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Flashcards in peritoneum and mesentery Deck (58):
1

Most common bug in SBP?

E coli

2

With regards to bowel displacement, what processes moves them medial? posterior?

Medial - ascites

Posterior - intraperitoneal abscess

3

What is pseudomyxoma peritonei? What are the causes?

Gelatinous ascites from ruptured appendiceal mucinous tumor or other mucinous tumors

4

What are the differentiating features of pseudomyxoma compared to simple ascites

Pseudomyxoma will have a scalloped liver margin due to mass effect from mucinous implants. There will also be high attenuating septa and punctate "ring and arc" calcifications

5

Where are the most common sites of peritoneal carcinomatosis? why?

Due to the flow of ascites

Pelvic cul de sac
Right paracolic gutter
Mesenteric root at ileocecal junction
Sigmoid mesocolon

6

DDx for enhancing nodules along peritoneal surface with marked nodular thickening of the omentum

Peritoneal carcinomatosis
Mesothelioma
Tuberculous peritonitis

7

DDx for peripherally enhancing centrally necrotic masses intraperitoneally?

Colon cancer
Invasive peritoneal mets
Primary peritoneal tumor
Peritoneal abscess

8

How does primary peritoneal mesothelioma present?

Multiple enhancing soft tissue masses present along peritoneum IN CONTACT with peritoneum with large volume ascites

9

How does cystic peritoneal mesothelioma differ from primary? Who gets it?

Young women

Benign

Low attenuation/anechoic multiloculated cystic mass filling peritoneal cavity

10

Most common primary tumor of small bowel?

Caricinoid

11

What cells does carcinoid arise from?

Enterochromaffin cells of kulchitsky in crypts of lieberkuhn

12

DDx for calcified mesenteric mass with radiating strands and adjacent bowel wall thickening

Carcinoid
Retractile mesenteritis

13

Where do most small bowel carcinoid tumors arise?

Terminal ileum

14

How does one differentiate carcinoid from mesenteric mets?

Mets wont have desmoplastic reaction, will be multiple

15

What causes the desmoplastic reaction in carcinoid?

Thickening along neurovascular bundles

16

What is the cardiac complication with carcinoid? Why

Tricuspid valve insufficiency due to direct release of serotonin into the hepatic veins by metastatic carcinoid

17

What is retractile mesenteritis?

Idiopathic mesenteric mass with dense calcifications and bowel tethering and obstruction.

Similar to carcinoid, but wont have spokewheel thickening and small bowel wall thickening

18

DDx for a solitary, ill defined mass at root of small bowel mesentery with marked associated calcification and bowel tethering

Retractile mesenteritis
Carcinoid

19

Most common primary mesenteric tumor

Desmoid

20

Which lymphoma more commonly affects the mesentery?

NHL

21

Lobulated confluent soft tissue mass encasing superior mesenteric vessels
What is the sign? Dx?

Hamburger/sandwich sign

Mesenteric lymphoma

22

DDx for low attenuation mesenteric LN with perihperal enhancement?

Treated lymphoma
Infection (fungal, MAI)
Whipples
testicular mets

23

Which nodes does abdominal TB affect most often?

Mesenteric and peripancreatic

24

HIV patient with centrally low attenuating LN

TB

25

What clues help differentiate MAI vs TB when considering them for centrally necrotic LN

TB more often has focal hepatic or splenic abnormalities and peritoneal involvement

26

What make up the nodes in CMLNS?

Chylous fluid surrounded by a thin rim of fibrous tissue

27

Cystic mesenteric adenopathy in a patient with celiac disease?

Cavitary mesenteric lymph node syndrome

28

What are the two responses with a retained surgical sponge?

Fibrinous - foreign body granuloma

Exudative - abscess formation

29

What is a gossypiboma?

Masslike inflammatory response surrounding a surgical sponge

30

Where do spilled gallstones accumulate?

Subdiaphragmatic or hepatorenal recess

31

When do complications most often occur with spilled gallstones?

4 months, but can be 1month-20years

32

What are the three types of abdominal hernia?

External, internal, diaphragmatic

33

Which hernia is most common?

Indirect

34

Which inguinal hernia goes medial/lateral to the inferior epigastric vessels? How can you quickly tell the difference?

MD - medial, direct
Lateral, indirect

Direct will NOT extend to the scrotum

35

What are the defects in the inguinal hernia types?

Direct - directly protrudes through abdominal wall defect
Indirect - protrudes through inguinal canal and emerges at the external ring

36

What is an incarcerated hernia?

One that cannot be manually reduced

37

Femoral hernias are more common in which sex?

Female

38

Where does a femoral hernia extend?

ALWAYS below the inguinal ligament and lateral to the pubic tubercle

Immediately medial to the femoral vein

39

Which hernia is more common to strangulate?

Femoral (10x) more than inguinal

40

Obstruction with pain radiating down medial thigh suggest what kind of hernia?

Obturator (impingement on obturator nerve)

41

Which hernia has the highest rate of mortality if strangulated?

Obturator

42

What is a richter hernia?

Hernia with only a portion of the circumference of a bowel loop

43

What is a spigelian hernia?

Abdominal wall defect involving the linea semilunaris

44

What is the most frequent internal hernia?

Paraduodenal

45

Where do most paraduodenal hernias occur and why?

Left side, as a result of bowel herniating through a peritoneal reflection created by the inferior mesenteric artery. Bowel resides lateral to the ascending limb of the duodenum

46

How do paraduodenal hernias appear?

Mass of small bowel loops in LUQ appearing to be encapsulated

47

What is a foramen of winslow hernia? Which part of bowel is more commonly herniated through it?

Herniation into the lesser sac

Small bowel (70%)
Ascending colon/cecum (30%)

48

What is the cause of infantile bochdalek hernia?

Failure of closure of the pleuroperitoneal canal

49

Which side do bochdalek usually occur?

Left, always posterior

50

What is a morgagni hernia?

Midline defect where right and left pleuoroperitoneal folds do not join. Substernal herniation often involving omentum

51

Which organ most commonly herniates through a traumatic diaphragmatic hernia?

Stomach!

52

Which side do most traumatic hernias usually occur?

Left

due to protective effect of liver

53

Which side do morgagni hernias usually occur?

Right, and anterior

54

What is the progression of infantile umbilical hernia?

Spontaneous closure

55

What is the differential for misty mesentery?

Fluid - CHF, portal hypertension, hypoalbuminemia, mesenteric arterial or venous thrombosis

Inflammation - pancreatitis, IBD, diverticulitis

Neoplasm - NHL

Retractile mesenteritis

56

Soft tissue stranding with the epicenter distinct from the colon wall or appendix along the antimesenteric border?

Epiploic appendigitis

57

Which side are omental infarcts more common?

Right side, due to longer length of right omentum

58

What is the key feature in differentiating diverticulitis/appendicitis and omental infarct?

Omental infarct will have a normal adjacent colon