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Retroperitoneum Flashcards

1
Q

What are the two peritoneum layers?

A

Parietal and visceral peritoneum

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2
Q

What is the parietal and visceral peritoneum?
- what is between them ?

A

Parietal outer layer lines the ABD wall
Visceral inner layer covers the ABD organs
- peritoneal cavity

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3
Q

What are the two compartments in the peritoneal cavity?

A

The lesser, Greater, and pouch of pouch of Douglas.

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4
Q

Where is the lesser sac?
- what is the entrance called?

A

Space between the liver, pancreas, and stomach.
- Epiploic foramen.

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5
Q

Where is the greater sac?

A

Area with bowel and ascitesW

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6
Q

Where is the pouch of Douglas?

A

Between the rectum and uterus (0r rectovesical pouch in men)

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7
Q

What is in the Intraperitoneal structures?

A
  • Liver, GB, stomach, Spleen
  • 1st duodenum, jejunum, Trans/Sigmoid colon
  • Cecum, Appendix, Rectum
  • Uterus, Fallopian tubes, Ovaries.
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8
Q

Where is the Retroperitoneum located?

A

Between the transversalis fascia and the posterior parietal peritoneum.

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9
Q

What divides the retroperitoneum coronally into three compartments?

A

Gerota’s fascia (renal fascia)
- Ant pararenal
- Perirenal space
- Post pararenal space

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10
Q

What renal fascia are the kidneys and adrenal glands located in?

A

perirenal space.

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11
Q

What is in the retroperitoneum?

A
  • Esophagus Pancreas
  • Adrenal gland, kidneys, ureters
  • Ao/IVC, sup mesenteric, renal, gonadal vessels
  • 2,3,4 duodenum, Asce/desen Colon, rectum
  • lymphatics, prostate.
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12
Q

Where are the quadratus lumborum muscles and psoas muscles located

A

Posterior to the posterior pararenal space
- Own fascia transversalis

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13
Q

How does the Ao travel through the ABD spaces?

A

Ao is located more posterior but goes more anterior as it travels caudally.

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14
Q

What are the branches of the CA?

A

Common hepatic artery
Left gastric artery
Splenic artery

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15
Q

What does the CA look like?

A

Sea gull or dove sign

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16
Q

Can you see the gastric artery?

A

NOOOO

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17
Q

What are the branches of the AO

A

CA (1cm inf)
SMA
Renal arteries
Gonadal arties
IMA

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18
Q

What is the Doppler waveforms for SMA

A

Fasting- high resistance
Postprandial- Low resistance

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19
Q

The RRA passes ____ to the IVC.
The LRA is shorter as the AO lies to the ___ of the midline

A

Posterior
Left

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20
Q

What is the most common tumor to involve the IVC

A

Renal cell carcinoma

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21
Q

What can cause displacement in the IVC?

A

Liver, renal masses
RRA aneurysm
Lymphadenopathy
Tortuous AO (goes right)

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22
Q

What is an IVC filter, where is placed and what is the most common?

A

Prevents traveling clots
- Below the renal veins
- Green filter.

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23
Q

The RRV is __ and drains directly into the IVC. The LRV is ___ passing between SMA and AO.

A

Short
Long

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24
Q

What is nutcracker syndrome?

A

Compression of LLV from SMA and AO.

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25
Q

What is retroacortic left renal vein?

A

variant where the LLV is located between AO and the vertebra and drains into the IVC

26
Q

Where does the right and left gonadal veins drain into ?

A

Right drains into the IVC
Left drains into the LRV.

27
Q

What is retroperitoneal fibrosis and what is also known as?

A

Inflammatory aneurysm of fibrosis tissue around AO bif (atherosclerotic Ao), rarely extends superiorly to L2. (Hypo midline mass)

Ormond’s disease

28
Q

What is retroperitoneal fibrosis associated with?

A

Bilateral ureteral obst.

29
Q

What is azygos, and hemiazygos veins?

A

Provided a pathway for venous return if the IVC becomes obst.
Connect Prox IVC to SVC (not seen unless something is wrong)

30
Q

Where is the azygos, and hemiazygos veins located?

A

azygos- right
hemiazygos- Left

31
Q

Where do the ascending lumbar veins travel and what are they branches off of?

