Retroperitoneum Powerpoint First 1/2

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1

Diaphragm; pelvis

Extraperitoneal fat; great vessels

Anterior pararenal; perirenal, and posterior pararenal

Anatomy of the Retroperitoneum: Area between the posterior portion of the parietal peritoneum and the posterior abdominal wall muscles. Extends from the ____ to the ____

Laterally, the boundaries extend to the _____ ___ planes within the transversalis fascia. Medially, encloses the ___ ___

Subdivided into: ___ ___ space, ____ space, and ____ ____ space

2

Ascending and transverse

Organs in the Anterior Pararenal Space:

  • Pancreas
  • Duodenal sweep
  • ___ and ____ colon
3

Adrenal

Great

Organs in the Perirenal Space:

  • ____ glands
  • Kidneys
  • Ureters
  • ____ vessels
4

Left; left

Medium

Adrenal Glands:

____ adrenal gland is semilunar in shape and extends along the medial border of the ___ kidney from the upper pole to the hilus

Internal texture is _____ in consistency; the cortex and medulla are not distinguished

5

Size; shape and configuration

Right; right

Adrenal Glands:

Adrenal glands vary in ____, ____ and ____

____ adrenal gland is triangular and caps the upper pole of the ____ kidney

6

Hypoechoic; echogenic

3-6

3-6

2-4

Adrenal Glands:

Adrenal glad is a distinct _____ structure; sometimes highly ____ fat is seen surrounding the gland

Normal Size:

  • __ to __ cm long
  • __ to __ mm thick
  • __ to __ cm wide
7

Larger

1/3; 1/13

Neonatal Adrenal Glands:

Infant adrenal gland is proportionately ____ than the adult adrenal gland

  • It is ____ the size of the kidney; in adults, it is ____ the size of the kidney
8

Thin; thick

Cortex; medulla

Neonatal Adrenal Glands:

Characterized by a ____, echogenic core surrounded by a ___ transonic zone

This thick rim of transoniticity represents the hypertrophied adrenal ____. Echogenic core is the adrenal _____

9

Two

Iliac and hypogastric

Paraaortic

Lymphatic

Paraaortic Lymph Nodes:

___ major lymph node bearing areas lie in the retroperitoneal cavity

  • ___ and ____ nodes within the pelvis
  • ____ group in the upper retroperitoneum

____ chain follows the course of the thoracic aorta, abdominal aorta, and iliac arteries

10

Finger

Infected and enlarged

Paraaortic Lymph Nodes:

Normal nodes are smaller than the tip of a ____ (less than 1 cm)

  • Not normally imaged with ultrasound
  • Can be seen when ____ and ____
11

Great vessels

Paraaortic Lymph Nodes: Common sites

  • Paraarotic and paracaval areas near the ___ ___
  • Peripancreatic area
  • Renal hilar area
  • Mesenteric region
12

Great vessels

Lymphatic

Organs in the Retroperitoneal Space: Posterior Pararenal Space

  • Lymph nodes

Iliac Fossa

  • Ureter
  • Major branches of the distal ____ ____
  • ____ vessels
13

Internal; iliopectineal

False pelvis

Transversalis fascia

Iliac Fossa: The region extending between the ____ surface of the iliac wings, from the crest to the _____ line

Known as the ___ ____ and contains the ureter, major branches of the distal great vessels and their lymphatic vessels

____ ____ extends into the iliac fossa at the iliac fascia

14

Prevesical

Presacral

Pelvic Retroperitoneum: 4 subdivisions -

  • ____
  • Rectovesical
  • ____
  • Pararectal (and paravesical) spaces
15

Rectum

Anteriorly; iliac

Bilateral Pararectal Space:

Bounded laterally by the piriformis and levator ani fascial and medially by the __

Extends ____ from the bladder, medially to the obturator internus, and laterally to the external ____ ____

16

Posterior; posterior

Straight

Common iliac

Anterior

Vascular Supply: Aorta

Enters the abdomen ____ to the diaphragm at the level of L1 and passes ____ to the left lobe of the liver

Has a ____ horizontal course at the level of L4

Bifurcates into the ____ ____ arteries at level of L4

Slight ____ curve of the aorta as a result of lumbar lordosis

17

Common iliac; cephalad

Anterior

Vascular Supply: IVC

Extends from the junction of the two ___ ___ veins to the right of L5 and travels ____

Curves ____ toward its termination into the right atrial cavity

18

Endocrine

Cortex

Medulla

Physiology of the Retroperitoneum:

Each adrenal gland is made up of two ____ glands

The ____, or outer part, secretes a range of steroid hormones

The ____, or core, secretes epinephrine and norepinephrine

19

Electrolyte metabolism

Aldosterone

Water content

Physiology of the Retroperitoneum - Cortex: Mineralcorticoids

Regulates ___ ____

____ is the principal mineralcorticoid

Has a regulatory effect on the relative concentrations of mineral ions in the body fluids and therefore on the ___ ___ of the tissue

20

Aldosterone

Lowered; acidosis

Physiology of the Retroperitoneum - Cortex: Mineralcorticoids

Insufficient ____ leads to increased excretion of sodium and chloride ions and water into the urine

Accompanied by a fall in sodium, chloride and bicarbonate concentrations in the blood, results in a ____ pH or ____

