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GIT Module > (16) Peritoneum > Flashcards

(16) Peritoneum Flashcards

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1
Q

What is the Peritoneum?

A

Serous membrane that lines the abdominal cavity and lies on the abdominal and pelvic organs

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2
Q

Histology of Peritoneum

A
  • Simple Squamous epithelium [mesothelium] that is semipermeable
  • both secretory and absorptive
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3
Q

What cell of the Peritoneum functions as a fibroblast>

A

Mesothelin

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4
Q

What is the function of the Peritoneum?

A
  • Support and protect abdominpelvic organs
  • Provides passage for neuromuscular bundle and lymphatics
  • Storage of fat
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5
Q

What is the embryological origin of the Parietal Peritoneum?

A

Somatic mesoderm

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6
Q

What is the embryological origin of the Visceral Peritoneum?

A

splanchnic layer of the lateral plated mesoderm

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7
Q

What is the Parietal Peritoneum?

A

Outer layer of the peritoneum that adheres to the anterior and posterior abdominal walls, and lines the inner surface of the abdominal and pelvic walls and diaphragm

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8
Q

What separates the parietal peritoneum from the abdominal wall?

A

separated by extraperitoneal tissue

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9
Q

Neurovascular bundle of the Parietal Peritoneum

A

same as the region of the abdominal wall that it lines [somatic nerve supply]

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10
Q

Neuromuscular bundle of the Visceral Peritoneum

A

same as the viscera it covers [autonomic nerve supply]

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11
Q

Somatosensation of Peritoneum

A

Parietal

  • well localized pain
  • sensitive to pressure, pain, laceration and temperature

Visceral

  • poorly localized pain
  • insensitive to pain caused by temperature or wounds [general stimuli-touch, pressure, temperature]
  • sensitive to stretch and chemical irritation
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12
Q

Where is pain from the foregut referred to?

A

Epigastric region [T7-T8]

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13
Q

Where is pain from the midgut referred to?

A

umbilical region [T9-T10]

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14
Q

Where is pain from the hindgut referred to?

A

pubic region [T12-L1/2]

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15
Q

Where is pain from the retroperitoneal organs referred to?

A

Back pain

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16
Q

Where does pain from an irritated diaphragm refer to?

A

Shoulder tip pain

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17
Q

What conditions cause irritation of the diaphragm?

A

results of inflammation of the liver, gallbladder or duodenum

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18
Q

Describe the course of referred pain in appendicitis

A

Acutely it is referred to the umbilical region, and as it becomes increasingly inflamed it localizes to the right lower quadrant [due to irritation of parietal peritoneum]

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19
Q

What are the two divisions of the peritoneal cavity?

A

Greater and Lesser sac

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20
Q

Where is the lesser sac found?

A

anterior to the pancreas and duodenum and posterior to the stomach and liver

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21
Q

What is the function of the lesser sac?

A

allow unhindered movement of the the stomach

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22
Q

What forms a passage of communication between the greater and lesser sac?

A

Epiploic foramen

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23
Q

Where is the epiploic foramen found?

A

posterior to free edge of lesser omentum

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24
Q

What are the parts of the lesser sac?

A

Superior and Inferior recesses

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25
Q

What borders the superior recesss?

A

Diaphragm and coronary ligament of the liver

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26
Q

What borders the inferior recess?

A

foldings layers of the greater omentum

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27
Q

What are the borders of the epiploic foramen?

A

A: Hepatoduodenal ligament
P: IVC + Right crus of diaphragm
S: Caudate lobe
I: superior part of duodenum

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28
Q

What are the parts of the Greater sac?

A

Supracolic and Infracolic compartments

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29
Q

What divides the greater sac into its two parts?

A

Transverse mesocolon

30
Q

What structures are found within the supracolic compartments?

A
  1. Liver
  2. Stomach
  3. Spleen
31
Q

What structures are found within the infra colic compartments?

A
  1. Small intestines
  2. Ascending colon
  3. Descending colon
32
Q

What divides the infracolic compartments?

A

root of mesentery of small intestines [divides into right and left infracolic spaces]

33
Q

Define the term intraperitoneal

A

organs almost wrapped by visceral peritoenum

34
Q

What are all the intraperitoneal organs?

A
  1. Liver
  2. Spleen
  3. Stomach
  4. Superior 1st part of the duodenum
  5. Jejunum
  6. Ileum
  7. Appendix
  8. Transverse colon
  9. Sigmoid colon
  10. Superior part of the rectum
  11. Tail of pancreas
35
Q

define retroperitoneal organs

A

found posterior to the peritoneum in the retroperitoneal space, with only their anterior surface covered by the parietal peritoneum

36
Q

Describe Primary retroperitoneal organs

A

Develop and remain outside the parietal peritoneum

37
Q

Describe Secondary retroperitoneal organs

A

Organs that were initially intraperitoneal and suspended by mesentery, but eventually as the fetal organs develop, the become retroperitoneal and their mesentery fused with the posterior abdominal wall

38
Q

What are all the Primary retroperitoneal organs?

A
  1. Esophagus
  2. Aorta
  3. IVC
  4. Kidneys
  5. Suprarenal (adrenal) glands
  6. Ureters
  7. Anal canal
  8. Distal one-third of rectum
39
Q

What are all the Primary retroperitoneal organs?