A

They travel lateral to the spine and posterior to the psoas muscle.
branch off the iliac veins and connect to the azygos, and hemiazygos veins.

32
Q

Where do the ascending lumbar veins connect to the azygos, and hemiazygos veins?

A

At the diaphragm at the left and right subcostal vein.

33
Q

Where is the right adrenal gland located
- what is the shape?
- where is it to the IVC and cruse diaphragm

A

Superior, anterior, and medial to the upper pole of the right kidney
- triangle/pyramid shape
- posterior to IVC and medial/posterior to cruse.

34
Q

Where is the left adrenal gland located
- what is the shape?
- where is it to the AO and cruse diaphragm

A

Anteriomedial to the upper pole of the left kidney
- crescent shape.
- medial to the AO and cruse.

35
Q

Where is the cruse of the diaphragm located?

A

Ant to aorta
Superior to CA (cruse never goes beyond CA)
Post to IVC

36
Q

Where can the cruse of the diaphragm be imaged?

A

Transverse and in longitudinal planes
Its medial and posterior to everything besides the ao.

37
Q

What is the echogenicity of the adrenal cortex and medulla?

A

Cortex is hypoechoic
Medulla is echogenic linear structure.

38
Q

What are the arteries that supplies the adrenal gland?

A

Suprarenal branch of the
- Inferior phrenic art
- ao
- renal art.

39
Q

Where does the adrenal gland drain into?

A

RT suprarenal vein into IVC
LT suprarenal vein into the LRV

40
Q

What are the ACH?

A

aldosterone
cortisol
androgens

41
Q

How is ACH regulated by

A

adrenocorticotropic hormones (ACTH) by the anterior pituitary gland.

42
Q

What two glands regulate hormone production

A

Adrenal and anterior pituitary gland

43
Q

A decrease in adrenal cortical function leads to ____ in ACTH
An Increased in adrenal cortical function leads to ____ in ACTH

A

Increase
decrease

44
Q

What does the adrenal medulla produce?

A

catecholamines
- epinephrine (adrenalin)
- norepinephrine

45
Q

What re the two types of functioning adrenal adenomas?

A

Hyperfunctioning
Nonhyperfunctioning (most common)

46
Q

What are the hyperfunctioning adrenal syndromes?

A

Cushing, Conn, and Hirsutism.

47
Q

What is Cushing’s syndrome?

A

Hypercortisolism

48
Q

What is Conn syndrome?

A

Primary Aldosteronism

49
Q

What is Hirsutism

A

Overabundance of hair excessive androgen

50
Q

What is Addisons disease?

A

Non Hyperfunctioning
Adrenal insufficiency

51
Q

When should you biopsy an adrenal tumor?

52
Q

Where do adrenal cortical carcinomas tend to invade?

A

Renal veins and IVC.

53
Q

What are pheochromocytoma
- where are the located
- associated with

A

secrete catecholamines
- originate in adrenal medulla but can be ectopic along the paraaortic sympathetic nerve chain.
- endocrine neoplasia, Von hippel-lindau dz, nurofibromatosis.

54
Q

What is the most common palpable ABD mass, in infancy and early child, 2m to 2 years old?

A

Adrenal neuroblastoma

55
Q

What is adrenal neuroblastoma

A

Malignant tumor of the sympathetic nervous system occurring in the adrenal medulla but can be in the neck, chest, or pelvis

56
Q

What is a difference between adrenal neuroblastoma vs wilms tumor?

A

Neuroblastoma displaces the kidney inferiorly
Wilms originates and invades the kidney

57
Q

What is increased with Adrenal neuroblastoma

A

Increase blood and urine catecholamines

58
Q

What is a myelolipoma?
- how does it look sonographically

A

Benign nonfunctioning adrenal mass of fat and bones
- hyperechoic mass (propagation speed artifact)

59
Q

Adrenal metastases are the ___ common mets after ___, ___, and ___.

A

4th
lungs, liver, and bones

60
Q

What is the most common cancer that metastases to the adrenal gland?

A

Lung cancer

61
Q

What is the most common adrenal mass in newborns?

A

Adrenal Hemorrhage

Abdominal Sonography (9 decks)

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