Biology

Due to the high frequency of appendicitis and duodenal ulcers, the most common potential space for a peritoneal abscess is: a. Right subphrenic space

b. Hepatorenal space

c. Left anterior subphrenic space

d. Space of Retzius

14. All of the following statements regarding a peritoneal abscess are true EXCEPT: a. The abscess may appear as a thick walled fl uid

collection with internal debris.

b. Color Doppler will frequently demonstrate internal vascularity.

c. An abscess may be located in a potential space or next to an infl amed or perforated organ.

d. A peritoneal abscess may be the result of a surgical complication.

15. A large hematoma may be associated with a decrease in which laboratory value? a. Amylase

b. White blood count

c. Bilirubin

d. Hematocrit

16. The common sonographic appearance of a lymphocele is: a. Hypoechoic collection with thick septations

b. Simple anechoic collection with possible thin septations

c. Complex mass with calcifi cations

d. Thick-walled collection with internal septations

17. An interventional procedure performed to remove ascites from the peritoneal cavity is called: a. Thoracentesis

b. Fine-needle aspiration

c. Percutaneous abscess drainage

d. Paracentesis

18. A fl uid collection that contains urine and is associated with a rupture of the urinary tract is called a/an: a. Biloma

b. Urinoma

c. Seroma

d. Lymphocele

19. All of the following statements regarding omental caking are true EXCEPT: a. Omental caking is a thickening of the greater

omentum from malignant infi ltration.

b. Nodular masses may be seen sonographically deep to the anterior wall.

c. Simple transudative ascites is frequently associated with omental caking.

d. Omental caking is commonly associated with cancers of the ovary, stomach, and colon.

20. Which of the following organs is NOT located within the peritoneal cavity? a. Liver

b. Pancreas

c. Spleen

d. Gallbladder

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3 — The Peritoneal Cavity 21

FILL-IN-THE-BLANK

1. Addison’s lines divide the abdomen into nine regions.

Those regions are the right and left

right and left , right and left

, and the central regions

, ,

and .

2. The abdominopelvic cavity is also frequently

divided into four quadrants. Those quadrants

are the , ,

, and .

3. The largest body cavity is called the

, which encompasses the abdomen

and pelvis.

4. The thin sheet of tissues that divides the abdominal

cavity into the peritoneal and retroperitoneal

compartments is called the

.

5. The lesser sac lies immediately posterior to the

.

6. The greater omentum divides the greater sac into two

compartments: the ,

which means above the colon, and the

, which means below the colon.

7. The right and left

are potential spaces along the lateral borders of the

peritoneal cavity that allow fl uids to travel between

the supracolic and infracolic compartments.

8. When a patient is supine, the most gravity-

dependent portion of the abdominal cavity is the

. This potential

space should always be checked for free fl uid during

the sonographic examination.

9. When a female patient is in the supine position,

the is the most

gravity-dependent portion of the pelvic cavity.

10. When a male patient is in the supine position, the

is the most

gravity-dependent portion of the pelvic cavity.

11. ascites typically has a simple

appearance because it is characterized by a lack of

protein and cellular material.

12. ascites has a more complex and

echogenic appearance because fl uid seeps out from

blood vessels and contains a large amount of protein

and cellular material.

13. The presence of within an abscess

may cause a “dirty” posterior shadow.

14. Free blood within the peritoneal cavity is called

; once the blood organizes into a

focal area or clot, the collection is called

a .

15. results when a

benign appendiceal or ovarian adenoma ruptures,

spilling epithelial cells into the peritoneum, causing

to accumulate within the peritoneal

cavity.

16. Seromas typically occur in the

postsurgical period, whereas

are typically slower to develop and may present

4 to 8 weeks after surgery, helping to establish a

more defi nitive diagnosis between the two similar-

appearing fl uid collections.

17. Mesenteric cysts may occur anywhere along the

mesentery but are most commonly found originating

from the

mesentery.

18. The term describes the enlargement

of lymph nodes that can result from

diseases such as colitis or malignancies such as

lymphoma or colon cancer.

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22 PART 1 — ABDOMINAL SONOGRAPHY

19. Peritoneal mesothelioma is a rare malignant tumor

of the peritoneum that is associated with exposure to

.

20. A paracentesis may be done for

purposes to remove a small amount of fl uid for

laboratory testing or for purposes

to relieve pain and pressure that the patient may be

experiencing due to a large volume of ascites.

SHORT ANSWER

1. What purpose does the greater omentum serve?

2. Explain the protocol used during a FAST examination. When and where is this procedure performed?

3. What are three common causes of ascites? Where is ascites most likely to accumulate?

4. Describe the sonographic appearance of a peritoneal abscess. Where might an abscess be located?

5. What is the purpose of the peritoneal membrane?

IMAGE EVALUATION/PATHOLOGY

Review the images and answer the following questions.

1. Which potential space is the single arrow pointing to? Which potential space is the double arrow pointing to? What pathology is seen in this image?

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3 — The Peritoneal Cavity 23

3. What potential space is the arrow pointing to? Why is this space signifi cant?

2. What potential space are the arrows pointing to? What pathologies might collect here?

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24 PART 1 — ABDOMINAL SONOGRAPHY

4. What type of ascites is seen in this image? What pathologies could have resulted in this type of ascites? What structure are the arrows pointing to?

5. What type of ascites is seen in this image? How would you describe the ascites? What pathologies could have resulted in this type of ascites?

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3 — The Peritoneal Cavity 25

CASE STUDIES

1. A 62-year-old man with a history of liver disease presents for an abdominal sonogram with a history of abdominal distention and pain. Your examination reveals an echogenic, irregular shrunken liver consistent with cirrhosis. You also discover portal vein thrombosis (PV) as the portal vein is fi lled with echogenic material and no color fl ow is identifi ed. What pathology is the arrow pointing to? What is the double arrow pointing to? What procedure could be done to relieve the patient’s symptoms of abdominal distention?

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27

REVIEW OF GLOSSARY TERMS

MATCHING

Match the key terms with their defi nitions.

Key Terms Defi nitions

1. Anastomosis

2. Aneurysm

3. Arteriovenous fi stula

4. Ectasia

5. Endograft

6. Graft

7. Prosthesis

8. Pseudoaneurysm

9. Thrombosis

a. Any tissue or organ for implantation or transplantation

b. Dilatation, expansion, or distention c. Connection between two vessels d. Focal dilatation of an artery caused by a structural

weakness in the wall e. An artifi cial substitute for a body part f. A metallic stent covered with fabric and placed

inside an aneurysm to prevent rupture g. The formation of a clot in a blood vessel h. Connection allowing communication between an

artery and vein i. Caused by a hematoma that forms as a result of a

leaking hole in an artery

4 Vascular Structure

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28 PART 1 — ABDOMINAL SONOGRAPHY

ANATOMY AND PHYSIOLOGY REVIEW

IMAGE LABELING

Complete the labels in the images that follow.

A.

D.

E.

F.

K. G.

H.

I.J.

B. C.

1. Abdominal vasculature

2. Abdominal vasculature

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4 — Vascular Structure 29

3. Abdominal vasculature

4. Abdominal vasculature

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30 PART 1 — ABDOMINAL SONOGRAPHY

CHAPTER REVIEW

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