Abdomen and small parts- Abd wall and peritoneal cavity

peritoneal cavity

made up of peritoneal ligaments and folds

- connects the organs to each other and abdominopelvic wall

peritoneum, what is it?

smooth membrane lining the entire abdominal cavity and organs

what are the two layers of peritoneum

1. parietal- lines the walls of the cavity

2- visceral- covers the abdominal organ

greater sac?

greater sac of peritoneum

lesser sac, what is it and what is it formed by?

formed by stomach and spleen

- located posterior to stomach

lesser omentum

double layer of peritoneum

- extends from liver to lesser curvature of the stomach

- acts like a sling for stomach

greater omentum

apron like fold of the peritoneum

- hangs from the greater curvature of the stomach

ascites

accumulation of serous fluid in the peritoneal cavity

what produces ascites

- low serum osmotic pressure

- high portal venous tension

what causes ascites

- cirrhosis

- budd-chiari syndrome

- heart failure

- cancer

ascites- sono

- gb wall is thickened

bengin

- free floating bowel, anechoic fluid regions

malignant

- bowel loops are matted posteriorly

- surrounded by complex fluid

abscess

collection of pus, cavity formed by necrosis

symp of abcess

- fever

- tenderness

- swelling

- increased wbc count

abscess sono

- fluid filled with irregular borders

- complex with debri or solid appearance

gas containing abscess

gas/air within

gas containing abscess- sono

densely echogenic mass

- may be shadowing

- may be enhancement

pseudomyoxma peritonei

malignant ascites

- mucinous material and gelatinous ascites

tumors found on peritoneal surfaces

pseudomyoxma peritonei- causes

metastasis/rupture

Pseudomyoxma Peritonei sonography

complex fluid

- matted bowel loops on posterior abdomen wall

Biloma

extrahepatic loculated collection of bile

biloma - causes

- trauma

- gb disease

- biliary surgery

biloma sono

cystic with weak internal echoes

- sharp margins

cysts causes

-Embryologic

-Traumatic

-Acquired

-Neoplastic

- Infective

cysts sono

Uniloculated or multiloculated

Smooth walls and thin internal septations

Internal echoes from fat, debris, blood or pus

urachal cyst

Incomplete regression of the urachus during

development

urachal cyst sono

Cystic mass between umbilicus and urinary bladder

Varies in size

May be septated

urinoma

an encapsulated collection of urine located outside the kidney or bladder

urinoma causes

renal trauma

renal surgery

obstruction lesion

urinoma sono

cystic mass

anechoic with low level echoes

peritoneal mestastases

develops from spread across the peritoneal cavity

most common places of peritoneal metastasis

ovaries, stomach, colon

peritoneal metastasis- sono

Nodular, sheet-like, irregular configuration

Adhesion to bowel loops

what are the two groups of Lymphoma of the Omentum and

Mesentary

1. non hodgkin lymphoma

2. hodgkin lymphoma

Lymphoma of the Omentum and

Mesentary- sono

Lobulated hypoechoic mass containing central

echogenic area

"sandwich or mantle sign" - presence of perivessel

lymphoma - cluster anterior and posterior to aorta or

SMA

mesothelioma

a malignant neoplasm originating

from pleural or peritoneal surfaces

who does mesothelioma affect?

middle aged men as a result of exposure to

asbestos

mesothelioma symp

abdominal pain

weight loss

ascites

mesothelioma- sono

large mass or diffuse small nodules

what are the 5 layers of the anterior abd wall

skin, fascia, and muscle, fascia transversalis, peritoneum

what are the types of muscles in the abd?

Rectus abdominis

External oblique muscle

Internal oblique muscle

Transverse abdominal muscle

lymphocele

collection of fluid that occurs after surgery

lymphocele sono

Loculated simple fluid collections

Complex fluid collections with septations

rectus sheath hematoma

acute or chronic collections of blood lying within the rectus muscle or between muscle and sheath

rectus sheath hematoma symp

acute sharp persistent, non radiating pain

rectus sheath hematoma causes

trauma, pregnancy, surgery

rectus sheath hematoma sono

Asymmetry of muscles

Acute: Anechoic mass with internal echoes

Chronic: solid in appearance due to clotting

bladder flap hematoma

collection of blood between the badder and lower uterine segment

bladder flap hematoma causes

lower-uterine transverse cesarian section bleeding from uterine vessels

abscess (abd wall pathology)

abscess or inflammation of abdominal wall

abscess symp (abd wall pathology)

- fever

- leukocytosis

- septicemia

abscess cause (abdomen wall pathology)

post- op

abscess- sono (abd wall pathology)

- cystic, complex or solid appearance

- superficial mass

-irregular margins

neoplasm

lipomas, desmoid tumors

lipoma

bengin fatty tumor

desmoid tumor

benign fibrous tumor

lipoma sono

hyperechoic

smooth and sharp defined walls

desmoid tumor sono

hypoechoic to cystic

smooth and sharp defined walls

hernia

protrusion of a peritoneal lined sac through a defect in abd wall

incarcerated hernia

one that cant be pushed back into the abdominal cavity

strangulation hernia-

interruption of blood flow may occur if incarcerated- results in necrosis

3 parts of hernia

sac, contents of sac and covering of the sac

hernia sono

palpable mass

interruption of the peritoneal line

fluid filled mass may contain peristaltic bowel

valsalva maneuver to see if mass moves