Abdominal Composition and Vasculature

Question 1

Peritoneal cavity

Answer 1

Made up of ligaments and folds that connect organs to each other and abdominal walls

Question 2

Peritoneal cavity is comprised of

Answer 2

• Lesser and greater omentum
• mesenteries
• ligaments
• fluid spaces

Question 3

What is peritoneum

Answer 3

Smooth membrane that lines the entire abdominal cavity and the organs contained within the cavity

Question 4

Parietal peritoneum

Answer 4

Lines the walls of the cavity

Question 5

Visceral peritoneum

Answer 5

Lines the abdominal organs

Question 6

Greater sac

Answer 6

General peritoneal cavity

Question 7

Lesser sac

Answer 7

Smaller area or peritoneal cavity formed by spleen and posterior stomach

Question 8

Greater and lesser sac communicate through

Answer 8

Opening inferior to liver and duodenum called epiploic foramen

Question 9

Lesser omentum

Answer 9

Double layer of peritoneum extending from the liver to the lesser curvature of the stomach

Question 10

The lesser omentum does what for the stomach

Answer 10

Acts like a sling

Question 11

Greater omentum

Answer 11

Apron-like fold of peritoneum that hangs from the greater curvature of the stomach

Question 12

The greater omentum lies

Answer 12

Freely over intestines except for the superior portion which is fused with the transverse colon

Question 13

The greater omentum can be compared to

Answer 13

A skirt for the intestines, covers small intestines

Question 14

The lesser omentum attaches

Answer 14

Stomach to liver

Question 15

Mesentery

Answer 15

2 layered peritoneal folds which suspend the small bowel and colon to the posterior abdominal and pelvic wall

Question 16

Mesentery is best visualized on ultrasounds with

Answer 16

Presence of ascites

Question 17

Peritoneal spaces

Answer 17

• right and left subphrenic spaces
• posterior cul-de-sac
• subhepatic space
• lesser sac
• right and left paracolic gutters

Question 18

Anterior abdominal wall layers (superficial to deep)

Answer 18

• skin
• fascia
• muscle
• fascia transversalis
• peritoneum

Question 19

Camper’s fascia

Answer 19

Fatty superficial layer

Question 20

Scarpa’s fascia

Answer 20

Deep fibrous layer

Question 21

Anterior abdominal wall muscles

Answer 21

• rectus abdominus
• external oblique
• internal oblique
• transverse abdominal

Question 22

Rectus abdominus

Answer 22

Longitudinally oriented muscles extending from xiphoid process to pubic bone, midline

Question 23

Rectus abdominus muscles are encased in

Answer 23

A sheath which joins at the midline to form the linea alba, sheath attaches and secures musculature to abdominal cavity

Question 24

Sonographic evaluation of anterior abdominal wall

Answer 24

Fatty composition layers: Hypoechoic depending on content
Musculature: linear striations, Hyperechoic (high density structures)

Question 25

Aorta

Answer 25

Main vessel that carries blood from heart to rest of body

Question 26

Abdominal aorta

Answer 26

Portion of descending aorta that supplies blood to abdomen, pelvis, and lower extremities

Question 27

Aorta layers

Answer 27

1. Tunica intima (inner) 2. Tunica media (mid) 3. Tunica adventitia (outer)

Question 28

Aorta position

Answer 28

Posterior to: - left lobe - body of pancreas - pylorus of stomach - splenic vein

Question 29

Main branches of aorta

Answer 29

- celiac - SMA - renal arteries - IMA

Question 30

Celiac branch

Answer 30

First branch off aorta Sub-branches: left gastric artery, common hepatic artery, splenic artery Supplies stomach, liver, spleen

Question 31

Superior Mesenteric artery supplies

Answer 31

Duodenum, small intestines, and transverse colon

Question 32

Renal arteries

Answer 32

Left renal artery branches off aorta first

Question 33

Inferior mesenteric artery supplies

Answer 33

Large intestines

Question 34

Aorta bifurcates at

Answer 34

Level of L4

Question 35

Aorta bifurcates into

Answer 35

Right and left iliac arteries which supply respective legs

Question 36

Sonographic evaluation of aorta

Answer 36

- blood filled lumen: anechoic - walls: echogenic - long, pulsatile, tubular structure - located anterior and left of the spine - can use left lobe of liver as landmark

Question 37

Sagittal aorta protocol

Answer 37

Proximal: AP diameter above celiac branch Mid Distal: normal increase in diameter due to upcoming bifurcation Bifurcation: right and left common iliac arteries

Question 38

Transverse aorta protocol

Answer 38

Proximal Mid Distal Bifurcation: color eval

Question 39

Patient prep

Answer 39

NPO 6-8 hours Curved transducer 3-5 MHz Patient scanned supine, can use decub to move gas

Question 40

Normal proximal AP diameter of aorta

Answer 40

Men: 2.5-2.7 cm Women: 2.1-2.3 cm

Question 41

Thrombus

Answer 41

Accumulation of blood cells, can embolize resulting in life threatening blockage of vessel

Question 42

Calcification

Answer 42

Accumulation of plaque products along the walls of the artery, resulting from disease, old age, poor dietary habits

Question 43

Wall dissection

Answer 43

Inner layer of aortic wall tears, caused inner and middle layer to separate

Question 44

What are we looking for during aorta evaluation

Answer 44

- normal diameter - thrombus - calcification - wall dissection

Question 45

Inferior vena cava

Answer 45

Main vessel that carries blood from the extremities and abdominal/pelvic cavity back to the heart

Question 46

IVC is formed by

Answer 46

Union of the common iliac veins

Question 47

The IVC ascends

Answer 47

Vertically through the retroperitoneal space, travels posterior to the liver and right of the aorta

Question 48

Sonographic evaluation of IVC

Answer 48

- blood filled lumen: anechoic - walls: thin, collapsible, not as echogenic as aorta walls - phasic: diameter changes, color doppler evaluation

Question 49

IVC protocol

Answer 49

Typically using IVC as landmark reference Included in abdominal evaluation Sagittal: proximal with color Doppler Look for thrombus