Ch. 39 Peritoneal Space

Question 1

What connects the stomach and the spleen?

Answer 1

Gastrosplenic ligament

Question 2

What connects the colon to the duodenum?

Answer 2

Duodenocolic ligament - descending colon to proximal part of ascending duodenum

Question 3

What and where is the mesenteric root?

Answer 3

site of the attachment of the mesentery to the dorsal abdominal wall, which commonly is located ventral to the second lumbar vertebra

Question 4

Where is the prostate gland
A) peritoneal
B) retroperitoneal
C) neither
D) both

Answer 4

B - the ventral aspect is covered by peritoneum, therefore it is retroperitoneal

Question 5

Are the adrenal glands peritoneal or retroperitoneal?

Answer 5

retroperitoneal

Question 6

In the _________ dog, the peritoneal cavity is _______.

Male/Female
Open/Closed
If open - where is it open

Answer 6

male - completely closed
female - open, via the cranial aspect of the uterine horns

Question 7

Answer 7

b) Through the cranial aspect of the uterine horns

Question 8

Answer 8

b) Mainly ventral, very movable, and contains variable amounts of fat

Question 9

Answer 9

b) Higher water content and opacity closer to that of soft tissue

Question 10

which is which in the images?
normal and mature cat / dog
young patient
obese/emaciated patient

Answer 10

Question 11

Causes of decreased serosal detail

Answer 11

Question 12

What could gas-filled bowel loops in a non-central location in patients with a large amount of peritoneal fluid suggest?

Answer 12

The presence of an abdominal mass or adhesions (which prevent free movement), or a large amount of peritoneal fat (esp. in cats)

Question 13

What additional finding might be observed on ultrasound in patients with sclerosing encapsulating peritonitis?

a) No fluid present
b) Large quantities of peritoneal fluid and small bands covering organ surfaces
c) Gas bubbles
d) Bone fragments

Answer 13

b) Large quantities of peritoneal fluid and small bands covering organ surfaces

Question 14

Answer 14

Question 15

Answer 15

Question 16

What is the echogenicity of fluid with moderate to high cellular content, such as exudate, blood, or chyle?

a) Hyperechoic
b) Hypoechoic
c) Isoechoic
d) Anechoic

Answer 16

a) Hyperechoic

Question 17

What is the echogenicity of fluid with low cellular content, such as urine or a transudate?

a) Hyperechoic
b) Hypoechoic
c) Isoechoic
d) Anechoic

Answer 17

d) Anechoic

Question 18

How long might proteinaceous fluids like serum, blood, and lymph be present in the peritoneal cavity after laparotomy?

a) 1 to 2 days
b) 3 to 4 days
c) 5 to 7 days
d) 1 to 2 weeks

Answer 18

d) 1 to 2 weeks

Question 19

How long does it take for solutions containing water, electrolytes, and low molecular weight components to be absorbed by the peritoneal membrane?

a) 6 hours
b) 12 hours
c) 24 hours
d) 48 hours

Answer 19

c) 24 hours

Question 20

Answer 20

Question 21

What pigment is deposited in fat during steatitis, causing increased radiopacity on radiographs?

a) Melanin
b) Bilirubin
c) Ceroid
d) Hemoglobin

Answer 21

c) Ceroid

Question 22

What condition can result in steatitis in cats due to dietary issues?

a) Vitamin B deficiency
b) Vitamin E deficiency and/or excessive polyunsaturated fatty acids
c) Excessive protein intake
d) High carbohydrate diet

Answer 22

b) Vitamin E deficiency and/or excessive polyunsaturated fatty acids

Question 23

Primary de novo peritoneal neoplasia in companion animals encompasses which of the following types of tumors, particularly considering those where the primary origin remains unidentified?

a) Lipoma, fibroma, hemangioma
b) Osteosarcoma, chondrosarcoma, rhabdomyosarcoma
c) Mesothelioma, leiomyoma, carcinomas with primary origin not identified
d) Melanoma, lymphoma, mastocytoma
e) Hemangioma, liposarcoma, adenocarcinoma

