Lesson 2 Abdomina Cavities and Abdominal wall.pptx

Lesson 2 Curry and Prince: Sonography, 5th Edition Chapter 1 and 6 Lesson 2: Outline Abdominal Pelvic cavity Ligaments Abdominal Wall, muscle and diaphragm Abdominal Cavities Abdominal pelvic cavity Abdominal Organs Divided into 9 regions 4 quadrants Regions & Quadrants Regions & Quadrants https://w...

Lesson 2 Curry and Prince: Sonography, 5th Edition Chapter 1 and 6 Lesson 2: Outline Abdominal Pelvic cavity Ligaments Abdominal Wall, muscle and diaphragm Abdominal Cavities Abdominal pelvic cavity Abdominal Organs Divided into 9 regions 4 quadrants Regions & Quadrants Regions & Quadrants https://www.registerednursern.com/four-a bdominal-quadrants-regions / Please watch at home Regions & Quadrants Regions & Quadrants https://www.registerednursern.com/four-abdominal-quadrants-regions/ Regions & Quadrants Right Upper Quadrant: Liver, stomach, gallbladder, duodenum, right kidney, pancreas, and the right adrenal gland. Left Upper Quadrant: Liver, stomach, pancreas, left kidney, spleen, and the left adrenal gland. Right Lower Quadrant: appendix, reproductive organs, right ureter. Left Lower Quadrant: left ureter, reproductive organs NOTE: All four quadrants contain portions of the small and large intestines https://www.registerednursern.com/four-abdominal-quadrants-regions/ Regions & Quadrants https://www.registerednursern.com/four-abdominal-quadrants-regions/ Regions & Quadrants 1.Right Hypochondriac Region: You’ll find organs such as the liver, gallbladder, right kidney, and portions of the small and large intestine in this region. 2.Epigastric Region: This region contains portions of the liver, as well as the stomach, pancreas, duodenum, spleen, and adrenal glands. 3.Left Hypochondriac Region: This contains the spleen, large/small intestines, left kidney, pancreas, stomach, and tip of the liver. 4.Right Lumbar Region: You’ll find portions of the ascending colon, small intestine, and right kidney in this region. 5.Umbilical Region: Here you’ll find the duodenum, the small intestine, as well as the transverse colon. 6.Left Lumbar Region: You’ll find parts of the descending colon, small intestine, and left kidney in this region. 7.Right Iliac Region: Here you’ll find the appendix, cecum, ascending colon, and small intestine. 8.Hypogastric Region: You’ll find the bladder, portions of the sigmoid colon, small intestine, and reproductive organs in this region. 9.Left Iliac Region: You’ll find parts of the sigmoid colon, descending colon and small intestine in this region. https://www.registerednursern.com/four-abdominal-quadrants-regions/ s Photo by Unknown Author is licensed under CC BY-SA Borders of the Abdominal Pelvic cavity Bordered by muscles and bones  Superior border - Diaphragm  Inferior border - Pelvic Floor  Posterior - spine, muscles  Anterior- abdominal wall Abdominopelvic Cavity Also known as: Peritoneal cavity Largest body cavity Includes the abdomen and the pelvis Lined by the peritoneal membrane/peritoneum Peritoneal Cavity Peritoneum a serous membrane that lines the abdominal cavity, secretes serous fluid Two Layers Parietal- lines the abdominal walls Visceral- covers the organs https://www.youtube.com/watch?v=Uo3jDAXR_Ww Parietal Peritoneum The portion of the peritoneum that forms a closed sac. **In females a section is open to the fallopian tubes** Males it is a “closed cavity” Divides the organs/structures into intraperitoneal and retroperitioneal Visceral Peritoneum The portion of the peritoneum that covers the organs Intraperitoneum Intraperitoneal organs - organs that are covered by peritoneum. Intraperitoneal Organs Liver (except the bare area), GB, Spleen, stomach, transvers colon, small bowel and ovaries. Males closed cavity Females communicates to the exterior through the fallopian tubes. Yellow shows intraperitoneal space Retroperitoneum Organs lie outside of the peritoneal cavity in the Retroperitoneal (behind, posterior) Great vessels (Aorta and Inferior vena cava), pancreas, kidneys, urinary bladder, rectum, majority of duodenum) Female organs (note: ovaries are intraperitoneal) Uterus Vaginal Males prostate Retroperitoneum A useful mnemonic to aid recollection of the abdominal retroperitoneal viscera is SAD PUCKER: S = Suprarenal glands (aka the adrenal glands) A = Aorta/IVC D = Duodenum (second and third segments [some also include the fourth segment] ) P = Pancreas (tail is intraperitoneal) U = Ureters C = Colon (only the ascending and descending parts) K = Kidneys E = Esophagus R = Rectum Green Retroperitoneal space (aka