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Summer 2014 - ABD 2 ✔️ > Retroperitoneum & Adrenal > Flashcards

Retroperitoneum & Adrenal Flashcards

0
Q

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

A

mesentery

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1
Q

the body cavity contains a large network of serous membranes is called the _________

A

peritoneum

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2
Q

what does the mesentaries do

A

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

tend to transmit important vessels and/or nerves

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3
Q

organs that have mesentaries are called ________ or ________

A

intraperitoneal or peritoneal

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4
Q

organs that have NO MESENTARIES are called _________

important

A

retroperitoneal

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5
Q

the retroperitoneal space technically is outside the peritoneum, between the ______ and the ______

A

abd and back

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6
Q

it is sometimes referred to as the retroperitoneum or __________ because of its location

A

extraperitoneum

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7
Q

________ organs are freely suspended by mesenteries. give examples of organs

A

intraperitoneal organs

stomach, liver, GB, spleen, jejunum, ileum, transverse colon, sigmoid colon, uterus, and ovaries

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8
Q

what develop and remain outside the peritoneal cavity

A

primarily retroperitoneal organs

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9
Q

what develop in the mesentaries, but get pushed against the body wall during growth so that only half of their surface or less is covered by peritoneum

A

secondarily retroperitoneal organs

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10
Q

define retroperitoneum

A

area between the posterior portion of the parietal peritoneum and posterior abd wall muscles

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11
Q

the retroperitoneum is delineated laterally by the lateral borders of the ______ ______ muscles and _______ leaves of the mesentery

A

quadratus lumborum

peritoneal

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12
Q

the retroperitoneal organs are the ones that adhere to the ______ ______ ______ and are not suspended by a ___________

A

posterior abd wall

mesentery

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13
Q

what are the 3 spaces within the retroperitoneum

A

anterior pararenal space
perirenal space
posterior pararenal space

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14
Q

what is found within the anterior pararenal space

A

second part of the duodenum
pancreas
ascending and descending colon

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15
Q

the perirenal space is surrounded by anterior and posterior layers of ______ ______

A

Gerotas’ fascia

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16
Q

what is found within the perirenal space

A 
kidney
adrenal
proximal ureter
renal vessels
ao
ivc
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17
Q

what is found within the posterior pararenal space

A

iliopsoas muscle

lymphatics

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18
Q

Pathologic processes can stretch from the anterior abd wall to the _________ space, ________, and _________ tissues of the back and flank

A

subdiaphragmatic space
mediastinum
subcutaneous tissues

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19
Q

retroperitoneum is protected by what parts

A

spine
ribs
pelvis
musculature

makes US difficult

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20
Q

retroperitoneum is _______ to assess by US. what is best to use

A

difficult

CT

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21
Q

retroperitoneum extends from the ________ to the _____ _____

A

diaphram to pelvic brim

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22
Q

retrofascial space is an…

A

extension of pathological processes - into the muscles

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23
Q

define diaphragmatic crura

A

linear muscular portions of the diaphragm

right crus / left crus

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24
Q

describe the right crus

A

longer and larger
posterior and medial to ivc
posterior to renal artery
anterior and medial to right kidney

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25
Q

indications for a retroperitoneal scan

A 
fever
pain
palpable mass
bleeding
distended abd
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26
Q

retroperitoneal scan will help in ruling out ________ collection…examples

A

fluid collection - hematoma, urinoma, ascites

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27
Q

what are bean shaped structures found in lymphoid tissue

A

lymph nodes - found along the great vessels

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28
Q

what are hypogastric nodes within the pelvis

A

iliac or para-aortic lymph nodes

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29
Q

para-aortic lymph nodes are within the _____ _____

A

upper retroperitoneum

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30
Q

indirect signs of para-aortic lymph nodes

A

sma and ao
course of sma
displacement of vessels
floating ao

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31
Q

normal lymph nodes are less than _____ cm

A

1

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32
Q

what will you do if the para-aortic lymph nodes are enlarged with infection or tumor