A
  1. Pancreas (head, neck and body)]
  2. Distal duodenum
  3. Ascending colon
  4. Descending colon
  5. Proximal one-third of rectum
40
Q

What are all the Infraperitoneal organs?

A
  1. Inferior two thirds of rectum
  2. Urinary bladder
  3. Uterus
41
Q

Define mesentry

A

Double layer of visceral and parietal peritoneum, and connects intraperitoneal organs to the posterior abdominal wall

42
Q

Function of Mesentry

A
  • connects intraperitoneal organs to the abdominal wall
  • provides pathway for neurovascular and lymphatic bindle to travel to the viscera
43
Q

Root of Mesentry of small intestines

A

15 cm long

44
Q

What is the Mesoappendix?

A

Small, triangular fold of peritoneum which suspends the vermiform appendix from posterior surface of the lower end of mesentery close to the ileocaecal junction.

45
Q

Greater Omentum

A

Four layers of visceral peritoneum that descends from the greater curvature of the stomach and proximal part of the duodenum, then folds back up reaches the posterior abdominal wall and attaches to the anterior surface of transverse colon and pancreas.

Hangs like a curtain covering the anterior surface of small
intestine.

46
Q

What is the clinical significance of the Greater omentum?

A

Has a role in immunity and can migrate to infected viscera or to the site of surgical disturbances to limit the spread of infection

47
Q

What structures are carried within the hepatoduodenal ligament?

A
  1. bile duct
  2. hepatic artery
  3. portal vein
48
Q

Lesser omentum

A

Double layer of visceral peritoneum that attaches from the lesser curvature of the stomach and proximal part of duodenum to the liver.

49
Q

What are the two parts of the Lesser Omentum?

A
  1. Hepatogastric ligament
  2. Hepatoduodenal ligament
50
Q

What structures are contained within the transverse mesocolon?

A

middle colic vessels, nerves, lymph nodes and lymphatics

51
Q

What is the transverse mesocolon?

A

Peritoneal formation that suspends the transverse colon from the posterior abdominal wall, its attached to the anterior aspect of the pancreas on the posterior abdominal wall

52
Q

What are the paracolic gutters?

A

connects the supracolic compartment with the infracolic compartment

53
Q

What is the clinical significance of the Paracolic gutters?

A

Form pathways for the spread of infection and fluids between the two compartments

54
Q

What structures are contained with the Sigmoid mesocolon?

A

sigmoid and superior rectal arteries, veins, nerves, lymph nodes and lymphatics

55
Q

What is the sigmoid mesocolon?

A

triangular formation of peritoneum that suspends sigmoid colon from the pelvic wall

Its apex lies over left ureter at the termination of the left common iliac artery

56
Q

What are the two main functions of the peritoneal ligaments?

A

Connects viscera together or connects viscera to abdominal wall.

Carry neurovascular structures which supply abdominal organs

57
Q

What are the types of the Peritoneal ligaments?

A
  1. Splenic ligament
  2. Gastric ligaments
  3. Hepatic ligement
58
Q

What are the Splenic Peritoneal ligaments?

A
  1. Phrenicocolic ligament
  2. Gastrosplenic ligament
  3. Splenorenal ligament
59
Q

What are the Gastric Peritoneal ligaments?

A
  1. Gastrophrenic ligament
  2. Gastrocolic ligament
60
Q

What are the Hepatic Peritoneal ligaments?

A
  1. Falciform ligament
  2. Gastrohepatic ligament
  3. Hepatoduodenal ligament
61
Q

What ligaments form parts of the Greater Omentum?

A
  1. gastrophrenic ligament
  2. gastrosplenic ligament
  3. gastrocolic ligament
  4. splenorenal ligament
62
Q

What is the clinical significance of the Peritoneal recesses?

A

potential sites for internal herniation of the abdominopelvic viscera

63
Q

What are the three main groups of the Recesses?

A
  1. Duodenal recesses
  2. Caecal recesses
  3. Intersigmoid recess
64
Q

What are Duodenal recesses?

A

fossae formed around 4th part of the duodenojejunal junction

65
Q

List all the Duodenal recesses

A
  1. Superior duodenal recess
  2. Inferior duodenal recess
  3. Retroduodenal recess
  4. Paraduodenal recess
  5. Duodenojejunal recess
  6. Mesentericoparietal recess
66
Q

List all the Caecal recesses

A
  1. Superior ileocaecal recess
  2. Inferior ileocaecal recess
  3. Retrocaecal recess
67
Q

What is the Intersigmoid recess?

A

funnel shaped recess that lies posterior to the apex of the V-shaped parietal attachment of sigmoid mesocolon

It is present and persists in fetal life and in childhood, but may disappear later in life.

68
Q

What forms the posterior wall of Intersigmoid recess?

A

parietal peritoneum of the posterior abdominal wall

69
Q

Alternative location of the Intersigmoid recess

A

within the layers of the sigmoid mesocolon, and is nearer to the bowel wall than the mesenteric root.

70
Q

What are the three individual spaces of the retroperitoneum?

A
  1. anterior pararenal space
  2. posterior pararenal space
  3. perirenal space
71
Q

What is ascites?

A

excessive accumulation of more than 20 mL of fluid within peritoneal cavity.

72
Q
A

GIT Module (16 decks)

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