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Abdomen 2 > Retroperitoneum > Flashcards

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
Q

How is the prevesical area defined?

A

pubis to anterior margin of the bladder

aka: space of retzius

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25
Q

What are the two parts of the adrenal glands?

A

endocrine glands

cortex - outer 90% of gland

medulla - inner

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26
Q

What makes up the cortex?

A

**know these **

zona glomerulosa

zona fasciculate

zona reticularis

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27
Q

What does the zona glomerulosa do?

A

regulates electrolytes

produces aldosterone

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28
Q

what does the zona fasciculate do?

A

produces glucocorticoids

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29
Q

what does the zona reticularis do?

A

stimulates testosterone and estrogen

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30
Q

the adrenal cortex produces _______

A

steroids

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31
Q

what do Mineralocorticoids do?

A
  • regulate electrolyte metabolism

made in the adrenal cortex

steroid

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32
Q

What do glucocorticoids do?

A

regulate carbohydrate metabolism

cortisone and hydrocortisone

made in adrenal cortex

steroid

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33
Q

what hormone from the pituitary affects the adrenal cortex?

A

ACTH - adrenocortiotropic hormone

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34
Q

what happens if you have too much ACTH?

A

hyperfunctions of adrenal cortex:

Cushing’s,

Conn’s

adrenogenital syndrome

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35
Q

what happens if there is too little ACTH?

A

hypofunction of the adrenal cortex

Addison’s disease

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36
Q

What does the medulla secrete?

A

epinephrine

norepinephrine

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37
Q

what does the medulla do?

A

regulates blood pressure

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38
Q

epinephrine and norepinephrine is also known as?

A

adrenalin

helps the liver release glucose and limits the release of insulin

both a hormone and a neurotransmitter

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39
Q

What is the shape of the right adrenal gland?

A

triangle

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40
Q

what is the shape of the left adrenal gland?

A

semilunar

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41
Q

When is the adrenal gland proportionately larger compared to kidney?

A

in infants 1/3 the size of the kidney

more prominent than on an adult 1/13 size of kidney

42
Q

Where are the adrenal glands?

A

anterior, medial and superior to the kidney

43
Q

What is the indication for an adrenal gland scan?

A

hypertension

decrease hematocrit

distention

anxiety

sweating

weight loss

follow up to CT

44
Q

How does the adrenal gland appear sonographically?

A

hypoechoic structure

sometimes highly echogenic fat

surrounds the gland

usually smaller than 5 cm

45
Q

What is the shape of the Rt adrenal gland?

A

triangular or pyramidal shape

46
Q

What is the function syndromes of the adrenal gland?

A

addison’s

adrenogenital

Conn’s

Cushing’s

47
Q

What is Addison’s disease?

A

Hypofunction

atrophy of the cortex

48
Q

what are the symptoms of Addison’s disease?

A

increased sodium retention

tissue edema

hyperpigmentation

fatigue and muscle weakness

cortex

49
Q

What is the prognosis for Addison’s disease?

A

good with steroid replacement therapy

50
Q

Addison’s disease is an ____________or _____________disorder

A

endocrine

hormonal

51
Q

With Addison’s disease what lab values decrease?

A

cortisol

aldosterone

52
Q

What is another name for Addison’s disease?

A

Adrenal insufficiency

hypocortisolism

53
Q

What is adrenogenital (AG) syndrome

A

excessive secretion

symptoms: hormonal changes

cortex

54
Q

What is Conn’s syndrome?

A

Hyperaldosteronism

excessive secretion of aldosterone

55
Q

what are the symptoms of Conn’s syndrome?

A

muscle weakness

hypertension

cortex

56
Q

What is Cushing’s syndrome?

A

hyperfunction

excessive secretion of cortisol

may have pituitary involvement

cortex

57
Q

What are the symptoms of Cushing’s syndrome?

A

moon face

buffalo hump

psychiatric issues

cortex

58
Q

What is waterhouse-Friderichsen syndrome?

A

bilateral adrenal hemorrhage

infection

can be fatal if not treated immediately

59
Q

can adrenal glands have cysts?

A

yes - typical criteria

60
Q

What causes adrenal hemorrhage?

A

severe trauma or infection

61
Q

What is the most common adrenal abnormality in a newborn?

A

adrenal hemorrhage

result of traumatic vaginal delivery

decreased hematocrit

62
Q

What is pheochromocytoma?

A

adrenal medulla tumor

63
Q

what does a pheochromocytoma produce?