A

scan along ao and ivc, pancreatic head, and liver porta hepatis

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33
Q

examples/types of para-aortic lymph nodes

A 
mantle
floating
bilateral leg swelling
lymphadenopathy
consistent non moving pattern
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34
Q

describe iliac fossa

A

region between the iliac wings
false pelvis
contains ureter, distal great vessels and lymphatics

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35
Q

what muscles are part of the retrofascial space

A

psoas
quadratus lumborum
iliac

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36
Q

bilateral pararectal is bounded by _______ and ______ ______ fascia - lateral to rectum

A

piriformis and levator ani

37
Q

describe prevesical

A

pubis to anterior margin of the bladder - space of Retzius

38
Q

describe rectovesical

A

between bladder and rectum

39
Q

describe presacral

A

between rectum and sacrum

40
Q

AO enters the abd at ____ and bifurcates at ____ into the _____ _____ arteries

A

L1

L4

common iliac

41
Q

IVC is from the _____ _____ _____ junction

A

common iliac veins

42
Q

adrenal glands can also be called what

A

suprarenal glands

43
Q

describe adrenal vessels

A

3 arteries - suprarenal branches

single vein drains each gland

44
Q

name 2 types of endocrine glands

A

cortex - outer - 90% of gland

medulla - inner

45
Q

what are the 3 zona’s in the cortex

A

zona glomerulosa

zona fasciculate

zona reticularis

46
Q

describe zona glomerulosa

A

regulates electrolytes

produces aldosterone

47
Q

describe zona fasciculate

A

produces glucocorticords

48
Q

describe zona reticularis

A

stimulates testosterone and estrogen

49
Q

steroids: describe mineralocorticoids

PART OF CORTEX

A

regulates electrolyte metabolism

aldosterone

50
Q

steroid: describe glucocorticoids

PART OF CORTEX

A

regulates carbohydrate metabolism

cortisone and hydrocortisone

51
Q

PART OF CORTEX…

ACTH - what is is
example of hypofunctions and hyperfunctions

A

ACTH - adrenocorticotropic hormone form the pituitary

hypofunctions - Addison’s disease

hyperfunctions - Cushing’s, Conn’s, or adrenogenital syndrome

52
Q

PART OF THE CORTEX

hormones:
male? female?

A

androgens male sex hormone

estrogens female sex hormone

secretes both regardless of gender

53
Q

describe the medulla part of the adrenal gland

A

central portion

regulates blood pressure
secretes epinephrine and nonepinephrine

54
Q

shape of the adrenal glands: left and right

A

left - semilunar

right - triangular

55
Q

______ adrenal glands are proportionately larger compared to the kidney

A

infant

1/3 size of kidney for infants
1/13 size of kidney for adults

56
Q

infant adrenal gland looks like what

A

thin echogenic core – medulla

surrounded by thick transonic zone - cortex

57
Q

where are the adrenal glands

A

anterior, medial, and superior to the kidneys

medial right adrenal gland posterior to the IVC

left adrenal is more medial to the kidney

58
Q

indications for an adrenal exam

A 
hypertension
decreases hematocrit - hemorrhage
distention
anxiety
sweating
weight loss
follow up to CT
59
Q

adrenal glands characteristics

A

hypoechoic structure
sometimes highley echogenic fat surrounds the gland
usually smaller than 5 cm

60
Q

why don’t we see the adrenal gland on US

A

patient size
surrounding fat
bowel gas
ability to move patients

61
Q

describe right adrenal gland

A

triangular or pyramidal shape
lateral to crus
line up IVC, liver, and superior kidney

62
Q

describe left adrenal gland

A

crescent or semilunar
posterior and medial to left crus
posterior to tail of pancreas
line up AO, spleen, and superior kidney

63
Q

adrenal gland function syndromes of the cortex

A

addison’s
adrenogenitial
conn’s
cushing’s

64
Q

describe Addison’s disease

A

hypofunction - decreased functions, not enough production of cortisol and aldosterone

atrophy of the cortex

prognosis - good with steroid replacement therapy

65
Q

what are symptoms of Addison’s disease

deals within the cortex

A

increased sodium retention
tissue edema
hyperpigmentation
fatigue and muscle weakness

