The Peritoneal Cavity

Question 1

What is the peritoneal membrane?

Answer 1

Thin sheet of tissue dividing the abdo cavity into peri and retroperi compartments

Question 2

What contains the liver, spleen, stomach, first part of the duodenum, jejunum, ileum, cecum, transverse colon, sigmoid colon, upper 2/3 of rectum

Answer 2

In the greater sac

Question 3

In the greater omentum, 2 layers are separate in infants but contains fat in adults. True or false?

Answer 3

True

Question 4

What does the greater omentum do?

Answer 4

Prevents the parietal peritoneum of the anterior abdo wall from adhering to the visceral peritoneum. Also divides greater sac into supracolic and infracolic compartments with communication via the paracolic gutters.

Question 5

The lesser sac is also called the…

Answer 5

Omental Bursa

Question 6

What two ligaments create the left lateral wall of the Omental Bursa?

Answer 6

Splenorenal and gastrosplenic

Question 7

The lesser omentum (aka small omentum) does what?

Answer 7

Encloses the sac superiorly

Question 8

The falciform ligament’s right layer forms the:

Answer 8

upper layer of the coronary ligament

Question 9

The falciform’s left layer forms the upper layer of the:

Answer 9

left triangular ligament

Question 10

The left triangular ligament is:

Answer 10

formed by the left branch of the falciform ligament and the parietal peritoneum; forms the left extremity of the bare area of the liver

Question 11

Describe the left subphrenic/suprahepatic space.

Answer 11

Extension of the greater sac between the diaphragm and the anterior superior liver to the left of the falciform ligament

Question 12

Describe the right subphrenic/suprahepatic space.

Answer 12

Extension of the greater sac between right hemidiaphragm and the anterior superior liver to the right of the falciform ligament

Question 13

Describe the left posterior suprahepatic space (superior recess of the lesser sac).

Answer 13

Extension of the lesser sac between the diaphragm and the posterior superior liver.

Question 14

Describe the Hepatorenal space (Morrisons pouch).

Answer 14

Between the liver and the right kidney, when supine it is the most gravity-dependent potential space in abdo.

Question 15

Describe the lesser sac (omental bursa).

Answer 15

Between the posterior stomach and parietal peritoneum. Covers anterior panc, splenorenal and gastrosplenic ligaments, epiploic foramen (foramen of Winslow)

Question 16

Describe the right and left paracolic gutters.

Answer 16

Along lateral ascending and descending colon, conducts fluid between supracolic and infracolic compartments

Question 17

What are the two types of ascites?

Answer 17

Transudative and exudative

Question 18

What are the causes of ascites?

Answer 18

Renal failure, abdo trauma, and malignancy

Question 19

Transudative ascites is associated with:

Answer 19

Portal hypertension and congestive cardiac disease

Question 20

Exudative ascites is associated with:

Answer 20

Renal failure, inflammatory of ischemic bowel disease, peritonitis, malignancy

Question 21

What is the most common space for a peritoneal abscess?

Answer 21

Right subphrenic space (due to appendicitis and duodenal ulcers)

Question 22

What is hemoperitoneum?

Answer 22

Blood within the peritoneum, unorganized

Question 23

Large hematomas will present with a drop in ________.

Answer 23

hematocrit

Question 24

What is pseudomyxoma peritonei?

Answer 24

Borderline malignant process that results when a benign appendiceal or ovarian adenoma ruptures, spilling epithelial cells into the peritoneum. Mucus then accumulates around bowel, causing fibrosis of the peritoneal membranes, creating adhesions.

Question 25

What are the sonographic signs and features of Pseudomyxoma Peritonei?

Answer 25

Simple or multiloculated ascites or several thin walled cysts in peritoneum. Can have omental caking.

Question 26

What is a seroma?

Answer 26

Fluid collection of blood products typically adjacent to transplanted organs. May contain septa.

Question 27

What is a lymphocele?

Answer 27

A collection of lymphatic fluid due to disruption of lymphatic vessels or lymph node resection. Develops 4-8 wks after surgery.

Question 28

What is a urinoma?

Answer 28

Collection of urine that can occur after a ruptured urinary tract. Typically found adjacent to kidney in the retroperitoneum.

Question 29

What is biloma?

Answer 29

Collection of bile. Associated with hepatic transplant due to biliary leak or ischemia, trauma, biopsy, or cholecystectomy.

Question 30

Where is the most common place for a mesenteric cyst?

Answer 30

Small bowel mesentery

Question 31

What are the complications of a mesenteric cyst?

Answer 31

Torsion, hemorrhage, mass effect

Question 32

Mesenteric adenopathy (definition, associations)

Answer 32

Enlarged lymph nodes along the mesentery or on the bowel. Associated with colitis, appendicitis, viral infections, lymphoma, metastatic malignancy (colon cancer)

Question 33

Peritoneal Mesothelioma is associated with:

Answer 33

Asbestos exposure

Question 34

Peritoneal Mesothelioma has a sonographic appearance of:

Answer 34

Discrete nodule or thickened peritoneum, mesentery, omentum, and bowel. May have areas of calcification and small amount of ascites.

Question 35

Peritoneal Implants are associated with:

Answer 35

Peritoneal mets!

Question 36

What is the sonographic appearance of Peritoneal Implants?

Answer 36

Multiple small polypoid masses projecting from peritoneum, complex ascites, omental caking

Question 37

What is omental caking?

Answer 37

Thickening of the greater omentum due to malignant infiltration

Question 38

Omental caking is associated with:

Answer 38

Peritoneal mets, primary cancers of the ovary/stomach/colon

Question 39

What has a sonographic appearance of: echogenic homogenous thick soft tissue layer deep to the anterior wall and is associated with complex ascites and peritoneal implants?

Answer 39

Omental caking