21

Carbohydrate

Increasing

Cortisone and hydrocortisone

Diminish

Cortex: Glucocorticoids- Responsible for ____ metabolism

Promote deposition of liver glycogen from proteins and inhibit the use of glucose by the cells, thus ____ the blood sugar level

____ and ____ are primary glucocorticoids

Cortisone and hydrocortisone ____ allergic response, especially the more serious inflammatory types such as rheumatoid arthritis and reheumatic fever

22

Androgens

Estrogens

Adrenal

Minute

Cortex - Sex Hormones: ____ are the male sex hormones

____ are the female sex hormones

___ gland secretion of both androgen and estrogen, regardless of the patient's gender

Normally secreted in ____ quantities and have almost insignificant effects

23

Masculine; prepubertal

Cortex; pituitary; glucocorticoid; increase

Cortex - Sex Hormones: Adrenal tumors in women can promote secondary ____ characteristics. Hypersecretion of the hormone in ____ boys accelerates adult masculine development and the growth of pubic hair

Adrenal ____ is controlled by adrenocorticotropic hormones (ACTH) from the ____ gland. Diminished ____ blood concentration stimulates the secretion of ACTH. Consequent ____ in adrenal cortex activity inhibits further ACTH secretion

24

Hypofunction

Cortex - Sex Hormones: Addison's Disease

_____ of the adrenal cortex in humans

Signs and symptoms - hypotension, general weakness, fatigue, loss of appetite and weight, and bronzing of the skin (hyperpigmentation)

25

Oversecretion

Hypersecretion

Cortex - Sex Hormones: Adrenal Hyperfunction

_____ from the adrenal cortex may be caused by an overproduction of ACTH caused by a pituitary tumor, hyperplasia, or a tumor in the cortex itself

_____ of the cortical hormones produces distinct syndromes: Cushing's syndrome, Conn's syndrome, and Androgenital syndrome

26

Sinusoids

Not

Epinephrine and norepinephrine

Medulla: Adrenal Medulla

Makes up the core of the adrenal gland in which groups of irregular cells are located amid veins that collect blood from the _____

____ essential for life, and can be removed surgically without causing untreatable damage

Produces _____ and ____

27

Amines

Heart rate; vasoconstrictor

Glycogenolysis

Medulla: Epinephrine and norepinephrine are ____, sometimes referred to as catecholamines

They elevate the blood pressure - epinephrine by working as an accelerator of the ___ ___ and norepinephrine by acting as a _____

The two hormones together promote _____ (breakdown of liver glycogen to glucose), which causes an increase in blood sugar concentration

28

Pheochromocytoma

Medulla: Increase in production of medulla hormones may be caused by a ______, a vascular tumor of the adrenal medulla characterized by hypersecretion of epinephrine and norepinephrine, causing persistent or intermittent hypertension.

29

Size

Rounded

Adrenal Glands: Visualization of the adrenal glands depends on several factors

  • ___ of the patient
  • Amount of perirenal fat surrounding the adrenal area
  • Presence of bowel gas
  • Ability to move the patient into various positions

Adrenal glands should not appear ____, if it does, this finding suggests a pathologic process

30

Rounded

Laterally

Paraaortic Lymph Nodes: Sonographic Patterns

  • ____, focal, echo-poor lesions (>1cm)
  • Confluent echo-poor masses, which often displace the kidney _____
31

Mantle

Sandwich

Paraaortic Lymph Nodes: May also detect

"____" of nodes in the paraspinal locations

"Floating" or anteriorly displaced aorta, secondary to the enlarged nodes

Mesenteric "____" sign representing the anterior and posterior node masses surrounding mesenteric vessels

32

Aorta and IVC

Supine or decubitus

Left; left

Paraaortic Lymph Nodes: Lymph nodes lie along the lateral and anterior margins of the ___ and ____

Best image is with the patient in the ___ or ____ position.

___ coronal view using the ___ kidney as a window may be used to discover paraaortic nodes.

33

Consistent

Constant

Homogenous

Reproducible

Paraaortic Lymph Nodes: Lymph nodes remain as ______ patterns on sonography.

As gentle pressure is applied with the transducer in an effort to displace the bowel, the lymph nodes remain _____ in shape.

Echo pattern posterior to each structure is different. Lymph nodes are _____ and transmit sound easily. Enlarged lymph nodes should be _____.

34

...

Pathologic Conditions of the Retroperitoneum: Adrenal cortical syndromes, Adrenal cysts, Adrenal hemorrhage, Adrenal tumors, Adrenal medulla tumors, Retroperitoneal fat, Primary retroperitoneal tumors, Secondary retroperitoneal tumors, Retroperitoneal fluid collections, and Retroperitoneal fibrosis (Ormond’s disease)

35

Atrophy

Addison's Disease (Adrenocrotical Insufficiency): Affects men and women equally; not related to age

_____ of the adrenal cortex occurs with decreased production of cortisol and sometimes aldosterone. Majority of the cortical tissue is often destroyed before adrenal insufficiency is diagnosed.

Primary causes of reduced adrenal cortical tissue: Autoimmune process, Tuberculosis (TB), Inflammatory process, Primary neoplasm and Metastases