66
Q

describe adrenogenital syndrome (AG)

deals within the cortex

A

excessive secretion

symptoms - hormonal changes

67
Q

describe conn’s syndrome

deals within the cortex

A

hyperaldosteronism

excessive secretion of aldosterone

symptoms - muscle weakness, hypertension

68
Q

describe Cushing’s syndrome

deals within the cortex

A

hyperfunction

excessive secretion of cortisol

may have pituitary involvement

symptoms - moon face, buffalo hump, psychiatric issue

69
Q

describe waterhouse-friderichsen syndrome

A

bilateral adrenal hemorrhage

infection

can be fatal if not treated immediately

70
Q

describe adrenal cysts

A 
anechoic
well defined borders
through transmission
round
smooth
71
Q

describe adrenal hemorrhage

A

severe trauma or infection
MOST COMMON adrenal abn in newborns
decreased hematocrit
result of traumatic vaginal delivery

72
Q

adrenal medulla tumors: describe pheochromocytoma

A

excessive epinephrine and nonepinephrine

sonographically - unilateral, homogeneous pattern

lab tests - metanephrine, catecholamine

73
Q

adrenal medulla tumors: pheochromocytoma are usually ______

list symptoms…

A

benign

headaches
tachycardia
tremors
anxiety
excessive sweating
uncontrollable HTN
74
Q

describe benign adrenal adenoma

A

solid
well defined
round

75
Q

adrenal gland _____ and _____ also exists

A

CA

metastasis

76
Q

adrenal medulla tumors: describe adrenal neuroblastoma

A

MOST COMMON malignancy of the adrenal gland in children

arise from medulla

sonographically - echogenic mass, metastatic to live

77
Q

what is the most common tumor of infancy, representing ____% of all neonatal tumors

A

adrenal neuroblastoma

30%

78
Q

do not confuse a neuroblastoma with what

A

nephroblastoma - Wilm’s tumor of the kidney

79
Q

malignant retroperitoneal tumors:

neurogenic?
leiomysarcomas?
liposarcomas?
fibrosarcomas?
rhabdomyosarcomas?
lymphomas?
teratomatous?
histiocytoma?
A 
neurogenic - nerve root
leiomysarcomas - smooth muscle
liposarcomas - adipose - MOST COMMON
fibrosarcomas - connective
rhabdomyosarcomas - skeletal muscle
lymphomas - lymphatics
teratomatous - skin, muscle, tissue
histiocytoma - immune system
80
Q

benign retroperitoneum tumors:

fibroma?
lipoma?
mesothelioma?
myxoma?
teratoma?
A 
fibroma - connective tissue
lipoma - fatty tissue
mesothelioma - epithelial cells
myxoma - connective tissue
teratoma - varied tissue
81
Q

what is a urinoma

A

walled off collection of urine

sonolucent unless infected

82
Q

what is a hemorrhage

A

sonolucent areas or organized thrombus

**adrenal hemorrhage

83
Q

what is an abscess

A

complex pattern

do not confuse gas pattern with normal bowel

84
Q

what is a hematoma

A

collection of blood

85
Q

describe transudative ascites

A

CHF or renal failure

86
Q

describe exudative ascites

A

malignancy or inflammatory

87
Q

what is ormond’s disease

A

thick sheets of fibrous tissue

88
Q

symptoms of ormond’s disease

A

flank and back pain
weight loss
nausea and vomiting
malaise

89
Q

what criteria is described for a retroperitoneal mass

A 
assess in 2 dimensions
measure
assess if it is fixed or free
determine echogenicity
discover solid, complex, or cyst
relationship to other organs
90
Q

what can ormond’s disease be mistaken for

A

horseshoe kidneys

Summer 2014 - ABD 2 ✔️ (9 decks)

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