adrenal glands, GI system, & interventional radiology

What is the acronym for the structures in the intraperitoneal?

FOULS JARS

What is the acronym for the structures in the retroperitoneal?

SAD PUCKER

List out what each letter of the intraperitoneal acronym stands for.

• Fallopian tubes

• Ovaries'

• Uterus

• Liver

• Spleen

• Jejunum

• Appendix

• Rectum

• Stomach

List out what each letter of the retroperitoneal acronym stands for.

• Suprarenal glands

• Aorta/IVC

• Duodenum

• Pancreas

• Ureter

• Colon

• Kidneys

• Esophagus

• Rectum

Is the stomach considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the jejunum considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the 1st part of the duodenum considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the appendix and cecum considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the spleen considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the transverse and sigmoid colon considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the liver considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the gallbladder considered an intra- or retroperitoneal organ?

Intraperitoneal

Are the uterus, fallopian tubes, and ovaries considered an intra- or retroperitoneal organ?

Intraperitoneal

Is the adrenal gland considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the aorta & IVC considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the duodenum considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the pancreas considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the ureter considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the ascending and descending colon considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the kidney considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the esophagus considered an intra- or retroperitoneal organ?

Retroperitoneal

Is the rectum considered an intra- or retroperitoneal organ?

Retroperitoneal

When scanning for the adrenal glands, they are more likely to be seen on children or adults?

Children

List the 3 anatomical areas where the adrenal glands can be found to the upper pole of the kidney.

• Superior

• Anterior

• Medial

What is the structure seen at the white arrow?

Adrenal gland

What is the prominent structure seen here?

Adrenal gland

What is the name of the structure crossed out?

Crus of the diaphragm

Label the structures seen in this image.

1. Gastro-esophageal junction

2. Crus of the diaphragm

3. Celiac Axis

What is another term for retroperitoneal fibrosis? 

Ormond’s disease

Ormond’s disease is another term for what?

Retroperitoneal fibrosis

Name the pathology:

“Abnormal formation of fiber-like tissue (fibrosis) occurs within the retroperitoneal space”

Retroperitoneal fibrosis (Ormond’s disease)

Retroperitoneal fibrosis is a rare ___________ disorder. 

Inflammatory

1. Retroperitoneal fibrosis is the abnormal formation of ______-like tissue fibrosis.

2. Occurs within the ____________ space.

1. Fiber-like

2. Retroperitoneal

Retroperitoneal fibrosis is abnormal tissue ________.

Growth

Retroperitoneal fibrosis often spreads to affect what other structure?

Ureter

Retroperitoneal fibrosis is generally located where?

Aortic bifurcation

Retroperitoneal fibrosis will resemble what other pathology?

Horseshoe kidney

In this lecture, a horseshoe kidney is similar in appearance to what pathology?

Retroperitoneal fibrosis (Ormond’s disease)

What pathology is seen at the arrow?

Retroperitoneal fibrosis (Ormond’s disease)

What imaging modality is seen here?

CT

List the 7 sonographic findings of retroperitoneal fibrosis (Ormond’s disease).

• Hypoechoic midline mass

• Bilateral ureteral obstruction

  • Hydronephrosis

• Decreased renal function

• IVC and lymphatic compression

  • Lower extremity edema

  • Scrotal swelling

How does retroperitoneal fibrosis affect the kidneys? (2)

• Bilateral ureteral obstruction

• Hydronephrosis

Compression of the IVC and lymphatic system from retroperitoneal fibrosis can lead to what 2 clinical findings?

• Lower extremity edema

• Scrotal swelling

How does lower extremity edema cause scrotal swelling? 

Compression of the gonadal veins

What pathology is seen here in this sagittal image of the aorta?

Retroperitoneal fibrosis (Ormond’s disease)

What pathology is seen here in this transverse image of the aorta?

Retroperitoneal fibrosis (Ormond’s disease)

The adrenal gland will produce hormones in response to signals from what other structure?

Pituitary gland

The pituitary gland will send signals to what other structure to produce hormones?

Adrenal glands

All cortical hormones fall under what category of hormones?

Adrenal-cortical

All medullary hormones fall under what category of hormones?

Catecholamines

Adrenal-cortical hormones are __________ hormones. 

Cortical

Catecholamine hormones are __________ hormones.

Medullary

List the 3 hormones that are considered cortical hormones.

