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Retroperitoneum Flashcards

0
Q

What are the two layers of the peritoneum?

A

Parietal and visceral layers

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1
Q

What is the peritoneum?

A

Serous membrane that forms the lining of the abdominal cavity and covers most of the abdominal organs

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2
Q

What are the two separate compartments of the peritoneal cavity?

A

Lesser sac and greater sac

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3
Q

Where is the lesser sac?

A

Between the liver, pancreas and stomach

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4
Q

Where is the entrance to the lesser sac?

A

Epiploic foramen

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5
Q

Where is the pouch of Douglas?

A

Peritoneal recess extending between the rectum and the uterus

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6
Q

List the intraperitoneal structures.

A 
Stomach
Jejunum
1st part of duodenum
Appendix
Spleen
Cecum
Transverse and sigmoid colon
Rectum
Liver
Uterus
Fallopian tubes
Ovaries
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7
Q

Where is the retroperitoneum located?

A

Posteriorly between the transversalis fascia and the posterior parietal peritoneum

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8
Q

What divides the retroperitoneum coronally into three compartments?

A

Renal fascia (Gerota’s fascia)

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9
Q

What are the 3 compartments of the retroperitoneum?

A

Anterior pararenal space
Perirenal space
Posterior pararenal space

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10
Q

List the structures of the retroperitoneum.

A 
Kidneys and ureters
Adrenal glands
Ascending and descending colon
Second, third and fourth parts of the duodenum
Pancreas
Aorta and IVC
Renal vessels
Superior mesenteric vessels
Gonadal vessels
Lymphatics 
Prostate
Rectum
Esophagus
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11
Q

List the “abdominal sandwich”.

A 
ANTERIOR
Transversalis fascia
Anterior parietal peritoneum
Peritoneal space
Anterior pararenal space
Anterior renal fascia
Perirenal space
Posterior renal fascia
Posterior pararenal space
Transversalis fascia
POSTERIOR
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12
Q

What two structures lie posterior to the posterior pararenal space and are separated by their own fascia?

A

Quadratus lumborum and psoas muscles

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13
Q

What is the first major branch of the abdominal aorta?

A

Celiac axis

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14
Q

What are the three branches of the celiac axis?

A

Common hepatic artery
Left gastric artery
Splenic artery

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15
Q

What two arteries make up the seagull or dove sign on ultrasound?

A

Common hepatic artery and the splenic artery

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16
Q

What is the 2nd branch off the abdominal aorta?

A

Superior mesenteric artery

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17
Q

What are the Doppler waveforms seen in the SMA?

A

Fasting state - high resistance

Postprandial - low resistance

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18
Q

Where do the renal arteries arise from on the aorta?

A

Just below the origin of the SMA

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19
Q

What is the most common tumor to involve the IVC?

A

Renal cell carcinoma

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20
Q

What are causes of IVC displacement?

A 
Liver mass
Right renal artery aneurysm
Lymphadenopathy
Tortuous aorta
Right renal/adrenal mass
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21
Q

What is the proper location for an IVC filter?

A

Inferior to the renal veins

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22
Q

List the three hepatic veins.

A

Right, middle and left

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23
Q

Which renal vein is longer?

