Retroperitoneum Flashcards
What are the two layers of the peritoneum?
Parietal and visceral layers
What is the peritoneum?
Serous membrane that forms the lining of the abdominal cavity and covers most of the abdominal organs
What are the two separate compartments of the peritoneal cavity?
Lesser sac and greater sac
Where is the lesser sac?
Between the liver, pancreas and stomach
Where is the entrance to the lesser sac?
Epiploic foramen
Where is the pouch of Douglas?
Peritoneal recess extending between the rectum and the uterus
List the intraperitoneal structures.
Stomach Jejunum 1st part of duodenum Appendix Spleen Cecum Transverse and sigmoid colon Rectum Liver Uterus Fallopian tubes Ovaries
Where is the retroperitoneum located?
Posteriorly between the transversalis fascia and the posterior parietal peritoneum
What divides the retroperitoneum coronally into three compartments?
Renal fascia (Gerota’s fascia)
What are the 3 compartments of the retroperitoneum?
Anterior pararenal space
Perirenal space
Posterior pararenal space
List the structures of the retroperitoneum.
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
List the “abdominal sandwich”.
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
What two structures lie posterior to the posterior pararenal space and are separated by their own fascia?
Quadratus lumborum and psoas muscles
What is the first major branch of the abdominal aorta?
Celiac axis
What are the three branches of the celiac axis?
Common hepatic artery
Left gastric artery
Splenic artery
What two arteries make up the seagull or dove sign on ultrasound?
Common hepatic artery and the splenic artery
What is the 2nd branch off the abdominal aorta?
Superior mesenteric artery
What are the Doppler waveforms seen in the SMA?
Fasting state - high resistance
Postprandial - low resistance
Where do the renal arteries arise from on the aorta?
Just below the origin of the SMA
What is the most common tumor to involve the IVC?
Renal cell carcinoma
What are causes of IVC displacement?
Liver mass Right renal artery aneurysm Lymphadenopathy Tortuous aorta Right renal/adrenal mass
What is the proper location for an IVC filter?
Inferior to the renal veins
List the three hepatic veins.
Right, middle and left
Which renal vein is longer?
Left renal vein
What is the Nutcracker syndrome?
Engorgement of the left renal vein due to its compression by the SMA and aorta
Which gonadal vein drains directly into the IVC?
Right gonadal vein
The left gonadal vein drains into the left renal vein
What is Ormond’s disease?
Retroperitoneal fibrosis, inflammatory aneurysm
Dense fibrous tissue proliferation confined to the paravertebral region
What is associated with bilateral ureteral obstruction?
Retroperitoneal fibrosis because it envelopes structures rather than displacing them