• Mineralcorticoids

• Glucocorticoids

• Androgens

Mineralcorticoids are also referred to as…

Aldosterone

Glucocorticoids are also referred to as…

Cortisol

Aldosterone is also referred to as…

Mineralcorticoids

Cortisol is also referred to as…

Glucocorticoids

Aldosterone is produced from which layer of the adrenal gland? 

Cortex

Glucocorticoids (cortisol) is produced from which layer of the adrenal gland? 

Cortex

Mineralcorticoids (aldosterone) is produced from which layer of the adrenal gland? 

Cortex

Epinephrine is also referred to as…

Adrenaline

Adrenaline is also referred to as…

Epinephrine

List the 2 hormones that are considered medullary hormones.

• Epinephrine (adrenaline)

• Norepinephrine

Epinephrine (adrenaline) is produced from which layer of the adrenal gland? 

Medulla

Norepinephrine is produced from which layer of the adrenal gland? 

Medulla

Adrenocortical hormones are regulated by what other hormone?

Adrenocorticotropic hormone

Adrenocorticotropic hormone regulates what other hormone?

Adrenocortical

What does ‘ACTH’ stand for?

Adrenocorticotropic hormone

What hormone is released from the anterior pituitary gland?

Adrenocorticotropic hormone (ACTH)

Adrenocorticotropic hormone is released from what structure?

Anterior pituitary gland

What structure is seen at the white arrow?

Adrenal gland

List the 2 sonographic findings of an adrenal gland.

• Hypoechoic cortex

• Echogenic medulla

Adrenal adenomas can have which 2 ‘functions’?

• Hyperfunctioning

• Non-functioning

Majority of adrenal adenomas are _______-functioning.

Non-

Adrenal adenomas are ________ findings. 

Incidental

Define a ‘hyperfunctioning adrenal adenoma.’

Adenomas will produce hormones, causing symptoms to occur

Define a ‘non-functioning adrenal adenoma.’

Hormones are not affected

What is the pathology seen here?

Adrenal adenoma

What is the pathology seen here?

Adrenal adenoma

Name the pathology:

“Excessive cortisol secretion (hypercortisolism)”

Cushing’s Syndrome

What is Cushing’s Syndrome?

Excessive cortisol secretion (hypercortisolism)

What is the term for excessive cortisol secretion?

Hypercortisolism

Define ‘hypercortisolism.’

Excessive cortisol secretion

Adrenal adenomas can lead to what 2 pathologies?

• Cushing’s Syndrome

• Conn Syndrome

List the 5 causes of Cushing’s Syndrome.

• High doses of corticosteroid medicine over time

• Adrenal adenoma

• Pituitary gland tumor

• Adrenal gland disease

• Hereditary

List the 6 clinical symptoms of Cushing’s Syndrome. 

• Thin arms and legs 

• Large belly

• Fat pad on the back of the neck

• Abnormal stretch marks

• Bruise easily

• Hirsutism

A patient who has been using high doses of corticosteroid medication mentions seeing changes in their body. Based on the clinical symptoms, what can be assumed here?

Cushing’s Syndrome

What is another term for Conn Syndrome?

Primary aldosteronism

Primary aldosteronism is another term for what pathology?

Conn Syndrome

Name the pathology:

“Excess production of aldosterone”

Conn Syndrome

Conn syndrome is the excess production of what hormone?

Aldosterone

Conn syndrome is most often caused by what pathology?

Adrenal adenoma

Why would an adrenal adenoma lead to Conn Syndrome?

Excess production of aldosterone, leading to a hyperfunctioning adrenal adenoma

What kind of adrenal adenoma can be seen with Conn syndrome?

Hyperfunctioning

List the 5 clinical symptoms of Conn’s Syndrome.

• High blood pressure

• Low blood potassium

• Polyuria

• Fatigue

• Increase aldosterone

Why does aldosterone increase with Conn’s Syndrome?

Due to stimulating the secretion of potassium by the kidneys

List the 7 clinical symptoms of Addison’s disease.

• Hair loss

• Blurry vision

• Abdominal pain

• Decreased appetite

• Darkening of the skin (hyperpigmentation)

• Shaking or tremors

• Depression

Addison’s Disease is an adrenal ___________. 

Insufficiency

Name the pathology:

“When the adrenal glands are not producing enough cortisol and/or aldosterone”

Addison’s Disease

Addison’s Disease is when the adrenal glands are not producing enough of which 2 hormones?

• Cortisol

• Aldosterone