A

Left renal vein

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24
What is the Nutcracker syndrome?
Engorgement of the left renal vein due to its compression by the SMA and aorta
25
Which gonadal vein drains directly into the IVC?
Right gonadal vein | The left gonadal vein drains into the left renal vein
26
What is Ormond's disease?
Retroperitoneal fibrosis, inflammatory aneurysm | Dense fibrous tissue proliferation confined to the paravertebral region
27
What is associated with bilateral ureteral obstruction?
Retroperitoneal fibrosis because it envelopes structures rather than displacing them
28
Which veins provide an alternate pathway for venous return in the case of IVC obstruction?
Azygos and hemiazygos veins
29
What is unique about the azygos vein?
It is unpaired, the hemiazygos is a tributary of the azygos vein
30
Where does the ascending lumber vein join the right subcostal vein to form the azygos vein?
Level of the diaphragm
31
What is the difference between the right and left adrenal glands?
The right is shaped like a triangle or pyramid | The left is crescent shaped
32
Where is the crus of the diaphragm located?
Anterior to the aorta Superior to the celiac axis Posterior to the IVC
33
How does the adrenal cortex appear on ultrasound?
Hypoechoic and typically is less echogenic than the surrounding retroperitoneal fat
34
How does the adrenal medulla appear on ultrasound?
Echogenic linear structure within the adrenal gland
35
What three arteries supply each adrenal gland?
Suprarenal renal branch of the inferior phrenic artery Suprarenal branch of the aorta Suprarenal branch of the renal artery
36
What steroid hormones does the adrenal cortex produce?
Mineralcorticoids (Aldosterone) Glucocorticoids (Cortisol) Androgens
37
What regulates the adrenal cortical hormones?
Adrenocorticotropic hormones of the anterior pituitary gland
38
What two organs function together to regulate hormones production?
Adrenal gland and the anterior pituitary gland
39
What stimulates the adrenal cortex?
Increased ACTH from a decrease in adrenal cortical function
40
What leads to a drop in the activity of the adrenal cortex?
Increase in adrenal hormones that leads to a drop in ACTH secretions
41
Which catecholamines are produced by the adrenal medulla?
Epinephrine | Norepinephrine
42
What syndromes are the result of adrenal hyperfunctioning from adrenal adenomas?
Cushing's syndrome | Conn syndrome
43
What is Cushing's syndrome associated with?
Excessive cortisol secretion Administration of glucocorticoids Increased ACTH from a pituitary adenoma Primary adrenal adenoma Ectopic ACTH
44
What is Conn syndrome associated with?
Excessive aldosterone secretion Adrenal adenomas Adrenal hyperplasia
45
What causes hirsutism?
``` Excessive androgen production from Congenital adrenal hyperplasia Pituitary tumor Adrenocortical carcinoma Ovarian tumor PCOS ```
46
How do patients with adrenal cortical carcinoma present?
Cushing's syndrome | Metastatic involvement
47
What do adrenal cortical carcinomas have a tendency to invade?
Renal veins and IVC
48
Where do pheochromocytomas originate?
Adrenal medulla | May occur in ectopic locations
49
What do pheochromocytomas secrete?
Catecholamines (Norepinephrine and epinephrine)
50
What are pheochromocytomas associated with?
MEN | Von Hippel-Lindau disease
51
What is an adrenal neuroblastoma?
Malignant tumor arising from the sympathetic nervous system
52
What is the most common presentation of an adrenal neuroblastoma?
Palpable abdominal mass
53
What is the most common adrenal mass of infancy and early childhood?
Adrenal neuroblastoma
54
Between what ages do adrenal neuroblastomas occur?
Two months and two years
55
How do adrenal neuroblastomas appear on ultrasound?
Solid mass that displaces the ipsilateral kidney inferiorly into the pelvis
56
What is a myelolipoma?
Benign, nonfunctioning adrenal masses that contain fat and bone elements
57
What artifact is a myelolipoma associated with?
Propagation speed artifact
58
What is the most common cell type associated with adrenal lymphoma?
Non-Hodgkin's disease
59
What is the fourth most common metastatic site?
Adrenal glands
60
At what age group is adrenal hemorrhage the most common?
Neonate
61
How does adrenal hemorrhage appear on ultrasound?
Variable due to blood coagulation
62
What is the most common adrenal mass in a newborn?
Adrenal hemorrhage
63
``` List the direction in which the IVC will be displaced? Right liver mass Right renal artery aneurysm Tortuous aorta Right adrenal mass Right renal mass ```
``` Posterior Anterior Right Medial/anterior Medial/left ```
64
How does lymphadenopathy displace the IVC and SMA?
Anteriorly
65
What direction will the splenic vein be displaced by a left adrenal mass?
Anterior
66
What direction will the bladder be displaced by hematoma in the pouch of Douglas?
Anterior
67
With a gastric outlet obstruction and dilatatian of the stomach, what direction will be pancreatic tail be displaced?
Posterior
68
What direction will a mass in the uncinate process displace the SMV?
Anterior
69
What direction will a neuroblastoma displace the ipsilateral kidney?
Inferior
70
What direction will a mass in the left lobe of the liver displace the gastroesophageal junction?
Posterior

Abdominal Sonography (12 decks)

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