Answer 23

c) Mesothelioma, leiomyoma, carcinomas with primary origin not identified

Question 24

What is a potential manifestation of peritoneal infection by Mesocestoides species tapeworms on imaging?

a) Solitary, solid mass
b) Multiple, fluid-filled cavities
c) Diffuse peritoneal thickening
d) Cavitary, septated structures with echogenic particles

Answer 24

d) Cavitary, septated structures with echogenic particles

Question 25

What imaging appearance is characteristic of peritoneal infection by Mesocestoides species tapeworms? a) Homogeneous solid masses b) Cavitary, septated structures with echogenic particles c) Linear calcified structures d) Diffuse hyperechoic regions

Answer 25

b) Cavitary, septated structures with echogenic particles

Question 26

Most common primary tumour of the retroperitoneal space

Answer 26

Lipoma

Question 26

How long will pneumoperitoneum persist following laparotomy?

Answer 26

Days to weeks, depending on size of patient and amount of gas

Question 27

How can small volumes of peritoneal gas be made more detectable on a radiograph? a) By using a vertical x-ray beam b) By using a horizontal x-ray beam and positioning the patient for 10 minutes before exposure c) By increasing the radiation dose d) By keeping the patient in a standing position

Answer 27

b) By using a horizontal x-ray beam and positioning the patient for 10 minutes before exposure

Question 27

Free peritoneal gas usually floats to the highest point within the abdomen. In lateral recumbency, this is usually _______________ or _________.

Answer 27

- under the caudal aspect of the ribs - in the mid abdomen.

Question 28

How can digital images be adjusted to make peritoneal gas more visible? a) Increase the brightness b) Decrease the brightness c) Increase the contrast d) Decrease the contrast

Answer 28

a) Increase the brightness

Question 28

Which projection is most sensitive for detecting small volumes of peritoneal gas? a) Oblique view with the patient in standing position b) Lateral view with a horizontally directed x-ray beam and the patient in dorsal recumbency c) Ventrodorsal view with the patient in right recumbency d) Anteroposterior view with the patient in left recumbency

Answer 28

b) Lateral view with a horizontally directed x-ray beam and the patient in dorsal recumbency c - VD view also, but in LL because in RL the fundus will be where gas would accumulate and may be gas filled

Question 29

Answer 29

Question 30

Answer 30

Question 31

Answer 31

Question 32

What sonographic artifact is commonly noted at the soft tissue to air interface in cases of free gas in the peritoneal cavity? a) Ring-down artifact b) Mirror image artifact c) Reverberation artifact d) Acoustic shadowing

Answer 32

c) Reverberation artifact (dirty shadowing) Incorrect Options: a) Ring-down artifact: While similar to reverberation artifacts, ring-down artifacts occur due to resonance within a fluid collection trapped between gas bubbles, often producing a continuous band of echoes below the gas bubble. It is not the primary artifact seen at the soft tissue to air interface in free peritoneal gas cases. b) Mirror image artifact: This occurs when an ultrasound wave reflects off a strong reflector, such as the diaphragm or a large vessel, creating a duplicate image on the opposite side of the reflector. It is not typically associated with free gas detection in the peritoneal cavity. d) Acoustic shadowing: This artifact occurs when an ultrasound wave is blocked by a dense structure (such as bone or a calcified object), creating a shadow behind it. Acoustic shadowing is not specific to the soft tissue to air interface and is not the primary indicator of free gas in the peritoneal cavity.

