10. Peritoneum Flashcards
Peritoneum lines the abdominopelvic cavity and has two layers: parietal and visceral. What is specific to parietal?
Lines body wall
Supplied by same BV, N, LN as region is lines
SENSITIVE to pressure, pain, temperature
What is specific to visceral peritoneum?
Covers organs
Supplied by same BV, N, LN as organ
Sensitive to stretch/chemical irritation ** not pain
Retroperitoneal means outside the peritoneal cavity and are only partially covered with peritoneum. What is the difference between primary and secondary?
Primary retroperitoneal means they were never covered in a mesentery
Secondary: they used to be covered in mesentery
what are the organs that are retroperitoneal in
SAD PUCKER
Suprarenal gland Aorta/ IVC * Duodenum + Pancreas except tail + Ureters * Colon- ascending/descending + Kidneys * Esophagus Rectum \+ means secondary * means primary
As the stomach rotates, you get the greater omentum (dorsal mesentery folds on itself), as well as the space behind the liver and stomach called the?
omental bursa
What do the falciform and splenorenal ligament connect?
falciform: from ventral mesentary connects ant body wall with liver
splenorenal: posterior body wall (infront of kidney) and spleen
What are the two ligaments from the lesser omentum, which is from the ventral mesentery?
gastrohepatic ligament and hepatoduodenal ligament (PORTAL TRIAD INSIDE, goes from gallbladder to 1st part dudoenum)
What are the three ligaments from the greater omentum, which is from the dorsal mesentery?
gastrophrenic: stomach to diaphragm
gastrosplenic: stomach to spleen
gastrocolic: stomach to trasnverse colon
Whats the blood supply in the lesser omentum ligaments: hepatoduodenal (3) and hepatogastric (2)?
proper hepatic A, cystic A, right gastric A
Right gastric and left gastric
right and left gastric will anastasmos
Whats the blood supply in the greater omentum ligaments: gastrophrenic(1), gastrosplenic(2), and the gastrocolic(2)?
Posterior gastric A
Short gastric A, Left gastro-omental/gastroepiploic A
Right gastroepiploic, Left gastroepiploic
What supplies the splenorenal ligament?
splenic A
What supplies the transverse mesocolon? (2)
middle colic A
Marginal A
What supplies the mesentery (3) and the roof of the mesentery(1)?
Superior Mesenteric A, ileal A, jujunal A
Iliocolic A
What supplies the sigmoid mesocolon?
sigmoid A
The lesser sac (omental bursa) which sits behind the lesser omentum, communicates with the greater sac which sits behind the greater omentum via the?
epiploic foramen (omental foramen) opening to lesser sac
What is anterior and posterior to the omental foramen?
anterior hepatoduodenal ligmanet with portal triad
posterior IVC/right crus of diaphragm
What does the portal triad consist of? which is inside the hepatoduodenal ligament
Proper hepatic artery
Bile duct
hepatic portal vein
What is superior and inferior to the opening to the lesser sac, epiploic foramen?
superior is caudate lobe of liver
inferior is 1st part of duodenum
What is the pringle maneuver?
Placing fingers into epiploic foramen, and cutting off blood supply to portal triad in the hepatoduodenal ligament
What is anterior to the lesser sac? (3)
lesser omentum, stomach, gastrocolic ligament
What is posterior to the lesser sac? (6)
pancreas, L suprarenal gland and kidney, aorta, IVC, spenic A/V
What is superior to the lesser sac or omental bursa? (2)
Liver, diaphragm
What is inferior to the omental bursa? (2)
transverse mesocolon, 1st part of duodenum
What is to the left of the lesser sac? (2)
hilum of spleen, gastrosplenic ligament
What is to the right of the lesser sac? (1)
epiploic foramen into the greater sac
Why is the lesser sac good to have if the pancreas were to rupture anteriorly, or if the stomach were to rupture posteriorly?
the contents would be contained within the lesser sac instead of within the entire abdomen
What occurs if there is intestine in the lesser sac? Can any of it’s boundaries be cut to release the intestines?
NO, because the portal triad, IVC, aorta cannot be cut… you must pull them out with your hands
The transverse mesocolon divides the cavity into two compartments… the supracolic and the infracolic compartment. What is contained in each? (3/3)
stomach, liver, spleen
SI, ascending, descending colon
The root mesentery of the small intestine further divides the infracolic compartment into the? How do they communicate?
right infracolic space and the left infracolic space
Communicate via the left and right paracolic gutters
When a patient is lying down, fluid would most likely reside in what two spaces that are divided by the falciform ligament?
right and left subphrenic spaces
from the lesser sac
when the patient sits up, fluid will travel on either side via? Why is one side more narrow than the other?
down via the right and left paracolic gutter.
Left side is more narrow due to the phrenicocolic ligament
When the patient is sitting / standing all the way up, fluid will collect in the pelvis, what is the space called in males and females?
males: rectovesicular pouch/space
females: rectouterine pouch/space
Large invasive, open incision are more painful because the peritoneum is exposed. What causes adhesions in the peritoneum?
when the area is touched, it is very sensitive
What is peritonitis and how is it caused?
infection of the peritoneal cavity caused by rupture of infected organ or external trauma, leading to abscesses
What is acites?
excess fluid in the peritoneal cavity due to cancer/malnutrition
Paracentesis is used to drain the extra fluid… where is the best place to place the needle?
AWAY from the inferior epigastric A, at the most inferior point of the rectouterine/vesicular pouch
What vertebral level is the head and tail of the pancreas at?
starts at L2 to L1 (transpyloric plane)
What is anterior to the pancreas? (2)
lesser sac and stomach
What is posterior to the pancreas? (9)
Aorta IVC Splenic Vein Bile duct right crus of the diaphragm left kidney and vessels left suprarenal gland superior mesenteric A/V
What is to the right of the pancreas? (1)
2nd part of the duodenum (it is craddled by it)
What is to the left of the pancreas? (2)
spleen, (tail of pancreas is intraperitoneal)
What is inferior to the pancreas? (1)
3rd part of the duodenum
The superior mesenteric artery and vein run posterior to the pancreas. Why is this a clinical significance?
Due to how the pancreas is located, the uncinate process goes around the SMA/V, if the cancer grows around the vessels, surgery cannot be performed :(
