Chapter 3 "Abdominal"

Splenorenal Ligament

Also called the lienorenal ligament connects the splenic hilum to the posterior abdominal wall thorough which the splenic vein and artery travel

Gastrosplenic Ligament

Connects the stomach to the spleen and inferior diaphragm

Falciform ligament***

Double layered fold of peritoneum that ascends from the umbilicus to the liver.

A Scanning technique that focuses specifically on the peritoneal cavity called

FAST has become more popular recently and may be used to assess the peritoneal spaces for free fluid in trauma situations.

the parietal peritoneum lining the inner anterior abdominal wall may be visualized using ..

High frequency 5 to 9 Mhz linear transducer

the lesser sac extends inferiorly into the fold of the greater omentum (Inferior recess of the lesser sac or omental bursa)

Note that this fold is patent in infants and small children but generally fuses in adults

when free fluid is observed within the peritoneal cavity the sonographer should assess it for specific characteristics taking images that demonstrate weather the fluid is

Simple or Complex and determine if it is loculated or freely mobile this may require using a higher frequency transducer, increasing gain above the optimally used during scanning and imaging from multiple angles of incidence in order to detect fine septa or particles within the fluid. LLD OR TRENDELENBURG POSITION (to demonstrate fluid movement)

the greater omentum subdivides the greater sac into ..

Supracolic (above the colon) Infracolic (below the colon)

Biloma

a collection of extravasated bile that can occur with trauma or rupture of the biliary tract.

Abscess

a pocket of infection typically containing, pus blood and degenerating tissue

Broad Ligament

a suspensory ligament that extends from the lateral uterine sidewalls to the pelvic sidewalls dividing the pelvis into anterior and posterior compartments in the female .

Gastrohepatic ligament

also called the lesser omentum, smaller omentum, and gastrohepatic omentum. Connects the lesser curvature of the stomach and the left sagittal fissure for the ligamentum vensosum (transverse fissure) of the liver

hematoma

an extravasated collection of blood localized within a potential space or tissue

lymphocele

an extravasated collection of lymph

Right and Left Paracolic Gutters Why is this important?

are potential spaces or grooves found alont the lateral ascending and descending colon that conducts fluid between the supracolic compartment of the abdomen and infracolic compartment of the inferior abdomen and pelvis. they are important determining the extension of disease.

hilum

area of the organ where blood vessels, lymph and nerves enter and exit

the hila of peritoneal organs are considered ___ because they lack __ these ___ are part of the retroperitoneum.

bare areas; peritoneal covering; bare areas..

Coronary ligament

bifurcation of the falciform ligaments layers that fuse with the parietal peritoneum to from borders of the bare area of the live suspending the liver from the diaphragm.

ascites will demonstrate __ moving freely within it

bowel

when assessing the paracolic gutters and posterior rectouterine/rectrovesical space for fluid it may be nessasary to ___ the gain settings

decrease

peritoneal membrane

divides the abdominal cavity into peritoneal and retro peritoneal compartments.

Addison's Line

divides the abdominopelvic cavity into nine regions by drawing two sagittal lines and two axial lines

lesser sac

does not contain any organs this potential space lies immediately posterior to the stomach

Ligamentum venosum***

exhibits as a fibrous band attached to the left branch of the portal vein.

hemoperitoneum

extravasated blood within the peritoneal cavity

seroma

fluid collection composed of blood products located adjacent to or surrounding transplanted organs in the early transplantation period

FAST Scan

focused assessment with sonography in trauma scan. A triage sonography examination performed in the field or emergency department to detect free fluid within the chest and peritoneum that would indicate bleeding

left triangular ligament

formed by the left branch of the falciform ligament and the parietal peritoneum. Forms the left extremity of the bare area of the liver

the peritoneal cavity is formed by the ..

fourth embryonic week and is derived from the mesoderm

Ascites

free fluid within the peritoneal cavity that may be associated with liver failure, abdominal trauma, or malignancy

organs develop along the posterior abdominal wall and protrude into the peritoneal cavity, they are covered by visceral peritoneum except at their ____ where blood vessels, nerves, and lymph enter and exit the organ..

hilum .

the peritoneum appears as a thin

hyperechoic continuous line posterior to the moderately hypoechoic internal oblique and rectus abdominis abdominal wall muscles

Vesicorectal Space

in the males I the potential space created by the peritoneal reflection over the rectum and posterior bladder wall. When the males in the supine position this space is most gravity dependent potential space of the pelvic cavity draining fluid from the infracolic area

the lesser omentum.. also called the small omentum gastrohepatic omentum and gastrohepatic ligament

is a fused double layer of peritoneum stretching between the lesser curvature of the stomach and the left sagittal fissure for the ligamentum venosum

greater omentum

is a large apron like double layered sheet of peritoneum called the ..