Question 33

What is the minimum volume of air in the peritoneal space detectable by ultrasound in dogs? a) 0.1 mL b) 0.2 mL c) 0.3 mL d) 0.4 mL

Answer 33

d) 0.4 mL

Question 34

What adjustment should be made to film radiography factors to make peritoneal gas more conspicuous? a) Increase the exposure time b) Intentionally underexpose the abdomen c) Increase the radiation dose d) Reduce the focal spot size

Answer 34

b) Intentionally underexpose the abdomen

Question 35

In which species are Bates bodies more commonly found? a) Dogs b) Cats c) Horses d) Birds

Answer 35

Answer: b) Cats can also occur in dogs

Question 36

What could result in a mineralized fetus in the peritoneal space? a) Chronic renal disease b) Ectopic pregnancy c) Ovarian cyst rupture d) Uterine fibroids

Answer 36

b) Ectopic pregnancy

Question 37

Answer 37

C) Lipoma

Question 38

Which lymph centers are included in the parietal group? A) Lumbar, iliosacral, and iliofemoral lymph centers B) Cervical, thoracic, and axillary lymph centers C) Mesenteric, hepatic, and splenic lymph centers D) Inguinal, popliteal, and axillary lymph centers

Answer 38

A) Lumbar, iliosacral, and iliofemoral lymph centers

Question 39

Where are all parietal lymph nodes, except the iliofemoral lymph nodes, located? A) In the thoracic cavity B) In the abdominal cavity C) In the retroperitoneal space D) In the mediastinum

Answer 39

C) In the retroperitoneal space

Question 40

Which structures do parietal lymph nodes receive afferent lymphatics from? A) Spine, adrenal glands, kidneys, genital organs B) Heart, lungs, liver, pancreas C) Muscles, bones, skin, joints D) Brain, eyes, ears, nose

Answer 40

A) Spine, adrenal glands, kidneys, genital organs

Question 41

What is the iliofemoral lymph center? A) A group of multiple lymph nodes B) Consists of only one distal femoral lymph node C) Located in the thoracic cavity D) Found in all dogs

Answer 41

B) Consists of only one distal femoral lymph node - in about 10% of dogs

Question 42

Where does the efferent vessels from the parietal lymph nodes drain into? A) Thoracic duct B) Jugular trunk C) Lumbar trunk D) Mesenteric trunk

Answer 42

C) Lumbar trunk > cisterna chyli Cranial parietal lnn may bypass lumbar trunk and go directly into cisterna chyli

Question 43

Where are the medial iliac lymph nodes typically located? A) Ventral to L1 and L2 B) Ventral to L3 and L4 C) Ventral to L5 and L6 D) Ventral to L6 and L7

Answer 43

D) Ventral to L6 and L7

Question 44

Which lymph centers make up the visceral lymph group? A) Cervical, axillary, and inguinal lymph centers B) Celiac, cranial mesenteric, and caudal mesenteric lymph centers C) Thoracic, abdominal, and pelvic lymph centers D) Superficial, deep, and intermediate lymph centers

Answer 44

B) Celiac, cranial mesenteric, and caudal mesenteric lymph centers

Question 45

The celiac lymph center includes lymph nodes serving which organs? A) Lungs and heart B) Liver, spleen, stomach, and pancreas C) Kidneys and adrenal glands D) Brain and eyes

Answer 45

B) Liver, spleen, stomach, and pancreas

Question 46

What is the relationship between the gas dilation of the duodenum and pancreatitis? A) It confirms pancreatitis B) It rules out pancreatitis C) It suggests but does not confirm pancreatitis D) It has no relation to pancreatitis

Answer 46

Answer C: The gas dilation, referred to as the sentinel loop sign, is not definitive evidence for pancreatitis.

