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Flashcards in Retroperitoneam Deck (49):
1

What is the peritoneum?

serous membrane that forms the lining of the abdominal cavity and covers most of the abdominal organs

2

What are the layers of the peritoneum?

1. Parietal peritoneum: outer layer, lines abdominal cavity
2. Visceral Layer: inner layer, covers the abdominal organs

3

What is the space called between the two layers?

Peritoneal cavity

4

What are the compartments of the peritoneal cavity?

1. Lesser Sac
2. Greater Sac
3. Pouch of Douglas

5

What is the Lesser Sac?

- Space between the liver. pancreas, and stomach
- entrance to lesser sac is epiploic foramen

6

What is the Greater Sac?

- rest of peritoneal cavity
- when imaging ascites with floating bowel, this is greater sacs

7

What is Pouch of Douglas?

- Rectouterine Pouch
- between uterus and rectum (females)
- rectovesical space (males)

8

What are the Intraperitoneal structures?

- stomach
-jejunum
- 1st part of duodenum
- appendix
- spleen
- cecum
- transverse sigmoid
- rectum
- liver
- uterus
- fallopian tubes
- ovaries

9

What is the Retroperitoneum?

Posteriorly located compartment that lies between the transversalis fascia and the posterior parietal peritoneum

10

How many layers does Gerotas Fascia have?

2

11

What do the two layers of gerotas fascia divide into?

1. anterior pararenal space
2. perirenal space
3. posterior pararenal space

12

Where do the kidneys and adrenal glands lie?

Perirenal space

13

What muscles lie posterior pararenal space?

Quadratus Lumborum and Psoas Muscles

14

What is the first major branch off of the aorta?

Celiac axis

15

What are the branches off of the celiac axis?

1. Common hepatic artery
2. Left gastric artery
3. splenic artery

16

What branches off of the common hepatic artery?

1. proper hepatic artery
2. Gastroduodenal artery (GDA)

17

What are the two branches off of the celiac axis?

1. common hepatic artery
2. splenic artery

18

What vessels travels parallel to the aorta?

SMA

19

What are the Doppler waveforms for the SMA?

- fasting state: High resistance
- Postprandial: Low resistance, increased velocity

20

Where do the renal arteries arise from aorta?

lateral walls of aorta just below the origin of the SMA

21

Where does the RRA pass posterior to?

IVC

22

What renal artery is shorter>

LRA

23

Where does the IMA arise from aorta?

Anterior aspect of distal aorta
- with SMA and CA stenosis or occlusion is becomes enlarged

24

Know about the IVC.....

- right of Aorta and posterior pancreatic head
- Dilates with cardiac failure and fluid overload
- Tumor: Renal cell carcinoma

25

What is the most common filter for the IVC?

Greenfield filter
- filters used to prevent ascent of lower extremity vein thrombus

26

How are IVC filters placed?

- catheters with entry at the femoral vein or internal jugular vein

27

Know about hepatic veins...

- right, middle, left
- drain into the IVC

28

What is the "Nutcracker Syndrome"?

engorgement of the left renal vein due to its compression by the SMA and aorta

29

Where do the gonadal veins drain into?

Left gonadal vein: LRV
Right gonadal vein: IVC

30

What is retroperitoneal fibrosis?

- Ormond's disease or inflammatory aneurysm
- dense fibrous tissue proliferation confined to the paravertebral region

31

What would a retroperitoneal fibrosis look like?

- hypoechoic midline mass
- typically at aortic bifurcation

32

What is retroperitoneal fibrosis associated with?

- bilateral ureteral obstruction
- progressive loss of kidney function

33

Where are the adrenal glands?

- Right adrenal gland: triangle or pyramid. Superior, anterior and medial of upper pole of kidney
- Left adrenal gland: crescent shaped located anteriomedial to upper pole

34

What hormones does the adrenal cortex produce?

- Mineralocorticoids (Aldesterone)
- Glucocorticoids (Cortisol)
- Androgens

35

What are the adrenal cortical hormones regulated by?

Pituitary Gland

36

What might tumors of the adrenal gland and anterior pituitary gland produce?

- overproduce or underproduce ACTH and ACH

37

What does the adrenal medulla produce?

- epinephrine (Adrenalin)
- norepinephrine

38

What is Cushings Syndrome?

- excessive cortisol secretion

39

What is Conn Syndrome?

- primary aldosteronism
- excessive aldosterone secretion

40

What is Hirsutism?

- Overbundance hair
- caused by excessive androgen production

41

Know about Adrenal Cortical Carcinoma...

- Majority of patients produce with Cushings syndrome
- Rare tumor > Poor prognosis
- Invade Renal veins and IVC

42

What is a Pheochromocytoma?

- originate from adrenal medulla
- occur along nerve chain
- majority > benign

43

What do Pheochromocytoma secrete?

Norepinephrine
Epinephrine

44

Know about Adrenal Neuroblastoma...

- malignant tumor arising from sympathetic nervous system
- Palpable mass
- Most common adrenal mass in infancy and childhood
- increase in blood and urine catecholamines
- Metastatic disease

45

What is a Myelolipoma?

- benign, nonfunctioning adrenal masses that contain fat, bone elements
- hyperechoic masses in adrenal bed
- Artifact: Propagation speed artifact

46

What is Adrenal Lymphoma?

Adrenal involvement with lymphoma is common and frequently bilateral
- Diffuse, hyperplasia or mass like
- Non-Hodgkin disease is most common cell type

47

Know about Adrenal Mets...

- 4th common metastatic site after lungs, liver and bone
- most common sites: lung, breast, skin, kidney, thyroid, and colon cancers

48

What is a Adrenal Hemorrhage?

- most common in neonate
- large size of the neonatal adrenals and their high degree of vascularity which makes them vulnerable to birth trauma

49

What is the most common adrenal mass in newborn?

Adrenal Hemorrhage