Retroperitoneum Flashcards Preview

Abdominal Scanning > Retroperitoneum > Flashcards

Flashcards in Retroperitoneum Deck (134):
1

This is the serous membrane that forms the lining of the abd cavity and covers most of the abd organs.

peritoneum

2

Name the two layers of the peritoneum.

parietal and visceral

3

This is the space between the parietal and visceral peritoneum containing serous fluid.

the peritoneal cavity

4

T/F? In males, the peritoneal cavity is completely closed.

true

5

The peritoneal cavity is ___ and essentially ___ to the outside environment.

sterile, closed

6

T/F? In females, the peritoneal cavity is completely closed.

FALSE, there is a communication between the cavity and the outside via the fallopian tubes.

7

Name the two compartments of the peritoneal cavity.

lesser sac and greater sac

8

This is the space that is situated between the liver, pancreas, and stomach. The entrance is the epiloic foramen.

lesser sac

9

The is the space that is situated around the bowel and lower organs.

greater sac

10

This is a posterior compartment that lies between the transversalis fascia and the parietal peritoneum.

retroperitoneum

11

This is the connective tissue that circles the inner abd.

transversalis fascia

12

The superior border of the retroperitoneum is the...

diaphragm.

13

The inferior border of the retroperitoneum is the...

pelvic rim.

14

The anterior border of the retroperitoneum is the...

parietal peritoneum.

15

The posterior border of the retroperitoneum is the...

posterior abd wall muscles.

16

The lateral border of the retroperitoneum is the...

transversalis fascia and peritoneal portions of the mesentery.

17

Name the three spaces within the retroperitoneum.

perirenal space, anterior pararenal space, and posterior pararenal space

18

What connective tissue divides the retroperitoneum into its three spaces?

Gerota's (renal) fascia

19

Kidneys and adrenals lie within the ___ space of the retroperitoneum.

perirenal

20

The perirenal space is separated from the pararenal spaces by the...

anterior and posterior renal (Gerota's) fascia.

21

This is the fat area between the peritoneum and Gerota's fascia.

anterior pararenal space

22

This is the space between Gerota's fascia and the posterior abd wall muscles.

posterior pararenal space

23

SAD PUCKERS is the acronym for what now?

The organs in the retroperitoneum

24

What does SAD PUCKERS stand for?

Suprarenal
Ao/IVC
Duodenum
Pancreas
Ureters
Colon
Kidneys
Esophagus
Rectum
SMV

25

These muscles lie in the pararenal space, separated by the transversalis fascia.

psoas and quadratus lumborum muscles

26

This retroperitoneal condition presents as a dense fibrous tissue proliferation confined to the paravertebral region.

retroperitoneal fibrosis, Ormond's disease, or inflammatory aneurysm

27

Where along the aorta does Ormond's disease tend to appear?

at the bifurcation

28

Sonographically, this retroperitoneal condition appears as a hyperechoic midline mass.

retroperitoneal fibrosis

29

This retroperitoneal condition is associated with bilateral ureteral obstruction as it envelopes structures rather than displace them.

retroperitoneal fibrosis

30

This is the most likely complication of retroperitoneal fibrosis.

hydronephrosis

31

What causes most cases of retroperitoneal fibrosis?

idiopathic

32

The adrenal glands are ___ to the kidneys.

anterior, medial, and superior

33

These are the smallest paired organs found in the abdomen.

adrenal glands

34

How can we differentiate between adrenal masses and renal masses during an u/s exam?

They will separate during deep inspiration and in the upright position.

35

Which adrenal gland is shaped like a triangle or pyramid?

right

36

Which adrenal gland is shaped like a cresent?

left

37

This part of the adrenal gland is hypoechoic and typically less echogenic than the surrounding retroperitoneal fat.

cortex

38

This is the echogenic linear structure within the adrenal gland.

medulla

39

What percentage of the adrenal gland is cortex?

90%. Which makes the medulla 10%.

40

What three arteries supply each adrenal gland?

suprarenal branch of the inferior phrenic artery, suprarenal branch of the aorta, and suprarenal branch of the renal artery

41

Which veins drain the adrenal glands?

the right suprarenal vein (drains into the IVC) and the left suprarenal vein (drains into the left renal vein)

42

What kind of hormones does the cortex produce?

steroids

43

What kind of steroids does the adrenal cortex produce?

mineralocorticoids (aldosterone)
glucocorticoids (cortisol)
androgens (gonadal hormones)

44

What do mineralocorticoids do?

Help maintain the body's fluid & electrolyte balance

45

What do glucocorticoids do?

Modify the body's response to inflammation

46

The adrenal cortical hormones (ACH) are regulated by the ___ hormones of the ___ gland.

adrenocorticotropic, anterior pituitary

47

The adrenal gland and the anterior pituitary gland function together to...

regulate hormone production.

