abd

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Author:
rbeacr
ID:
121989
Filename:
abd
Updated:
2011-12-08 21:13:21
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16 Retroperitoneum
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Description:
the retroperitoneum
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  1. Three categories
    • anterior pararenal space: duodenum, pancreas, ascending and transverse colon
    • perirenal space: around kideney, adrenal glands, perirenal fat
    • posterior pararenal space:iliospaoas muscle, ureter, brances of ivc, aorta, lymphatics
  2. Illiac fossa
    • ureter
    • major branches of great vessles
    • lymphatics
  3. Retrofascial space
    three compartments
    • psoas
    • lumbar (quadratus lumborum
    • iliacus
  4. Anterior pararenal space
    • pancrease
    • duodenum
    • asceding and descending colon
  5. perirenal space
    • adrenal glands
    • kindey
    • ureter
    • great vessles
    • lymphnodes
  6. right adrenal gland
    • more superior to kidney
    • medial part of rt ad. gland is posterior to ivc
    • triangular
    • smaller than 3 cm
    • in adults 1/13th kidney
  7. left adrenal gland
    • more medial to the lt kindey
    • lateral-posteriolateral to aorta
    • semilunar
    • smaller than 3 cm
    • in adults 1/13th kidney
  8. neonatal adrenal gland
    • thin ecogenic core surrounded by a transonic zone
    • echogenic core= medulla
    • hypo outside=cortex
    • proportionally larger than adult
    • 1/3rd
  9. diaphragmatic crura
    • right crus is longer, larger, more lobular
    • right renal artery is anterior to the crus
    • right crus- ivc aneriolaterally and right adrenal and rt lobe of liver posteriolaterally
  10. para-arortic lymph nodes
    • 2 areas
    • pelvis (illiac and hypogastric)
    • para aortic
    • normal nodes less than 1 cm
    • only seen on sonogram if enlarged
  11. posterior para renal space
    iliopsoas, ureter, branches of ivc, aorta, lymphatics
  12. illiac fossa
    • aka false pelvis
    • contains ureter and major branches of distal great vessles and lymphatics
  13. retrofascial space
    posterior abd wall, muscles, nerves, lymphatics, areloar tissues behind transversalis fascia contains:

    • psoas compartment
    • lumber region
    • illiac area
  14. pelvic retroperitoneum
    • btwn sacrum and pubis
    • prevssical, retrovesicle, presacral, bilateral pararectal (paravesical) spaces
  15. prevesical and retrovesical
    • btwn bladder and rectum= rectovesical
    • btwnpubis to ant bladder= prevescical
  16. bilateral pararectal space
    ureters run through

    know!
  17. aorta
    • L1-L4
    • bifurcates at L4
  18. ivc
    • illiacs join to the right of l5
    • enters right atrium of heart
  19. adrenal gland cortex
    • outter part
    • secretes steroid horomones
    • 1- mineralcorticoids
    • 2- glucocorticoids
    • 3- sex horomones (androgen/estrogen)
  20. adrenal gland medulla
    core- inner- secretes epinephrine and norepinephrine (elevate bp, heart rate, and increase blood sugar)

    pheochromocytoma- increases production of medualla horomones- rare
  21. mineralocorticoids
    • regulate electrolye metabolism
    • aldosterone
    • concentration of minearl ions in body fluid
  22. glucocorticoids
    • carbohydrate metabolism
    • increase blood sugar
    • (cortisone and hydrocortisone)
    • diminish allergetic response
  23. sex horomones
    androgen and estrogen
  24. addisons disease
    • hypo function of adrenal cortex
    • atrophy of cortex
    • decreased cortisol production
    • steroid replacement therapy
  25. cushings syndrome
    • excessive secretion of glucocorticoid
    • hyperfunction of adrenal
    • excessive cortisol from adrenal hyperplasia, adenoma, carcinoma
    • pencil thin extremeties and buffalo hump, moonface,htn, stones
  26. para aortic lymphnodes
    1-3cm may displace aorta or kideney
  27. lymphadenopathy
    enlargement of lymphnodes or lymph vessles

    evaluate spleen- nodes in hilum of spleen
  28. adrenal corical syndromes
    • addisons disease
    • adrenogenital syndrome (adrenal virilism)
    • conns syndrome
    • cushings syndrome
    • waterhouse-frderichsen syndrome
  29. adrenogenital syndrome (adrenal virilism)
    • excessive sex horomone secretion and androgens/estrogen
    • inadrenal tumor or hyperplasia
    • may be ambiguous genetalia
    • masculizing effects
    • precocious puperty
    • adrenal, ovarian, or pituitary tumor
  30. conns syndrome (aldosteronism)
    • excessive secretion of aldosterone
    • cortex adenoma
    • htn
  31. waterhouse-friderichsen syndrome
    bacterial sepsis, shock, necrosis, bilateral hemorrhage of adrenal glands
  32. medulla tumor
    pheochromocytoma
    excessive secretion of epinephrine and norepinephrine
  33. adrenal hemorrhage
    • rare- trauma or infection
    • bilateral hemorrhage may cause insufficency
    • more common in neonates
  34. adrenal adenocarcinoma
    • benign- non functioning
    • most common primary adrenal tumor
    • nodules <2.5cm
    • diabetes htn- increase incidence
  35. adrenal malignant tumors
    primary adrenal carcinoma is rare and may be hyper or hypo functional
  36. metastasis
    • 4th most common site after breast, lung (50%), liver, testes, melanoma and bone
    • cause adrenal insufficiency
  37. Medualla tumors
    • pheochromocytoma
    • adrenal neuroblastoma
  38. pheochromocytoma
    • secretes epinephrine and norepinephrine in excss
    • vascular adrenal medulla tumor
    • usually benign but can turn malignant
    • echogenic
    • 18-30s
  39. adrenal neuroblastoma
    • most common malignancy of adrenal
    • prenatal-18 months
    • glands in childhood/infancy
    • displaces kidney inferiorly- rapid growth palpable mass
  40. lymphoma
    • most common primary retroperitoneal tumor
    • lymphadenopathy
    • renal, hepatic & splenic hilum
    • para aortic, celiac/sma
    • larger than 2cm, round- may be malignant
    • increased vascularity
  41. tumors of muscle
    leiomyosarcoma- smooth muscle of small blood vessles or within GI tract extend into retroperit.
  42. germ cell tumors
    • benign or malignant
    • teratomas (dermoid)in pelvis or upper pole of lt kidney
    • seen in childhood
  43. urinoma
    • walled off collection of urine after trauma, surgery, or urinary obst.
    • collect around kidney or upper ureter
  44. hemorrhage
    trauma, vasculitis, leaking aorta anyursm, bleeding neoplasm
  45. abcess
    • surgery, trauma, perforation of bowel or duodenum
    • complex pattern with debris
  46. ormond's disease
    retroperitoneal fibrosis (RPF)
    • idiopathic conditon
    • usually cancer pts with beam radiation
    • thick sheets of fibrous tissues in retro that encases and obstructs ureters, ivc- hydro
    • difficult to scan hard to penetrate
  47. posterior cul de sac
    peritoneal! not retro
  48. hyperstimulation of adrenal
    • cushings
    • conns
    • adrenogenital
  49. adrenal gland size
    • 3-6cm long
    • 3-6mm a/p
    • 2-4cm wide

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