

What is the 4th most common metastatic site

Adrenal metastases

What type of hemorrhage is the most common in the neonate

Adrenal

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

b) mesocolon

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) celiac, SMA, and IMA

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

b) as a hypoechoic ring around the echogenic medulla

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

b) at the level of the L4 vertebral body

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

d) splenic vein

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

b) lateral to the left diaphragm crura

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) anterior

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) right renal artery

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

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

d) none of the above

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) right renal artery

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

c) comet tail artifacts

What is another name for the posterior renal fascia

Zuckerkandl fascia

What space contains no organs and only fat

Posterior pararenal space