A

excessive epinephrine and norepinephrine

64
Q

What is the sonographic appearance of pheochromocytoma?

A

unilateral

homogeneous pattern

Lab Tests: metanephrine, catecholamine

65
Q

how does a pheochromocytoma appear?

A

very large

homogeneous

benign

in the space of the adrenal gland

66
Q

What are the symptoms of a pheochromocytoma?

A

hormonal abnormalities

headaches

tachycardia

tremors

anxiety

excessive sweating

uncontrollable HTN

more common than the other syndromes

67
Q

What are the adrenal tumors?

A

adenoma - benign

carcinoma

metastasis

68
Q

what is a adrenal neuroblastoma?

A

most common malignancy in children

69
Q

Where do you find an adrenal neuroblastoma?

A

arises from medulla

70
Q

What is the sonographic appearance of a neuroblastoma?

A

echogenic mass

metastatic to liver

71
Q

What is the the difference between a nephroblastoma (Wilm’s Tumor) and a Neuroblastoma?

A

Nephroblastoma - kidney, children

Neuroblastoma - adrenal gland, children

72
Q

What is the most common tumor of infancy?

A

adrenal neuroblastoma

30% of all neonatal tumors

73
Q

What does spectral doppler look like if you have a adrenal neuroblastoma?

A

demonstrates low resistance arterial, increased blood flow

74
Q

What is a neurogenic tumor?

A

malignant retroperitoneal tumor

nerve roots

75
Q

What is leiomysarcoma?

A

malignant retroperitoneal tumor

smooth muscle

76
Q

What is liposarcoma?

A

malignant retroperitoneal tumor

adipose - most common primary tumor of the retroperitoneum

77
Q

what is a fibrosarcoma?

A

malignant retroperitoneal tumor

connective

78
Q

what is a rhabdomyosarcoma?

A

malignant retroperitoneal tumor

skeletal muscle

79
Q

what is a lymphoma?

A

malignant retroperitoneal tumor

lymphatics

most common of the cavities that can spread to the retroperitoneum, the Ca you will most likely see

80
Q

What is a teratomatous?

A

malignant retroperitoneal tumor

skin, muscle, tissue

81
Q

What is histiocytoma?

A

malignant retroperitoneal tumor

immune system

82
Q

what is a fibroma?

A

benign retroperitoneum tumor

connective tissue

83
Q

what is a lipoma?

A

benign retroperitoneum tumor

fatty tissue

84
Q

What is mesothelioma?

A

benign retroperitoneum tumor

epithelial cells

85
Q

What is myxoma?

A

benign retroperitoneum tumor

connective tissue

86
Q

What is a teratoma?

A

benign retroperitoneum tumor

varied tissue

87
Q

What is a urinoma?

A

a walled off collection of urine

sonolucent unless infected

88
Q

How does a hemorrhage appear in the retroperitoneum?

A

Sonolucent areas or organized thrombus

89
Q

See slide 96 for adrenal hemorrhage

A

trauma - due to abuse

90
Q

what is a hematoma?

A

a collection of blood

91
Q

What do you not want to confuse an abscess with in the retroperitoneum?

A

dont confuse gas pattern with normal bowel

92
Q

What is ascites?

A

fluid collection

93
Q

what does transudative ascites mean?

A

CHF or renal failure

94
Q

What does Exudative ascites mean?

A

malignancy or inflammatory

95
Q

What is Ormond’s disease?

A

a retroperitoneal fibrosis

thick sheets of fibrous tissue

96
Q

what are the symptoms of Ormond’s disease?

A

flank and back pain

weight loss

nausea and vomiting

malaise

97
Q

When you find a retroperitioneal mass what do you sonographically?

A

assess in two dimensions

measure

assess if it is fixed or free

determine echogenicity

solid, complex or cyst?

relationship to other organs

98
Q

don’t mistake a mass for _______

A

horseshoe kidney

99
Q

Where do the “Oma’s” usually live?

A

around the aorta or great vessels

100
Q

What muscles and spaces are found in the pelvic retroperitonem?

A

bilateral pararectal space:

bounded by piriformis and levator ani fascia (lateral to rectum)

101
Q

Where is the retrovesical space?

A

between the bladder and rectum

102
Q

What does aldosterone do?

A

related to sodium and chloride ions and pH

made in the cortex

steroid

103
Q

If you see lymphadenopathy what does the patient most likely have?

A

a primary tumor some where in the body

Abdomen 2 (8 decks)

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