48

Which hormones does the adrenal medulla produce?

epinephrine and norepinephrine

49

Indications for an adrenal u/s:

1. tachycardia
2. severe anxiety
3. HTN
4. Abd distention
5. sweating
6. weight loss
7. diabetes mellitus
8. eval of a previously seen mass

50

This adrenal condition is rare, usually unilateral, and asymptomatic.

adrenal cysts

51

Sonographically, this adrenal condition appears in the typical cystic pattern and may calcify or hemorrhage.

adrenal cysts

52

This is a benign adrenal cortical mass, usually asymptomatic or elevated adrenal hormones.

adrenal adenoma

53

Adrenal hyperplasia, adenomas, or adenocarcinomas are tied to...

adrenal cortical hyperfunctioning.

54

This is caused by excessive cortisol secretions associated with adrenal adenomas.

Cushing's syndrome

55

This is caused by excessive cortisol secretions due to a pituitary tumor and causes purplish striae on the skin.

Cushing's disease

56

This is caused by excessive aldosterone secretion.

Conn's disease

57

This is caused by excessive androgen secretion.

adrenal virilism

58

The symptoms of this adrenal disease include hirsutism, baldness, acne, and amenorrhea.

adrenal virilism

59

This is a life-threatening condition caused by partial or complete failure of the adreno-cortical function.

Addison's disease

60

Addison's disease destroys the adrenal ___ and loses the ___ and ___ secretions.

cortex, cortisol, aldosterone

61

T/F? Females have an increased incidence of Addison's disease.

true

62

This condition presents as anorexia, bronzed skin, salt cravings, emotional changes and GI disorders.

Addison's disease

63

T/F? The treatment for Addison's disease is to surgically remove an adrenal gland.

FALSE, to remove *both* adrenal glands

64

When endocrine studies are negative (indicating a non-hyperfunctioning adrenal mass), the deicision to resect is usually based on its...

size.

65

What size would an adrenal mass be before they decide to remove it?

greater than 3 cm

66

This is a rare adrenal tumor with a poor prognosis.

adrenal cortical carcinoma

67

T/F? The majority of patients with adrenal cortical carcinoma present with Addison's disease.

FALSE, Cushing's syndrome

68

T/F? Many patients with adrenal cortical carcinoma present with metastatic involvement.

true

69

T/F? Adrenal cortical carcinomas have a tendency to invade the renal veins and IVC.

true

70

This is a rare vascular tumor of the medulla that may occur in ectopic locations such as along the para-aortic sympathetic nerve chain.

pheochromocytoma

71

T/F? Pheochromocytomas are usually malignant.

FALSE, benign

72

What catecholamines do pheochromocytomas secrete?

epinephrine and noreinephrine

73

T/F? Pheochromocytomas are associated with Multiple Endocrine Neoplasia (MEN) and Conn's disease.

FALSE, MEN and *von Hippel-Lindau disease*

74

This is the most common childhood adrenal mass.

adrenal neuroblastoma

75

This adrenal condition presents as a palpable abdominal mass in children.

adrenal neuroblastoma

76

T/F? Adrenal neuroblastomas are benign.

FALSE, malignant

77

___ typically displaces the kidneys inferiorly into the pelvis, while ___ originates from and destroys the kidney.

Adrenal neuroblastoma, Wilm's tumor

78

This is a benign non-functioning adrenal mass that contains fat and bone elements.

myelolipoma

79

Sonographically, these appear as hyperechoic masses in the adrenal beds.

myelolipoma

80

This is the most common cell type of Non-Hodgkin disease.

adrenal lymphoma

81

T/F? Adrenal involvement with lymphomas is common and frequently unilateral.

FALSE, *bilateral

82

The adrenal glands are the ___ most common metastatic site.

fourth

83

The most common primary sites are...

*lung*, breast, melanoma, kidney, thyroid, and colon cancers.

84

This is the most common adrenal mass seen in a newborn.

adrenal hemorrhage

85

Sonographically, the normal evolution of this adrenal condition ends with a pseudocyst formation.

adrenal hemorrhage

86

What is the most likely diagnosis in a newborn with an abdominal mass and decreasing hematocrit?

adrenal hemorrhage

87

The crus of the diaphragm is ___ to the aorta.

anterior

88

The crus of the diaphragm is ___ to the celiac axis.

superior

89

The crus of the diaphragm is ___ to the IVC.

posterior

90

The most common manifestation of retroperitoneal pathology is...

the presence of a mass.

91

Sonographic signs of retroperitoneal disease include...

1. displacement of normal structures to an abnormal location
2. direct invasion of adjacent organs
3. asymmetry of normal structures
4. silhouetting of normal structures by disease & loss of retroperitoneal?

92

If you find a mass you should...

1. Assess it in 2 dimensions.
2. Trace the circumference and measure it.
3. Assess for air or calcium
4. Assess if it is fixed or free
5. Determine echogenicity and blood flow.
6. Determine cystic, solid, or vascular.
7. Determine the relationship to other structures.
8. Determine its origin.
9. Check for the 'beak' sign, 'embedded organ' sign, and 'phantom organ' sign.

