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Retroperitoneum Flashcards

0
Q

what is a mesentery?

A

double layer of peritoneum that extends from the body wall to an organ in the abdominopelvic cavity

hold some organs in place, suspending them from the body wall

they also ten to transmit important vessels and/or nerves

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1
Q

What is the retroperitoneum?

A

organs that have NO MESENTARIES

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2
Q

Where is the Retroperitoneum located?

A

outside of the peritoneum

between the abdomen and the back

aka: extraperitoneum

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3
Q

What structures are part of the retroperitoneum?

A

kidneys

suprarenal glands

aorta

ivc

urinary bladder

prostate

vagina

rectum

secondary retro: pancreas, duodenum, ascending and descending colon

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4
Q

What is the area between the posterior portion of the parietal peritoneum and posterior abdominal wall muscles?

A

retroperitoneum

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5
Q

What muscles line the retroperitoneum?

A

delineated laterally:

lateral borders of the QUADRATUS LUMBORUM muscles

peritoneal leaves of the mesentery

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6
Q

What is the tricompartmental theory of the retroperitoneum?

A

Three compartments:

anterior pararenal space

perirenal space

posterior pararenal space

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7
Q

What is in the anterior pararenal space?

A

second part of the duodenum

pancreas

ascending and descending colon

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8
Q

What is in the perirenal space?

A

surrounded by anterior and posterior layers of Gerota’s fascia

kidneys

adrenal

proximal ureter

renal vessels

Ao

IVC

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9
Q

What is in the posterior pararenal space?

A

illiopsoas muscle

lymphatics

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10
Q

Pathologic processes can stretch from the ____________space, __________ and ______________tissues of the back and flank

A

subdiaphragmatic

mediastinum

subcutaneous

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11
Q

can we see the Retroperitoneum by US?

A

difficult to assess - CT is better

too much air and bowel in the way

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12
Q

What the the borders of the retroperitoneum?

A

from diaphragm to pelvic brim

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13
Q

what is the retrofascial space and what muscles are affected by it?

A

extension of pathological processes

psoas

quadratus lumborum

iliacus

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14
Q

What is the diaphragmatic crua?

A

linear muscular portions of the diaphragm

right and left

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15
Q

What is the difference between the right and left crus of the diaphragm?

A

right:

longer and larger
posterior and medial to IVC
anterior and medial to rt kidney

LEFT:

lateral to aorta

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16
Q

What are some reasons we might scan the retroperitoneum?

A

fever

pain

palpable mass

bleeding

distended abdomen

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17
Q

What can you rule out with sonography of the retroperitoneum?

A

r/o fluid collection

hematoma

urinoma (bladder leaking etc)

Ascitic fluid

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18
Q

Lymph tissue can be seen along ______ _______

A

great vessels (aorta, IVC)

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19
Q

Where are para-aortic lymph nodes?

A

within the upper retroperitoneum

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20
Q

what size are normal lymph nodes?

A

less than 1 cm

will enlarge with infection

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21
Q

What indicates a problem with para-aortic lymph nodes?

A

Mantle

floating

bilateral leg swelling

lymphadenopathy

consistent non moving pattern

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22
Q

Where is the iliac fossa?

A

region between the iliac wings

false pelvis

contains ureter, distal great vessels and lymphatics

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23
Q

what muscles are found in the retrofascial space?