Question 47

How does an abnormal pancreas appear on MRI in cats? A) T1 pre-contrast isointense and T2 hypointense B) T1 pre-contrast hypointense and T2 hyperintense C) T1 pre-contrast hyperintense and T2 hypointense D) T1 pre-contrast isointense and T2 hyperintense

Answer 47

B: T1 pre-contrast hypointense and T2 hyperintense

Question 48

What were the characteristics of the pancreas in dogs with suspected pancreatitis on the three-phase contrast enhanced CT? A) The pancreas was shrunken and well-defined B) The pancreas was normal-sized and homogeneously enhancing C) The pancreas was enlarged, homogenously or heterogeneously contrast enhancing, and had ill-defined borders D) The pancreas was small and heterogeneously enhancing

Answer 48

B : The pancreas was enlarged, homogenously or heterogeneously contrast enhancing, and had ill-defined borders. heterogeneously - worse prognosis clinically

Question 49

What is the most common primary pancreatic tumour in dogs?

Answer 49

islet cell carcinoma compatible with insulinoma, followed by pancreatic adenocarcinoma

Question 50

Where do exocrine pancreatic carcinoma is tend to invade and metastasise?

Answer 50

They tend to invade the duodenum and often metastasise to regional lymph nodes liver, and the peritoneum

Question 51

What is the sensitivity of ultrasound for detecting pancreatic tumours?

Answer 51

28 to 75%

Question 52

Non-neoplastic differentials for a pancreatic tumour

Answer 52

Nodular hyperplasia, ectopic, splenic tissue, enlarged hypoechoic, lymph nodes

Question 53

In cats, there was overlap in the radiographic and sonographic appearance of neoplasia and nodular hyperplasia; however, if __________________ was present, neoplasia was more likely.

Answer 53

a solitary pancreatic nodule 2 cm in diameter or larger

Question 54

Adrenal gland width of less than _____ is highly suggestive of hypoadrenocorticism. A) 1.8mm B) 2.3mm C) 2.8mm D) 3.2mm

Answer 54

D) 3.2mm

Question 55

In cats which of the following can represent an initial sign of pancreatitis? A) Pancreatic enlargement B) Sentinel loop sign C) Dilation of the pancreatic duct D) Heterogeneity of the pancreas on ultrasound

Answer 55

C) Dilation of the pancreatic duct

Question 56

What percentage of dog with Cushings syndrome have functional adrenocortical carcinomas or adenomas? 5-8% 8-10% 10-20% 20-30-%

Answer 56

10-20%

Question 57

In dogs, what is the generally accepted minimal amount of air that can be seen in the peritoneal space using ultrasound? 0.2ml 0.4ml 0.6ml 0.8ml

Answer 57

0.4ml

Question 58

Medial iliac lymph nodes with a resistive index greater than__ are more likely to be neoplastic. 0.475 0.675 0.857 0.957

Answer 58

0.675

Question 59

Which of the following statements is false regarding canine pancreatitis? A) Dogs with pancreatitis that underwent CT which showed homogenous contrast enhancement and poorly- defined borders of the pancreas had an overall poorer outcome B) Ultrasonographicaly, the pancreas can be enlarged, hypoechoic with hyperechoic surrounding mesentery C) The pancreas can appear normal on ultrasound D) Radiographically, it can cause the sentinel loop sign, but this is not definitive for pancreatitis

Answer 59

A) Dogs with pancreatitis that underwent CT which showed homogenous contrast enhancement and poorly- defined borders of the pancreas had an overall poorer outcome ---- heterogenous has poorer outcome

Question 60

Horizontal beam radiographs to look for free peritoneal gas are not recommended with the animal in which recumbency? A) Right lateral B) Left lateral C) Sternal

Answer 60

A) RIGHT LATERAL as gas can be confused with gas in the fundus

Question 61

What is the most common primary tumour in the retroperitoneal space? Renal carcinoma Renal lymphoma Lipoma Leiomyoma

Answer 61

Lipoma

Question 62

Steatitis in cats can be caused by a disorder of which vitamin? A D E C

Answer 62

vit E deficiency

Question 63

Which of the following is not a ligament that attaches the liver to the diaphragm? Diaphragmatic-hepatic Triangular Coronary Falciform

