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Retroperitoneum Flashcards

1
Q

What are the two peritoneum layers?

A

Parietal and visceral peritoneum

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2
Q

What is the parietal and visceral peritoneum?
- what is between them ?

A

Parietal outer layer lines the ABD wall
Visceral inner layer covers the ABD organs
- peritoneal cavity

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3
Q

What are the two compartments in the peritoneal cavity?

A

The lesser, Greater, and pouch of pouch of Douglas.

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4
Q

Where is the lesser sac?
- what is the entrance called?

A

Space between the liver, pancreas, and stomach.
- Epiploic foramen.

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5
Q

Where is the greater sac?

A

Area with bowel and ascitesW

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6
Q

Where is the pouch of Douglas?

A

Between the rectum and uterus (0r rectovesical pouch in men)

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7
Q

What is in the Intraperitoneal structures?

A
  • Liver, GB, stomach, Spleen
  • 1st duodenum, jejunum, Trans/Sigmoid colon
  • Cecum, Appendix, Rectum
  • Uterus, Fallopian tubes, Ovaries.
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8
Q

Where is the Retroperitoneum located?

A

Between the transversalis fascia and the posterior parietal peritoneum.

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9
Q

What divides the retroperitoneum coronally into three compartments?

A

Gerota’s fascia (renal fascia)
- Ant pararenal
- Perirenal space
- Post pararenal space

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10
Q

What renal fascia are the kidneys and adrenal glands located in?

A

perirenal space.

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11
Q

What is in the retroperitoneum?

A
  • Esophagus Pancreas
  • Adrenal gland, kidneys, ureters
  • Ao/IVC, sup mesenteric, renal, gonadal vessels
  • 2,3,4 duodenum, Asce/desen Colon, rectum
  • lymphatics, prostate.
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12
Q

Where are the quadratus lumborum muscles and psoas muscles located

A

Posterior to the posterior pararenal space
- Own fascia transversalis

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13
Q

How does the Ao travel through the ABD spaces?

A

Ao is located more posterior but goes more anterior as it travels caudally.

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14
Q

What are the branches of the CA?

A

Common hepatic artery
Left gastric artery
Splenic artery

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15
Q

What does the CA look like?

A

Sea gull or dove sign

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16
Q

Can you see the gastric artery?

A

NOOOO

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17
Q

What are the branches of the AO

A

CA (1cm inf)
SMA
Renal arteries
Gonadal arties
IMA

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18
Q

What is the Doppler waveforms for SMA

A

Fasting- high resistance
Postprandial- Low resistance

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19
Q

The RRA passes ____ to the IVC.
The LRA is shorter as the AO lies to the ___ of the midline

A

Posterior
Left

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20
Q

What is the most common tumor to involve the IVC

A

Renal cell carcinoma

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21
Q

What can cause displacement in the IVC?

A

Liver, renal masses
RRA aneurysm
Lymphadenopathy
Tortuous AO (goes right)

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22
Q

What is an IVC filter, where is placed and what is the most common?

A

Prevents traveling clots
- Below the renal veins
- Green filter.

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23
Q

The RRV is __ and drains directly into the IVC. The LRV is ___ passing between SMA and AO.

A

Short
Long

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24
Q

What is nutcracker syndrome?

A

Compression of LLV from SMA and AO.

