Chapter 14- Peritoneum

Question 1

What is the mesentery?

Answer 1

the double fold of peritoneum that suspends the intestines from the posterior abdominal wall.

Question 2

What is the greater sac

Answer 2

The general peritoneal cavity

Question 3

Where is the lesser sac

Answer 3

Anterior to the pancreas and posterior to the stomach

Question 4

What attaches the greater and lesser sacs?

Answer 4

The foramen of Winslow or Epiploic foramen

Question 5

Where is the lesser omentum

Answer 5

from the liver to lesser curve of stomach

Question 6

What is the greater omentum

Answer 6

Apronlike fold of peritoneum that hangs from the greater curvature of the stomach

Question 7

When examining a patient for pathologic collectins of fluid, where should you look first? Why?

Answer 7

The pelvis and lateral flanks. The fluid will accumulate in the
lowest parts of the body due to gravity.

Question 8

What is the other name for Morison’s pouch

Answer 8

The hepatorenal or right subhepatic space

Question 9

What is a subcapsular fluid collection and how does it appear sonographically?

Answer 9

Subcapsular fluid collections are between the organ capsule and parenchyma. They conform to the shape of an organ capsule

Question 10

What separates the right subhepatic from the subphrenic spaces?

Answer 10

The bare area of the liver

Question 11

What is the paracolic gutter?

Answer 11

The peritoneal spaces lateral to the colon.

Question 12

How might ascites appear if it is malignant or inflammatory?

Answer 12

Internal echoes, loculation, unusual bowel

Question 13

What is an abscess?

Answer 13

A cavity within a solid tissue formed by necrosis or a collection of pus

Question 14

What are some symptoms of an abscess?

Answer 14

An unexplained fever, leukocytosis, sepsis or bacterial cultures

Question 15

What is leukocytosis?

Answer 15

An increase in white blood cell production

Question 16

How does an abscess appear sonographically?

Answer 16

fluid filled with irregular borders, irregular echoes

Question 17

How might a gas filled abscess appear sonographically?

Answer 17

It varies but typically echogenic with a dirty shadow

Question 18

How does fluid move between the pelvis and abdomen?

Answer 18

The paracolic gutters allow for the fluid to move

Question 19

What divides the right and left subphrenic spaces?

Answer 19

The falciform ligament

Question 20

What is paracentesis? What is thoracentesis

Answer 20

the drainage of abdominal fluid. The drainage of pleural fluid

Question 21

What is an abscess? What is it caused by?

Answer 21

A large collection of pus usually caused by infection due to trauma/surgery

Question 22

Bacteria entering the liver might cause a hepatic abscess. How could the bacteria enter? What way is the most common?

Answer 22

The bacteria could enter through the portal system, hepatic artery, from an infection or implantation after trauma. the most common is through the CBD

Question 23

What is peritonitis

Answer 23

Inflammation of the peritoneum that might be diffuse or localized

Question 24

What is biloma and what causes it?

Answer 24

Loculated collections of bile outside of the liver. It is caused by GB disease, trauma, rupture of biliary tree, or iatrogenic

Question 25

How are renal abscesses classified?

Answer 25

according to their locations.

Question 26

What is renal carbuncle?

Answer 26

An abscess that forms in the renal parenchyma.

Question 27

What is a perinephric abscess?

Answer 27

A perforated renal that leaks into the material around the tissue

Question 28

1/3 of masses are malignant in the omentum. What kind is most frequent, primary or secondary?

Answer 28

Secondary neoplasms are more frequent.

Question 29

What kind of mesentery tumor is most common, primary or secondary?

Answer 29

A benign, secondary neoplasm

Question 30

What is the difference between a sac and an omentum?

Answer 30

A sac is a pouch or sac within the peritoneum whereas the omentum is a fold of the peritoneum.

Question 31

What is the cause of an abdominal cyst?

Answer 31

They are embryologic, traumatic or aquired, and neoplastic, infective or degenerative organs.

Question 32

what is the median umbilical ligament

Answer 32

formed by incomplete regreassion of the urachus, a fetal channel between the bladder and the umbilicus.

Question 33

What are the symptoms of a urachal cyst and how does it appear sonographically?

Answer 33

Ab pain, pain with urination, umbilical discharge, fever, UTI. Mass found between umbilicus and bladder.

Question 34

What is urinoma? How does it appear sonographically

Answer 34

encapsulated collection of urine caused by renal trauma. It appears as a subcapsular or perirenal fluid collection

Question 35

What are the most common primary sites for peritoneal metastasis?

Answer 35

Ovaries, Stomach, Colon

Question 36

How does lymphoma of the omentum/mesentery appear sonographically?

Answer 36

As a thick hypoechoic band that follows the abdominal wall. Lobulated surrounding an echogenic area and "sandwich sign"

Question 37

What pathology occurs most often in middle-aged men with recent exposure to asbestos?

Answer 37

Mesothelioma

Question 38

What are the symptoms of Mesothelioma? How does it appear sonographically?

Answer 38

Symptoms are ab pain, weight loss, and ascites. It appears as diffuse nodes and plaques over a large area of the peritoneum

Question 39

What is Extraperitoneal Rectus sheath Hematoma? What are some causes

Answer 39

a collection of blood in the rectus muscle or between the muscle and sheath. It is caused by trauma, pregnancy, muscle disease, extreme exercise

Question 40

What are symptoms of Rectus Sheath Hematoma?

Answer 40

Sharp acute pain, shock, decrease in hematocrit levels

Question 41

What is a lymphocele?

Answer 41

A collection of fluid that occurs after trauma. Can be loculated or under tension and displacing organs

Question 42

What is bladder flap hematoma and what is a cause?

Answer 42

Collection of blood between the bladder and lower uterine segment. Occurs after C-Section

Question 43

Where are subfascial hematomas found? What is the cause

Answer 43

They are aterior to the bladder and caused by a disruption of the inferior epigastric vessels during C-section

Question 44

What might cause an abscess of the abdominal wall? What are some symptoms?

Answer 44

They are caused by trauma. The patient might have leukocytosis or sepsis.

Question 45

How might an abdominal wall abscess appear sonographically?

Answer 45

As an anechoic mass with internal echoes and irregular borders

Question 46

What is a lipoma? How does it appear?

Answer 46

A growth of fat cells in a fibrous capsule. It appears superficial and ovular with smooth walls

Question 47

What is a desmoid tumor?

Answer 47

A rare, benign, neoplasm that most commonly occurs in the rectus abdominis and its sheath

Question 48

How does a desmoid tumor appear sonographically

Answer 48

Anechoic to hypoechoic with smooth walls

Question 49

What is a hernia What is the most common area for it to occur?

Answer 49

A protrusion through the weakened abdominal wall. The most common location is the umbilical area and femoral and inguinal rings.

Question 50

What is an incarcerated hernia?

Answer 50

When the blood supply of the bowel is interrupted. The bowel may become necrotic.

Question 51

Where are indirect inguinal hernias located?

Answer 51

An indirect hernia is located lateral to the epigastric vessels and projects through the inguinal ring.

Question 52

Where are direct inguinal hernias located?

Answer 52

A direct hernia is located medial to the epigastric vessels and projects through the abdominal wall.

Question 53

What is the sonographic appearance of a hernia?

Question 54

Which type of hernia is congenital?

Answer 54

Indirect hernias are often congenital

Question 55

What is the valsalva maneuver

Answer 55

Using strain to exaggerate a lesion (hernia)