Answer 63

Diaphragmatic-hepatic does not exist

Question 64

The mesenteric root is usually below which lumbar vertebrae? 1 2 3 4

Answer 64

L2

Question 65

What pulsatility index (PI) value indicates a suspicion of neoplasia in mesenteric lymph nodes? a) Greater than 0.65 b) Greater than 0.675 c) Greater than 1.025 d) Greater than 1.23

Answer 65

d) Greater than 1.23

Question 66

Which characteristic is associated with malignancy in enlarged lymph nodes of dogs but not predictive in cats? a) Homogeneity b) Heterogeneity c) Hyperechogenicity d) Hypoechogenicity

Answer 66

b) Heterogeneity

Question 67

What is a pathognomonic imaging finding for metastatic lymphadenopathy? a) Enlarged lymph nodes b) Hypervascularity c) There are no pathognomonic imaging findings d) Presence of calcifications

Answer 67

c) There are no pathognomonic imaging findings

Question 68

Which RI value indicates suspicion of neoplasia in mesenteric lymph nodes? a) Greater than 0.65 b) Greater than 0.675 c) Greater than 0.76 d) Greater than 1.025

Answer 68

c) Greater than 0.76

Question 69

The pancreaticoduodenal vein can be an anatomic landmark for __________ in dogs/cats.

Answer 69

- the right lobe of the pancreas - dogs

Question 70

Pancreatic hyperechogenicity can be seen in A) healthy dogs B) Hypothyroidism C) Cushing's disease D) Addison's disease

Answer 70

A) healthy dogs C) Cushing's disease

Question 71

What should not be misinterpreted as a diseased pancreas in healthy dogs and dogs with hyperadrenocorticism? a) Hypoechoic pancreas b) Hyperechoic pancreas c) Isoechoic pancreas d) Anechoic pancreas

Answer 71

b) Hyperechoic pancreas

Question 72

In cats, what is the echogenicity of a normal pancreas relative to the liver and surrounding mesentery? a) Hyperechoic to the liver and mesentery b) Isoechoic to the liver and hypoechoic to the mesentery c) Hypoechoic to the liver and isoechoic to the mesentery d) Isoechoic to both the liver and mesentery

Answer 72

b) Isoechoic to the liver and hypoechoic to the mesentery

Question 73

What is the normal width (ventral to dorsal dimension) of the left lobe and body of the pancreas in cats? a) 0.1 to 0.5 cm b) 0.25 to 1.0 cm c) 0.3 to 0.6 cm d) 0.9 to 2.1 cm

Answer 73

b) 0.25 to 1.0 cm

Question 74

What is the commonly reported width of the right lobe of the pancreas in cats? a) 0.1 to 0.3 cm b) 0.25 to 1.0 cm c) 0.3 to 0.6 cm d) 0.6 to 1.2 cm

Answer 74

c) 0.3 to 0.6 cm

Question 75

What is the maximum dimension range of the right lobe of the pancreas in healthy dogs? a) 0.25 to 1.0 cm b) 0.3 to 0.6 cm c) 0.9 to 2.1 cm d) 1.5 to 3.0 cm

Answer 75

c) 0.9 to 2.1 cm

Question 76

What should be the normal width of the feline pancreatic duct? a) Less than 0.1 cm b) Less than 0.25 cm c) Less than 0.5 cm d) Less than 0.75 cm

Answer 76

b) Less than 0.25 cm

Question 77

What is one of the advantages of scintigraphy in pancreatic imaging? a) It is less invasive b) It provides detailed anatomical images c) It can identify functional abnormalities, such as insulinomas d) It is faster than other imaging techniques

Answer 77

c) It can identify functional abnormalities, such as insulinomas

Question 78

In what scenario has scintigraphy shown promise for pancreatic evaluation? a) Detecting pancreatic cysts b) Identifying insulinomas when no abnormality is noted sonographically c) Measuring pancreatic enzyme levels d) Evaluating pancreatic ductal obstructions

Answer 78

b) Identifying insulinomas when no abnormality is noted sonographically