Peritoneum
lymphoceles are the development of lymph-containing fluid collections caused by ...
- *leakage of lymph* (from renal allograft) - *surgical disruptions* (of lymphatic channels) - *surgical complications* (renal transplants, gyn, vas. or urological surgery)
causes of Ascites
- CHF - liver disease - nephrotic syndromes - infections - malignancy - trauma
which vessels/organs are included in the anterior pararenal space?
- IVC/ aorta - pancreas -splenic & hepatic vessels - duodenum - ascending & descending colon - SMA/SMV
lymphoma sono appearance
- an anechoic to hypoechoic mass contain a central echogenic focus - seen throughout peritoneum, especially around the great vessels and organ hilums - "sandwich" or "mantle"
small collections of ascites can be found:
- around the inferior/posterior to the right love of the liver (*morrison's pouch*) - superior portion of the right flank - pelvic cul de sac
causes of retroperitoneal fibrosis
- connective tissue disease - systemic vasculitis due to AIDS - drug related - tumor induced - trauma - surgery - response to aortic aneurysm growth
retroperitoneal fibrosis sono appearance
- envelopes structure rather than displacing them! - hypoechoic midline mass
what is the clinical sign (triad) of intraperitoneal abscess?
- fever - pain - leukocytosis (high WBC)
the next sites for ascitic collections are located:
- in the parabolic gutters - lateral and anterior to the liver
the Perirenal space includes what organs?
- kidneys - adrenal glands - proximal ureter
what are differential diagnosis of lymphocele?
- located ascites - urinoma - hematoma - abscess
mesothelioma sono appearance
- mantle or sheet like thickening of the omentum - anterior surface of the mass generally conforms to the contour of the abdominal cavity, while the posterior deeper surfaces appear lobulated - hypoechoic, containing scattered small, echogenic foci
ascites sono appearance
- may have debris - possible GB wall thickening
Pseudomyxoma peritonei causes
- metastasis or rupture of a cystadenocarcinoma of the ovary - mutinous tumor of the appendix
metastatic implants of peritoneum sono appearance
- minute to extensive - if massive, caused the omentum to become a plate like mass appearing as relatively anechoic band of tissue beneath the abd. wall - hemorrhagic ascites may be present
pseudomyxoma peritonei sono appearance
- multiple hypoechoic or multicystic masses throughout the peritoneum and mesentery due to tumor implants - if ascites is present, it is massive in volume and may be echogenic as a result of the gelatinous content of the fluid
what is in the posterior pararenal space?
- no organs - psoas muscle - quadratus lumborum
the retroperitoneum is divided into the:
- perirenal spacew - anterior pararenal space - posterior pararenal space
Lymphocele sono appearance
- predominantly anechoic - may contain septations and debris
symptoms of peritonitis
- severe pain w. possible rebound tenderness - fever, chills - nausea, vomiting
mesenteric & omental cyst sono appearance
- single or multiple - thin walled - may have debris and septations - may be calcified
intraperitoneal asbcess' are usually the result of :
- trauma - surgery - infection in other body areas
symptoms for peritoneal mesothelioma
- weight loss - abdominal swelling and pain - bowel obstruction
intraperitoneal abscess sono appearance
- well defined - thick wall - debris - septations - gas
Mesothelioma occurs predominantly...
- with prior exposure to asbestos - usually Middle Aged men
what are the 2 other functions of the peritoneum , besides holding the viscera in position?
1. *secrete serous fluid* -- lubricates the surfaces of the peritoneum and facilitates free movement between he viscera 2. *help to resist infection* -- contains injury/infection; attempting to localize and wall it off
folds of peritoneum form ligaments which various organs are suspended within the peritoneal cavity. what are the 3 ligaments?
1. falciform ligament 2. coronary ligament 3. triangular ligament
what are the 2 parts of the mesocolon?
1. transverse mesocolon - attaches transverse colon to posterior abdominal wall 2. sigmoid mesocolon - attaches sigmoid colon to posterior abdominal wall
the greater omentum is ___ layers of peritoneum that hangs from the greater curvature of the stomach and loops down in front of the intestines, draping like an apron and attaches the _______ colon
4 transverse
paracolic gutters: ___ important paracolic gutters are formed by the arrangements of the ________ and _______
4! ascending and descending colons (lateral to ascending, medial to ascending, medial to descending & lateral to descending)
Malignant ascites may be associated with?
Bowels that are matted posteriorly to abdominal wall
the opening between the greater and lesser omentum is called...
Foramen of Winslow (Epiploic/ Omental Foramen)
retroperitoneal fibrosis rarely extends superior to the level of the _______ , and may extend inferiorly to the dome of the _______
L2 bladder
what is the most common location for free fluid ?
Morrison's pouch (posterior sub hepatic space/ hepatorenal space)
what are the retroperitoneal organs?
S - suprarenal *adrenal* gland A - aorta/IVC D - duodenum P - pancreas (except tail) U - ureters C - colon K - kidneys E - esophagus R - rectum
what is the mnemonic for retroperitoneal organs?