A

psoas

quadratus lumborum

iliac

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24
How is the prevesical area defined?
pubis to anterior margin of the bladder aka: space of retzius
25
What are the two parts of the adrenal glands?
endocrine glands cortex - outer 90% of gland medulla - inner
26
What makes up the cortex?
****know these **** zona glomerulosa zona fasciculate zona reticularis
27
What does the zona glomerulosa do?
regulates electrolytes produces aldosterone
28
what does the zona fasciculate do?
produces glucocorticoids
29
what does the zona reticularis do?
stimulates testosterone and estrogen
30
the adrenal cortex produces _______
steroids
31
what do Mineralocorticoids do?
- regulate electrolyte metabolism made in the adrenal cortex steroid
32
What do glucocorticoids do?
regulate carbohydrate metabolism cortisone and hydrocortisone made in adrenal cortex steroid
33
what hormone from the pituitary affects the adrenal cortex?
ACTH - adrenocortiotropic hormone
34
what happens if you have too much ACTH?
hyperfunctions of adrenal cortex: Cushing's, Conn's adrenogenital syndrome
35
what happens if there is too little ACTH?
hypofunction of the adrenal cortex Addison's disease
36
What does the medulla secrete?
epinephrine norepinephrine
37
what does the medulla do?
regulates blood pressure
38
epinephrine and norepinephrine is also known as?
adrenalin helps the liver release glucose and limits the release of insulin both a hormone and a neurotransmitter
39
What is the shape of the right adrenal gland?
triangle
40
what is the shape of the left adrenal gland?
semilunar
41
When is the adrenal gland proportionately larger compared to kidney?
in infants 1/3 the size of the kidney more prominent than on an adult 1/13 size of kidney
42
Where are the adrenal glands?
anterior, medial and superior to the kidney
43
What is the indication for an adrenal gland scan?
hypertension decrease hematocrit distention anxiety sweating weight loss follow up to CT
44
How does the adrenal gland appear sonographically?
hypoechoic structure sometimes highly echogenic fat surrounds the gland usually smaller than 5 cm
45
What is the shape of the Rt adrenal gland?
triangular or pyramidal shape
46
What is the function syndromes of the adrenal gland?
addison's adrenogenital Conn's Cushing's
47
What is Addison's disease?
Hypofunction atrophy of the cortex
48
what are the symptoms of Addison's disease?
increased sodium retention tissue edema hyperpigmentation fatigue and muscle weakness cortex
49
What is the prognosis for Addison's disease?
good with steroid replacement therapy
50
Addison's disease is an ____________or _____________disorder
endocrine hormonal
51
With Addison's disease what lab values decrease?
cortisol aldosterone
52
What is another name for Addison's disease?
Adrenal insufficiency hypocortisolism
53
What is adrenogenital (AG) syndrome
excessive secretion symptoms: hormonal changes cortex
54
What is Conn's syndrome?
Hyperaldosteronism excessive secretion of aldosterone
55
what are the symptoms of Conn's syndrome?
muscle weakness hypertension cortex
56
What is Cushing's syndrome?
hyperfunction excessive secretion of cortisol may have pituitary involvement cortex
57
What are the symptoms of Cushing's syndrome?
moon face buffalo hump psychiatric issues cortex
58
What is waterhouse-Friderichsen syndrome?
bilateral adrenal hemorrhage infection can be fatal if not treated immediately
59
can adrenal glands have cysts?
yes - typical criteria
60
What causes adrenal hemorrhage?
severe trauma or infection
61
**What is the most common adrenal abnormality in a newborn?**
adrenal hemorrhage **result of traumatic vaginal delivery** *decreased hematocrit*
62
What is pheochromocytoma?
adrenal medulla tumor
63
what does a pheochromocytoma produce?
excessive epinephrine and norepinephrine
64
What is the sonographic appearance of pheochromocytoma?
unilateral homogeneous pattern Lab Tests: metanephrine, catecholamine
65
how does a pheochromocytoma appear?
very large homogeneous benign in the space of the adrenal gland
66
What are the symptoms of a pheochromocytoma?
hormonal abnormalities headaches tachycardia tremors anxiety excessive sweating uncontrollable HTN more common than the other syndromes
67
What are the adrenal tumors?
adenoma - benign carcinoma metastasis
68
what is a adrenal neuroblastoma?
**most common malignancy in children**
69
Where do you find an adrenal neuroblastoma?
arises from medulla
70
What is the sonographic appearance of a neuroblastoma?
echogenic mass metastatic to liver
71
What is the the difference between a nephroblastoma (Wilm's Tumor) and a Neuroblastoma?
Nephroblastoma - kidney, children Neuroblastoma - adrenal gland, children
72
What is the most common tumor of infancy?
adrenal neuroblastoma 30% of all neonatal tumors
73
What does spectral doppler look like if you have a adrenal neuroblastoma?
demonstrates low resistance arterial, increased blood flow
74
What is a neurogenic tumor?
malignant retroperitoneal tumor nerve roots
75
What is leiomysarcoma?
malignant retroperitoneal tumor smooth muscle
76
What is liposarcoma?
malignant retroperitoneal tumor adipose - most common primary tumor of the retroperitoneum
77
what is a fibrosarcoma?
malignant retroperitoneal tumor connective
78
what is a rhabdomyosarcoma?
malignant retroperitoneal tumor skeletal muscle
79
what is a lymphoma?
malignant retroperitoneal tumor lymphatics most common of the cavities that can spread to the retroperitoneum, the Ca you will most likely see
80
What is a teratomatous?
malignant retroperitoneal tumor skin, muscle, tissue
81
What is histiocytoma?
malignant retroperitoneal tumor immune system
82
what is a fibroma?
benign retroperitoneum tumor connective tissue
83
what is a lipoma?
benign retroperitoneum tumor fatty tissue
84
What is mesothelioma?
benign retroperitoneum tumor epithelial cells
85
What is myxoma?
benign retroperitoneum tumor connective tissue
86
What is a teratoma?
benign retroperitoneum tumor varied tissue
87
What is a urinoma?
a walled off collection of urine sonolucent unless infected
88
How does a hemorrhage appear in the retroperitoneum?
Sonolucent areas or organized thrombus
89
See slide 96 for adrenal hemorrhage
trauma - due to abuse
90
what is a hematoma?
a collection of blood
91
What do you not want to confuse an abscess with in the retroperitoneum?
dont confuse gas pattern with normal bowel
92
What is ascites?
fluid collection
93
what does transudative ascites mean?
CHF or renal failure
94
What does Exudative ascites mean?
malignancy or inflammatory
95
What is Ormond's disease?
a retroperitoneal fibrosis thick sheets of fibrous tissue
96
what are the symptoms of Ormond's disease?
flank and back pain weight loss nausea and vomiting malaise
97
When you find a retroperitioneal mass what do you sonographically?
assess in two dimensions measure assess if it is fixed or free determine echogenicity solid, complex or cyst? relationship to other organs
98
don't mistake a mass for _______
horseshoe kidney
99
Where do the "Oma's" usually live?
around the aorta or great vessels
100
What muscles and spaces are found in the pelvic retroperitonem?
bilateral pararectal space: bounded by piriformis and levator ani fascia (lateral to rectum)
101
Where is the retrovesical space?
between the bladder and rectum
102
What does aldosterone do?
related to sodium and chloride ions and pH made in the cortex steroid
103
If you see lymphadenopathy what does the patient most likely have?
a primary tumor some where in the body

Abdomen 2 (8 decks)

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