Uterovesicle Space

is also called the uterovesicle pouch or anterior cul-de-sac in the female and the potential space created by the peritoneal reflection over the uterine fundus, anterior uterus. board ligament, and the posterior urinary bladder

Hepatorenal Space in supine postion this space is most ?

is also referred to as Morrision Pouch .. this peritoneal potential space is created by the peritoneum, reflecting from the liver over the right kidney and right posterior peritoneal wall. When the patient is in a supine position this space is most gravity-dependent potential space of the abdominal cavity, collecting fluid from the supracolic area and the lesser sac

Rectouterine Space

is also the rectovaginal pouch, pouch of Douglas, or posterior cul-de-sac in the female. created by the parietal peritoneum draping over the anterior rectum posterior vaginal wall and posterior uterus. when the female is in a supine position this space is the most gravity dependent.

Left Anterior Suprahepatic Space (or suprahepatic space)

is an extension of the greater sac between the diaphragm and the anterior superior liver leftward of the falciform ligament.

Right Subpherenic Space or (suprahepatic space)

is an extension of the greater sac between the right hemi diaphragm and the anterior superior liver rightward of the falciform ligament

Space of Retzius

is called the prevesicle or retropubic space and is an extraperitoneal potential space located between the anterior wall of the urinary bladder and the pubic symphysis.

Supracolic ..

is located anterior to the greater omentum and stomach and inferior to the liver .

Infracolic

is posterior to the greater omentum surrounding the small bowel and colon within the remainder of the greater sac.

the greater sac ..

is the largest housing the liver, spleen, stomach, first part of the duodenum, jejunum, ileum, cecum, transverse colon, sigmoid colon, and the upper two thirds of the rectum. this sac contains several potential spaces that must be evaluated for free fluid..

this division is important because ..

it limits the spread of infected materials, pus ascetic fluid, and malignant cells within the peritoneal cavity.

the visceral peritoneum and parietal peritoneum of the posterior peritoneal wall are typically not appreciated to their depth. A __ FREQUENCY ...

lower frequency 2-5 Mhz curvilinear or sector transducer is required to adequately visualize these deeper structures

extraperitoneal organs

organs outside of the parietal peritoneum, but typically covered by parietal peritoneum on one side

retro peritoneal organs

organs posterior to the parietal peritoneum that are typically covered on their anterior surface or fatty capsule by parietal peritoneum

communication between these two compartments is via the ..

paracolic gutters. lateral borders of the ascending and descending colon ..

visceral peritoneum

peritoneum encasing peritoneal organs

parietal peritoneum

peritoneum lining the walls of the peritoneal cavity

Omental Bursa

posterior stomach and parietal peritoneum covering the anterior pancreas and the splenorenal and gastrasplenic ligaments and epiploic foramen. a pseudocyst may be identified in this space

ligamentum teres****

remnant of the fetal umbilical vein, which is contained within the falciform ligament. It passes into a fissure on the visceral liver surface to join the left branch of the portal vein in the porta hepatis.

this thin layer coating all surfaces of the peritoneal cavity and its organs secretes a small amount of ______ approx. 50ml

serous fluid

peritoneal organs

solid organs within the peritoneal cavity that are covered by visceral peritoneum

bare area

surface area of a peritoneal organ devoid or peritoneum

According to the ultrasound guide for emergency physicians ..

the FAST examination is performed by acquiring longitudinal and transverse images to include Morrison Pouch, the posterior right hemidiaphargm/liver surface, the spleen/ left kidney interface in the LUQ, and the pouch of Douglas.

the peritoneal cavity is generally divided into 2 compartments

the greater sac and the lesser sac

what is generally the primary focus of a diagnostic examination?

the peritoneal organs are the focus of the examination with the potential spaces of the peritoneal cavity viewed secondarily.

Hepatoduodenal ligament

thickened free edge of the lesser omentum thorough which courses the portal triad. Connects the liver to the duodenum

Left Posterior Suprahepatic Space ALSO CALLED THE SUPERIOR RECESS OF THE LESSER SAC

this space is an extension of the lesser sac between the diaphragm and the posterior superior liver

iatrogenic

treatment induced; may be intentional or unintentional

mesentery

two layers of fused peritoneum that conduct nerves lymph and blood vessels between the small bowel/colon and the posterior peritoneal cavity wall

the greater omentum is ..

very mobile and moves to areas of inflammation surrounding the inflamed area by creating adhesions to wall off infection. it also acts to cushion the abdominal organs to prevent trauma and acts to prevent the loss of body heat from abdominal organs.

the greater omentum funtions to prevent the parietal peritoneum of the anterior abdominal wall from adhering to the

visceral peritoneum