Extraperitoneal) Cross section showing division btw. Intra and Retroperiteum Peritoneal Layers and potential spaces Normally do not notice on normal ultrasound Seen well if patient has Ascites (an abnormal increase in abdominal fluid) seen as echogenic line surrounding organs or cavity Normally do not notice Layers of peritoneum When we get +++fluid we can see! ++fluid around Spleen, What quadrant is the spleen located? How are our organs held in place? What keeps my liver from falling to my pelvis? Ligaments and Mesentry Double folds of Peritoneum that attaches organs to the abdominal wall or different organs Ligaments for organs & mesentery for bowel Greater and lesser Omentum Double layer of peritoneum that extends from the stomach to adjacent abdominal organs: Greater omentum – attaches the greater curvature of the stomach and the transverse colon Lesser omentum – attaches the lesser curvature of the stomach to the porta hepatis Insulation for the organs (apron) Lesser Omentum Copyright © 2018 Elsevier Inc. All rights reserved. 33 Abdominal Wall, Muscles, Diaphragm Muscles, linea Albae, Ultrasound appearance of muscle Borders of the Abdominal Pelvic cavity  muscles and bones  Superior border  Diaphragm  Inferior border  Pelvis ◦ iliopsoas lateral to bladder ◦ Obturator Internis medial to iliopsoas ◦ posterior Piriformis muscle ◦ Leviator ani and coccygeus muscle  Posterior border ◦ spine, ◦ psoas muscle just lateral to spine as goes inferior called iliopsoas ◦ Quadratus Lumborum - “known as kidney bed” Quadratus Lumborum https://www.google.com/search? rlz=1C1GCEA_enCA921CA921&source=univ&tbm=isch&q=abdominal+cavi ty+image&sa=X&ved=2ahUKEwi5kfbl-pTyAhXImeAKHTDA5gQjJkEegQIBxAC&biw=1536&bih=871#imgrc=gv1DmM0Fbv1jnM psoas muscle Posterior muscles Anterior Border laterally 3 muscles  External oblique  Internal oblique  Transversus abdomenous medially  Rectus abdominus runs down midline from thorax to pubis Anterior Border Aponeuroses (broad flat sheet of connective tissue)of the external oblique, internal oblique and the transverse abdominus muscles form the rectus sheath Rectus sheath covers the rectus abdominus fuse in midline Linea Alba- tough band of connective tissue in midline Sonographic appearance of Muscle  Muscles and should Fat be symmetrical when comparing sides  Muscle  medium level echogenicity and may see high echogenicity fibrous strands within Fat- appearance varies depending on water content ◦ Fat mixed with water can be echogenic ◦ Pure fat is anechoic  Linea Alba  Hyperechoic compared to muscle Linea Alba midline Transverse Anterior muscles Sagittal or Long axis of muscle Split Image Artifact Transverse planes at the midline sound is refracted at the muscle/fat interface ( linea alba and rectus abdominus muscles) smaller structures in abdomen or pelvis appear duplicated Artifact is only seen in transverse plane, so turn on area and will disappear or come from anther angle Examples- aorta appears as two https://radiopaedia.org/articles/double-aorta-artifact-ultrasound Sonographic Appearance of Diaphragm  Shape  Curvilinear or dome shaped  Contour  Smooth  Echogenicity  Muscles of diaphragm seen as thin, hypoechoic band  Interface between liver (or spleen) appears as a thin echogenic line  Interface between diaphragm and lung thicker echogenic line Echogenicity Crura anchor the diaphragm to the spine and join in midline Right Crura thin hypoechoic band Lt not usually seen PLATE 265 POSTERIOR ABDOMINAL WALL: INTERNAL VIEW (2 of 2) Netter/Atlas of Human Anatomy, 7e ©2019 Elsevier 51 Diaphragm -Sonographic normal variations or pitfalls Mirror Image Artifact A second thin echogenic line superior to the diaphragm/lung interface can appear liver tissue can be seen opposite side of diaphragm in thoracic cavity “not real” Mirror Image Artifact Diaphragmatic slips https://radiopaedia.org/cases/diaphragmatic-slips-mimicking-peritonealimplants Prominent diaphragm muscles Seen in some conditions mostly in the elderly and emphysematous lung. In ultrasound examination they are similar to echogenic nodules on transverse view, which could be confused with hepatic masses When you rotate the transducer their shape change to a linear structure which differentiates slips from other diagnoses. Diaphragmatic slips prominent diaphragmatic slips (yellow arrows) of different sizes, and also the indentation of the liver surface (green arrows). Notice the presence of ascites (red arrows) which allowed better visualization of the findings. https://radiopaedia.org/cases/diaphragmatic-slips-mimicking-peritonealimplants