SON110 Peritoneal Cavity and Abd Wall

a smooth serous membrane that lines the entire abdominal cavity and covers most of the abdominal organs

peritoneum

The abdominal cavity has 9 regions divided by _______ lines

Addison

Two peritoneal compartments:

Greater and lesser sac

Does not contain organs. Potential space posterior to stomach, extending superiorly to left suprahepatic recess.

Lesser Sac

Contains liver, spleen, stomach, first portion of duodenum, jejunum, ileum, cecum, transverse colon, sigmoid colon, and upper 2/3 of rectum

Greater Sac

peritoneum 2 layers:

parietal peritoneum &

visceral peritoneum

outer layer that lines the walls of the peritoneum cavity

parietal peritoneum

inner layer that covers abdominal organs of the peritoneum cavity

visceral peritoneum

small intestine is suspended from the posterior abdominal wall by the

mesentery

transverse colon is suspended from the posterior abdominal wall by the

transverse mesocolon

sigmoid colon is suspended from the posterior abdominal wall by the

sigmoid mesocolon

the general cavity of the peritoneum is the

greater sac

lesser sac, AKA

omental bursa

the peritoneal recess posterior to the stomach and anterior to the pancreas

lesser sac

the space between the liver, pancreas, and stomach

lesser sac

the lesser sac communicated with the greater sac through a small opening, the

epiploic foramen of winslow

attachments of the peritoneum to the abd walls and organs help determine the way abnormal collections of fluid within the cavity ________ or ________

collect, move

when the patient is laying supine, the lowest part of the body is in the

pelvis

on transverse view, the _______ are lower than the midabdomen

flanks

fluid will accumulate in the ___________ parts of the body

lowest/dependent

________ and ________ should always be examined for pathologic collections of fluid

pelvis

lateral flanks

double layer of peritoneum that extends from the liver to the lesser curvature of the stomach

lesser omentum

acts as a sling for the stomach and suspends it from the liver

lesser omentum

apron-like fold of peritoneum that hangs from the greater curvature of the stomach

greater omentum

greater omentum lies freely over the intestine except for the ______ part, which is fused with the transverse colon and mesocolon

upper

helps prevent further spread of infection by "walling off" stomach from rest of body

greater omentum

the greater omentum can bring masses of ________ to areas it adheres to, which helps combat infection

blood phagocytes

The lesser omentum, it connects the lesser curvature of the stomach and the left sagittal fissure for the ligamentum venosum of the liver.

Gastrohepatic ligament

Thickened free edge of the lesser omentum through which courses the portal triad; it connects the liver to the duodenum

Hepatoduodenal ligament

Double layered fold of peritoneum that contains the ligamentum teres. Can only be seen on ultrasound if ascites is present.

Falciform ligament

Bifurcation of the falciform ligament layers that fuses with the parietal peritoneum to form borders of the bare are of the liver, suspending the liver from the diaphragm

Coronary ligament

Formed by left branch of the falciform ligament. It forms the left extremity of the bare area of the liver.

Left Triangular Ligament

AKA Lienorenal Ligament. Connects the splenic hilum to the posterior abdominal wall.

Splenorenal Ligament

Connects the stomach to the spleen and inferior diaphragm

Gastrosplenic Ligament

Suspensory ligament that extends from the lateral uterine sidewalls to the pelvic sidewalls, dividing the anterior and posterior compartments in women.

Broad Ligament

Remnant of the fetal umbilical vein that is contained within the falciform ligament. It passes into a fissure within the visceral liver surface to join the left branch of the portal vein at the porta hepatic.

Ligamentum Teres

Remnant of ductus venosus. It is attached to the left branch of the portal vein and ascends into a fissure on the visceral liver surface to attach above the inferior IVC.

Ligamentum Venosum

collections in the right posterior subphrenic space ______ extend between the bare area of the liver and diaphragm

cannot

because the right pleural space extends medially to the attachment of the right superior coronary ligament, pleural collections appear _______ to the bare are of the liver

opposed

unless it is loculated, the pleural fluid tends to distribute _________ in the chest

posteromedially

subcapsular liver and splenic collections are seen when they are _______ to the diaphragm and ______ to the shape of an organ capsule

inferior, conform

subcapsular fluid collections may extend _______ to the attachment of the superior coronary ligament

medially

will subcapsular fluid collections move with patient position or stay in same place?