SAD PUCKER
peri-vessel lymphoma is typically seen as lymphomatous nodules anterior and posterior to the ________
SMA
intraperitoneal abscess
a collection of bacteria, necrotic tissue, and WBC's, located in any of the spaces of the peritoneal cavity
lymphocele
a collection of lymphatic fluid
lymphoma
a general term applied to malignancies affecting lymphoid tissues
the parietal peritoneum is the outer layer that is attached to the _____________
abdominal wall
the greater omentum contains large quantities of ___________ tissue, which may serve as an insulating/protective layer
adipose
posterior sub hepatic space is _____ to the right kidney
anterior
the falciform ligament extends from the umbilicus to the diaphragm and attaches the liver to the _________
anterior abdominal wall
what is the sub hepatic space divided into?
anterior and posterior spaces
retroperitoneal fibrosis is associated with _______ ________ ________
bilateral ureteral obstruction
with _____________, ascites is caused by increased pressure n the portal vein (portal HTN)
chronic liver disease (transudate!)
pseudomyxoma peritonei
condition can be described as a filling of the peritoneal cavity with *mucinous material and gelatinous ascites*
retroperitoneal fibrosis
dense fibrous tissue proliferation confined to the paravertebral region
the greater sac (general sac) is the largest compartment covering the entire width of the abdomen and extending from the ________ to the _____
diaphragm pelvis
ascites
excessive accumulation of serous fluid in the peritoneal cavity
_________ are caused by fluid that has escaped out of the blood vessels and has been deposited in the tissues or on tissue surfaces
exudates
the suphrenic space is inferior to the diaphragm and divided into right and left spaces by the _________ ligament
falciform
peritoneum contains what things?
fat, blood, vessels, lymphatics, and nerves
Benign ascites may be associated with?
floating bowel and mesentery
the anterior sub hepatic space is in the region of the ________
gallbladder
the peritoneal cavity is divided into several pouches or compartments that are created by peritoneal folds. what are the names of the sacs?
greater sac (general sac) lesser sac
the subphrenic space is created by the folding of the peritoneum in the _______ region
hepatic
the posterior sub hepatic space is also called _________ and ________
hepatorenal space Morrison's pouch
Exudates are characterized by _____ protein, ______ WBC, and ______ pH
high WBC high protein low pH
mesothelioma tumors are _____________
highly malignant (fatal within a year)
the major function of the peritoneum is to ...
hold the viscera in position by its folds
the sub hepatic space is located ________ to the liver
inferior
peritonitis
inflammation of the peritoneum
the presence of _____________ within the collection is more consistent with abscess/hematoma than with a lymphocele
internal echoes
the lesser sac is the small compartment lying behind the stomach, it is a diverticulum from the greater sac between the stomach and the pancreas. the lesser sac lies between the _________ and _______
lesser and greater omenta
where is the most common region of pancreatic pseudocyst
lesser sac
peritonitis is a potentially __________ condition
life-threatening (requires immediate medical attention)
__________ attach to the liver, spleen, stomach, kidneys, bladder and uterus to the peritoneum
ligaments
the right anterior subprenic space is anterior to the ________
liver
Transudates are characterized by ____ WBC, ____ protein, and ____ pH
low WBC low protein (hypoalbuminemia) high pH
the ______________ connect portions of the intestine with the posterior abdominal wall to the peritoneum
mesenteries
____________: double sheet of peritoneum suspending jejunum and ileum from the posterior abdominal wall, it fans out to encircle the small bowel loops
mesentery (proper)
mesenteries are folds of peritoneum that unite the abdominal wall with the intestines, that carry blood vessels, nerves, and lymphatics to organs. what are the two types of mesenteries ?
mesentery (proper) & mesocolon
_____________: surrounds parts of the colon and attaches it to the posterior abdominal wall
mesocolon
the _______ attach to the stomach to the peritoneum
omenta
the visceral peritoneum is the inner layer that is wrapped around the internal _________ located inside the abdominal cavity
organs (ex. glissons capsule around liver)
metastatic implants of the peritoneum can originate from a wide variety fo primary causes, mostly _______ of from the _______
ovarian GI tract
_______periteoneum: the outer layer
parietal
"sandwich" or "mantle" sign is the presence of __________
peri-vessel lymphoma
________: the potential space between the visceral and parietal layers of the peritoneum
peritoneal cavity
the space between the parietal and visceral peritoneum is called the _________
peritoneal cavity
the retroperitoneum is located ...
posterior to the parietal peritoneum
posterior sub hepatic space is located ___________ to the liver
posterior/inferior
between the two layers of peritoneum, there is a __________ between them
potential space *PERITONEAL CAVITY*
mental and mesenteric cysts
rare cysts that ares from the omentum or mesentery
Mesothelioma
rare neoplasm arising from the serous membranes line the pleural, pericardial, and peritoneal compartments
the perirenal space is separated from the pararenal spaces by the ____________
renal fascia (Gerota's fascia)
the right posterior subphrenic space lies posterior to the __________ lobe of the liver
right
the peritoneum is a __________ membrane
serous
the peritoneal cavity contains __________
serous fluid
the peritoneal cavity is filled with a small amount of....
slipper serous fluid (50 ml), allowing the two ayers to slide freely over each other
the left subphrenic space (anterior and posterior) is inferior to the diaphragm and anterior and posterior to the ________
spleen
folds of omen are attached to the _________
stomach
the lesser omentum is attached to the lesser curvature of the _______ and the _______
stomach and the liver
the potential space under the diaphragm is called the _______ space
subphrenic
which part of the pancreas is not retroperitoneal?
tail
any substance passing through a membrane or being pushed out through a tissue is a ________
transudate
what are the two major types that ascites can be subdivided into?
transudate and exudate
how many layers of peritoneum are there?
two
____________ peritoneum: the inner layer
visceral