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25
What is retroacortic left renal vein?
variant where the LLV is located between AO and the vertebra and drains into the IVC
26
Where does the right and left gonadal veins drain into ?
Right drains into the IVC Left drains into the LRV.
27
What is retroperitoneal fibrosis and what is also known as?
Inflammatory aneurysm of fibrosis tissue around AO bif (atherosclerotic Ao), rarely extends superiorly to L2. (Hypo midline mass) Ormond's disease
28
What is retroperitoneal fibrosis associated with?
Bilateral ureteral obst.
29
What is azygos, and hemiazygos veins?
Provided a pathway for venous return if the IVC becomes obst. Connect Prox IVC to SVC (not seen unless something is wrong)
30
Where is the azygos, and hemiazygos veins located?
azygos- right hemiazygos- Left
31
Where do the ascending lumbar veins travel and what are they branches off of?
They travel lateral to the spine and posterior to the psoas muscle. branch off the iliac veins and connect to the azygos, and hemiazygos veins.
32
Where do the ascending lumbar veins connect to the azygos, and hemiazygos veins?
At the diaphragm at the left and right subcostal vein.
33
Where is the right adrenal gland located - what is the shape? - where is it to the IVC and cruse diaphragm
Superior, anterior, and medial to the upper pole of the right kidney - triangle/pyramid shape - posterior to IVC and medial/posterior to cruse.
34
Where is the left adrenal gland located - what is the shape? - where is it to the AO and cruse diaphragm
Anteriomedial to the upper pole of the left kidney - crescent shape. - medial to the AO and cruse.
35
Where is the cruse of the diaphragm located?
Ant to aorta Superior to CA (cruse never goes beyond CA) Post to IVC
36
Where can the cruse of the diaphragm be imaged?
Transverse and in longitudinal planes Its medial and posterior to everything besides the ao.
37
What is the echogenicity of the adrenal cortex and medulla?
Cortex is hypoechoic Medulla is echogenic linear structure.
38
What are the arteries that supplies the adrenal gland?
Suprarenal branch of the - Inferior phrenic art - ao - renal art.
39
Where does the adrenal gland drain into?
RT suprarenal vein into IVC LT suprarenal vein into the LRV
40
What are the ACH?
aldosterone cortisol androgens
41
How is ACH regulated by
adrenocorticotropic hormones (ACTH) by the anterior pituitary gland.
42
What two glands regulate hormone production
Adrenal and anterior pituitary gland
43
A decrease in adrenal cortical function leads to ____ in ACTH An Increased in adrenal cortical function leads to ____ in ACTH
Increase decrease
44
What does the adrenal medulla produce?
catecholamines - epinephrine (adrenalin) - norepinephrine
45
What re the two types of functioning adrenal adenomas?
Hyperfunctioning Nonhyperfunctioning (most common)
46
What are the hyperfunctioning adrenal syndromes?
Cushing, Conn, and Hirsutism.
47
What is Cushing's syndrome?
Hypercortisolism
48
What is Conn syndrome?
Primary Aldosteronism
49
What is Hirsutism
Overabundance of hair excessive androgen
50
What is Addisons disease?
Non Hyperfunctioning Adrenal insufficiency
51
When should you biopsy an adrenal tumor?
3-6 cm
52
Where do adrenal cortical carcinomas tend to invade?
Renal veins and IVC.
53
What are pheochromocytoma - where are the located - associated with
secrete catecholamines - originate in adrenal medulla but can be ectopic along the paraaortic sympathetic nerve chain. - endocrine neoplasia, Von hippel-lindau dz, nurofibromatosis.
54
What is the most common palpable ABD mass, in infancy and early child, 2m to 2 years old?
Adrenal neuroblastoma
55
What is adrenal neuroblastoma
Malignant tumor of the sympathetic nervous system occurring in the adrenal medulla but can be in the neck, chest, or pelvis
56
What is a difference between adrenal neuroblastoma vs wilms tumor?
Neuroblastoma displaces the kidney inferiorly Wilms originates and invades the kidney
57
What is increased with Adrenal neuroblastoma
Increase blood and urine catecholamines
58
What is a myelolipoma? - how does it look sonographically
Benign nonfunctioning adrenal mass of fat and bones - hyperechoic mass (propagation speed artifact)
59
Adrenal metastases are the ___ common mets after ___, ___, and ___.
4th lungs, liver, and bones
60
What is the most common cancer that metastases to the adrenal gland?
Lung cancer
61
What is the most common adrenal mass in newborns?
Adrenal Hemorrhage
62

Abdominal Sonography (10 decks)

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