stay in same place

a mass is within the retroperitoneal cavity when _______ renal displacement or anterior displacement of the dilated _______ can be seen

anterior

ureters

retroperitoneal lesions displace echoes _________ and ________

ventrally, cranially

hepatic and subhepatic lesions produce _______ and _______ displacement

inferior, posterior

ligaments on the _______ side of the liver form the subphrenic and subhepatic spaces

right

divides the subphrenic space into right and left components

falciform ligament

ascends from the umbilicus to the umbilical notch of the liver within the falciform ligament before coursing in the liver

ligamentum teres

the bare area is delineated by right ________ and _______ coronary ligaments

superior, inferior

separate the posterior subphrenic space from the right superior subhepatic space

right superior and inferior coronary ligaments

lateral to the bare are and right triangular ligament are the

posterior subphrenic and subhepatic spaces

left coronary ligaments anatomically separate the __________ space into anterior and posterior compartments

subphrenic

connects the gastric greater curvature to the superior splenic hilum

gastrosplenic ligament

separates the lesser sac from the splenorenal recess

splenorenal ligament

pouch of Douglas, AKA

rectouterine pouch

a peritoneal recess extending between the rectum and uterus

rectouterine pouch

in men, the rectouterine pouch is called the

retrovesical pouch

ascites displaces the distended bladder _________ but not ________

inferiorly, posteriorly

paired rectus abdominis muscles are delineated medially in the midline of the body by the

linea alba

linea alba can cause ___________ on ultrasound

refraction artifact

accumulation of serous fluid in the peritoneal cavity

ascites

causes:

cirrhosis

renal failure

congestive heart failure

cancer

ascites

most common cause of ascites

cirrhosis

amount of intraperitoneal fluid depends on the __________, ___________, and patient ________

location, volume, position

peritoneal pressure, area in which fluid originates, rapidity, presence of adhesions, density, degree of bladder fullness are all

factors that can affect the distribution of intraperitoneal fluid

sonographic findings:

anechoic fluid regions indented and shaped by the organs and viscera it surrounds

ascites

______ thickening is common with ascites

GB wall

fluid fills the ____________ first

pouch of Douglas

fluid fills pouch of Douglas first, then _____________, then ______________

lateral paravesical recesses

paracolic gutters

what do you want to see moving within the ascites fluid on US?

bowel

sonographic findings:

fine or coarse echoes

loculation

unusual distribution, matting, or clumping of bowel loops

thickening of interfaces between the fluid

inflammatory/malignant ascites

hepatorenal recess, AKA

Morrison's pouch

generalized ascites, inflammatory fluid from acute cholecystitis, fluid from pancreatic autolysis, blood from ruptured hepatic neoplasm can all cause

hepatorenal recess fluid collections

generalized ______ , inflammatory fluid from acute _________, fluid from pancreatic _______, blood from ________ hepatic neoplasm or ectopic pregnancy can all cause hepatorenal recess fluid collections

ascites

cholecystitis

autolysis

ruptured

abd fluid collections persist _____ week after abdominal surgery as part of normal healing process

1

abd fluid collections post-abdominal surgeries should be gone within ____

1 week

abscess is a cavity formed by _______ within a solid tissue or a _________ collection of purulent material

necrosis

circumscribed

clinical findings:

fever

tenderness

swelling from post-op surgery

chills

weakness

normal LFTs

leukocytosis

sepsis

abscess

sonographic findings:

varies with time

complex mass with irregular borders

contains debris, septation, gas

abscess

gas in peritoneal abscesses may produce _________ artifact

comet tail

gas containing abscesses have scattered __________

air reflectors

densely echogenic mass with or without acoustic shadowing and otherwise increased through transmission

gas-containing abscess

peritonitis and the resultant abscess may be a ________ or _________ process

generalized, localized

the epiploic foramen usually ________ the lesser sac from inflammatory processes

seals off

if the process begins within the lesser sac, such as with a _______________, the sac may be involved along with it.

pancreatic abscess

differential diagnoses of lesser sac abscesses should include:

pseudocyst

pancreatic abscess

gastric outlet obstruction

fluid-filled stomach

___________ may make it difficult to examine the LUQ

air interference

to image subphrenic abscesses, alter pt position to ________ to scan along the coronal plane of the body

right lateral decubitus

pleural effusions appear ______ diaphragm

above

subphrenic abscesses can be confused with

pleural effusions

subcapsular collections of fluid within the liver can mimic loculated ___________ fluid

subphrenic

intraabdominal fluid displaces the liver __________ rather than indenting the border laterally

medially

intraabdominal fluid may be differentiated by its _______ border and its tendency to _______ to the contour of the liver

smooth, conform

extrahepatic loculated collections of bile =

biloma abscess

biloma abscess may develop from _______, _____ disease, or _________

trauma

GB disease

biliary surgery

sonographic findings:

cystic with weak internal echoes or fluid filled level if clots/debris aren't present

crescentric shaped, surrounding and compressing structures in which they come in contact

biloma abscess

extrahepatic biloma abscesses are normally _______ shaped

crescentric

general abdominal abscess may occur after _______ or _________

surgery, trauma

most common sites for abscess formation

hepatic recesses and perihepatic spaces