93

This is when a mass deforms the edge of an adjacent organ into a wedge shape, indicating that that is the organ of origin.

'beak' sign

94

This is when a mass compresses an adjacent organ, indicating that it is not the organ of origin.

'embedded organ' sign

95

This is when a large mass obscures a small organ, indicating that it is the organ of origin.

'phantom organ' sign

96

Solid masses of the retroperitoneum are usually classified into these categories:

1. lymphadenopathy
2. primary malignancies
3. secondary malignancies
4. infections
5. lesions that masquerade as solid masses

97

T/F? It if frequently possible to determine the categories of solid retroperitoneal masses by u/s alone.

FALSE, *not possible

98

The function of ___ is to form lymphocytes and antibodies to fight infections.

lymphnodes

99

The two classifications of lymphnodes are:

1. parietal nodes (aka deep)
2. visceral nodes (aka superficial)

100

These are located in the retroperitoneum along the coarse of the prevertebral vasculature, connected to each other by lymph vessels.

parietal nodes

101

T/F? Parietal nodes are positioned 360 degrees around the aorta and IVC.

true

102

These nodes lie in the peritoneal cavity and follow the visceral vasculature.

visceral nodes

103

Sonographically, these look like a hypoechoic solid mass with a hyperechoic fatty center, smooth margins, oval shape with interal vascular blood flow, usually measuring less than 1 cm.

normal lymphnodes

104

Sonographically, these appear as an enlarged hypoechoic mass greater than 1 cm with a loss of the hyperechoic fatty center with irregular margins and more round than oval. May displace adjacent structures.

abnormal lymphnodes

105

Enlarged retroperitoneal lymphnodes are referred to as...

lymphadenopathy.

106

T/F? U/s is the preferred modality for assessing lymphadenopathy.

FALSE, *CT

107

Sonographically, these appear as a symmetric, hypoechoic areas around the aorta, possibly with a 'floating aorta', 'silhouette', or 'mantle/sandwich' sign.

para-aortic nodes (lymphadenopathy)

108

If the angle of the SMA exceeds 15 degrees, what should be considered?

lymphadenopathy

109

This are a rare form of retroperitoneum tumor. Heterogeneous, secondary lesions.

germ cell tumors

110

T/F? Germ cell tumors are always benign.

FALSE, they may be either benign or malignant.

111

Where should you check next if you see a germ cell tumor in the retroperitoneum?

the scrotum

112

Name five kinds of benign retroperitoneal neoplasms.

1. fibroma
2. lipoma
3. mesothelioma
4. myxoma
5. teratoma

113

This retroperitoneal neoplasm is a hyperechoic mass consisting largely of fibrous connective tissue.

fibroma

114

This retroperitoneal neoplasm is a hyperechoic mass consisting of fatty tissue.

lipoma

115

This retroperitoneal neoplasm is a localized echogenic mass with irregular walls consisting of an abnormal growth of epithelial cells.

mesothelioma

116

This retroperitoneal neoplasm is a complex or echogenic mass consisting of connective tissue – usually extremely large.

myxoma

117

This retroperitoneal neoplasm is a complex mass composed of different types of tissues which do not occur together or at the site of the tumor.

teratoma

118

This is the most common primary malignant retroperitoneal tumor.

liposarcoma

119

These rare neoplasms arise and develop in the retroperitoneal space but are not attached to the adjacent retroperitoneal organs.

primary malignant retroperitoneal tumor

120

This is the most common type of soft tissue tumor.

liposarcoma

121

T/F? Liposarcomas only happen in the retroperitoneum and the extremeties.

FALSE, They can happen anywhere but those are the most common places.

122

Sonographically, these appear as a hyperechoic mass due to the large amount of fat content.

liposarcoma

123

T/F? Liposarcomas are usually large, as much as 20 lbs is not uncommon.

true

124

This is a malignant smooth muscle tumor.

leiomyosarcoma

125

This malignant tumor may be found in the uterus or GI tract as well as the retroperitoneum, tends to grow rapidly and invade nearby structures.

leiomyosarcoma

126

Sonographically, these appear as well-circumscribed mixed echogenicity that can have anechoic fluid filled areas due to hemorrhage and necrosis.

leiomyosarcoma

127

T/F? Leiomyosarcoma affects more men than women.

true

128

This is a highly malignant tumor of the striated muscle.

rhabdomyosarcoma

129

Sonographically, this appears as either a hyperechoic or complex mass in the retroperitoneum.

rhabdomyosarcoma

130

What are the four divisions of the pelvic retroperitoneum?

1. prevesical
2. rectovesical
3. presacral
4. bilateral pararectal & paravesical space

131

This space spans from the pubis to the anterior margin of the bladder, bordered laterally by the obturator fasica.

prevesical space aka space of retzius

132

This space spans from the bladder to the rectum.

rectovesical space

133

This space is located between the rectum and fasia covering the sacrum and posterior pelvic floor musculature.

presacral space

134

This space is bound laterally by the piriformis and levator ani fascia and medially by the rectum.

bilateral pararectal space