Retroperitoneum

Question 1

Peritoneum

Answer 1

• 2 layers
• ligaments & folds

Question 2

2 layers of the peritoneum

Answer 2

• parietal = external
• visceral = internal (touching tissue)

Question 3

Function of ligaments & folds in peritoneum

Answer 3

• creates a “cavity”
• support organs
• contains spaces/sacs

Question 4

Retroperitoneum

Answer 4

area (space) btwn. posterior parietal peritoneum & posterior abdominal wall (retrofascia)

Question 5

Borders of retroperitoneum

Answer 5

• diaphragm (pelvic floor)
• spine/ribs
• musculature
• parietal peritoneum (posteriorly)

Question 6

Spaces in retroperitoneum

Answer 6

• anterior pararenal
• perirenal
• posterior pararenal
• subphrenic

Question 7

Anterior pararenal space

Answer 7

• btwn. parietal peritoneum and kidney (majority in this space)
• duodenum/colon/pancreas

Question 8

Perirenal space

Answer 8

• surrounding kidneys (Gerota’s fascia)
• adrenal gland/kidney/proximal ureter/great vessels

Question 9

Posterior pararenal space

Answer 9

• btwn. kidney & posterior abdominal wall
• muscles (psoas/quadratus lumborum)
• spine is also behind it

Question 10

Subphrenic space

Answer 10

btwn. liver or spleen & diaphragm

Question 11

Other structures of retroperitoneum

Answer 11

• diaphragmatic crura (crus)
• lymph nodes

Question 12

Diaphragmatic crura (crus)

Answer 12

• connections of the diaphragm to the spine, cross aorta & IVC
• right is longer & larger - posterior to IVC

Question 13

Lymph nodes

Answer 13

• bean-shaped organs that collect lymphoid tissue (immunity/vascular filtration)
• found along aorta & its branches

Question 14

Adrenal glands

Answer 14

• endocrine function
• paired
• Rt = triangular/pyramid shape
• Lt = crescent shaped
• blood supplied by multiple “suprarenal” arteries

Question 15

Adrenal gland location/anatomy

Answer 15

• sit next to kidney w/in Gerota’s fascia
• larger at fetus & pediatric stages
• smaller as adults
• don’t mistake them for the kidneys

Question 16

What does the cortex produce?

Answer 16

steroid & hormones

Question 17

What does the medulla produce?

Answer 17

fight or flight response

Question 18

What does the hypothalamus control?

Answer 18

hormone production

Question 19

What does the anterior pituitary gland secrete?

Answer 19

adrenocorticotropic hormone

Question 20

3 zones of the cortex

Answer 20

• zona glomerulosa
• zona fasciculata
• zona reticularis

Question 21

What hormones are produced in the medulla?

Answer 21

epinephrine & norepinephrine

Question 22

Epinephrine

Answer 22

• increases HR, BP, & blood flow
• opens airways in lungs
• narrows blood vessels in skin & intestines

Question 23

Norepinephrine

Answer 23

• increases HR & BP
• contracts blood vessels

Question 24

What is the vascular supply to the adrenal glands?

Answer 24

• lots of small vessels
• not a main system

Question 25

Landmark for finding adrenal glands

Answer 25

kidneys

Question 26

Scanning adrenal glands: adult

Answer 26

- medium-level echoes on superior & medial aspect of kidneys

Question 27

Scanning adrenal glands: neonate

Answer 27

- hypoechoic rim seen around an echogenic core (hypertrophied cortex) - proportionately larger in newborns

Question 28

Lymph nodes sonographic anatomy

Answer 28

- less than or equal to 1cm - not usually seen unless abnormal - look for displacement of great vessels

Question 29

Fluid collections/tumors sonographic anatomy

Answer 29

- evaluate clinical hx - anechoic/hypoechoic/hyperechoic area

Question 30

Ascites sonographic anatomy

Answer 30

- abnormal accumulation of serious fluid - M/C cause is cirrhosis - transudative - exudative

Question 31

Sarcoma

Answer 31

- retroperitoneal tumors - bad - found on all types of tissue

Question 32

Pitfalls to imaging retroperitoneum

Answer 32

- bowel gas - small size medial/posterior location adjacent anatomy has similar appearance to small structures

Question 33

Landmarks of retroperitoneum location

Answer 33

- kidneys - aorta/IVC - spine (posterior location)

Question 34

What type of scan is the primary choice for imaging retroperitoneum?

Answer 34

- CT/MRI is more valuable - U/S is more for a follow up

Question 35

Scanning retroperitoneum for fluid-type collection

Answer 35

- hematoma - urinoma - ascites