8. Abdomen II Flashcards
What does the term intraperitoneal mean?
- organs are completely covered with visceral peritoneum
- organs are attached to each other or to the abdominal wall by a double fold of peritoneum
What is the abdominal cavity bounded by?
- Diaphragm
- Anterolateral abdominal wall – external and internal oblique, transversus abdominis and rectus abdominis and pyramidalis
- Posterior abdominal wall - vertebral column, quadratus lumborum, PSOAS major and iliacus
- Pelvic inlet
What is the pelvic inlet bounded by?
- Posterior : sacral promontory
- Arcuate line
- Pectineal line and pubic crest
- Pubic symphysis is a secondary cartilaginous joint
What is everything below the pelvic inlet called and what structures are included?
- lesser pelvis
- (reproductive organs, terminal end of alimentary canal and bladder)
What 2 structures make up the abdominal cavity?
- greater pelvis and the abdomen proper
What is peritoneum?
- one continuous layer that is wrapped around all of the organs in the abdominal cavity
What is the difference between visceral and parietal peritoneum?
- Anything that touches an organ is known as visceral peritoneum and anything that is not touching an organ is called parietal peritoneum
What is peritoneal fluid made of?
- water, electrolytes,interstitial fluid, leukocytes and antibodies
Why is the peritoneal cavity open in females?
- space between the fimbriae and the ovary means that the peritoneal cavity in females is open
How does the peritoneum communicate with the exterior in females?
- via the vagina, uterus and uterine tubes in females
What does parietal peritoneum line?
- wall of the abdominal and pelvic cavities
What is the parietal peritoneum sensitive to?
- pain
- temperature
- touch
- pressure
What is the parietal peritoneum innervated by?
- T7-L1
What does the visceral peritoneum line?
- the abdominal and pelvic organs/viscera
What is the visceral peritoneum sensitive to?
- stretch
- tearing
What is the visceral peritoneum innervated by?
- afferent nerves that travel with autonomic supply to viscera it covers
Label this image
What does over distension of the visceral peritoneum lead to?
- pain
Where is the peritoneal cavity?
- The space between the parietal and visceral peritoneum
What is contained within the peritoneal cavity?
- peritoneal fluid
What is the greater sac?
- space of the peritoneal cavity, posterior to the anterolateral abdominal wall
Why is pain from the abdominal region poorly localized?
- Dermatomes share a convergent spinal root with the autonomic nerve which supply that particular organ
What is the foregut region supplied by?
- greater splanchnic nerves
- T5-T9
What is the midgut supplied by?
- lesser splanchnic nerves
- T9-T11
What is the hindgut supplied by?
- lumbar splanchnic nerves
- L1-L2
What is the lesser omentum and what does it do?
- double fold of peritoneum that attaches the liver to the lesser curvature of the stomach (hepatogastric ligament) and to the first part of the duodenum (hepatoduodenal ligament)
What is the lesser omentum derived from?
- ventral mesogastrium
What are the 3 things that a double fold of peritoneum can be called?
- mesentery, ligament or an omentum
What structures are located within the free edge of the lesser omentum?
- hepatic artery
- the portal vein
- the common bile duct
- lymph glands
- lymph vessels
- nerves
Where is the lesser sac and what is it continuous with?
- The lesser sac lies posterior to the stomach and is continuous with the greater sac through the epiploic foramen.
Label this image
What are the boundaries of the epiploic foramen?
roof:
floor :
posterior border :
anterior border :
- roof: caudate process of liver
- floor : hepatic artery and 1st part of duodenum
- posterior border : IVC
- anterior border : free border of lesser omentum
What are 5 subperitoneal structures?
- rectum lower 1/3
- urinary bladder
- distal ureters
- uterus
- uterine tubes
What is the mesentery?
- parietal peritoneum surrounding the small intestine comes together to form the mesentery
What are 13 intraperitoneal organs?
- stomach
- liver
- spleen
- tail of pancreas
- duodenum
- jejunum
- ileum
- caecum
- appendix
- transverse colon
- sigmoid colon
- sigmoid colon
- rectum (upper 1/3)
- ovaries
What are retroperitoneal organs (SAD PUCKER) ?
- suprarenal glands
- aorta + IVC
- Duodenum
- Pancreas
- Ureters
- Colon
- Kidneys
- Esophagus
- Rectum
What are the 4 secondary retroperitoneal organs?
- Duodenum (distal)
- pancreas
- ascending + descending colon
What does secondary retroperitoneal mean?
- During their embryological development they were intraperitoneal but then they migrated backwards.
- They became retroperitoneal as their mesentery fused with the posterior abdominal wall.
What are the stomach and liver connected by?
- lesser omentum
What does the mesentery connect the small intestine to?
- the abdominal wall
What are the 2 types of peritoneal folds?
1) reflection of peritoneum that connects organs to another organ or abdominal wall
2) reflection of peritoneum that is raised form the body wall by underlying blood vessels,ducts + ligaments formed by obliterated fetal vesels
How is the liver attached to the anterior abdominal wall?
- via a double fold of peritoneum called the falciform ligament
What is the lateral umbilical fold?
- parietal peritoneum folding on top of the inferior epigastric artery
What is the midline parietal peritoneum fold/Median Umbilical Fold?
- Overlies the Median Umbilical Ligament
- Which is a remnant of the Fetal Urachus
Label this image
with
1) urachus
2) lateral umbilical fold
3) medial umbilical fold
What is the function of peritoneal folds?
- route of blood vessels, lymphatics, nerves
- prevents effects of gravity
- immunity
What can peritoneal folds contain?
- contain varying amounts of fat
- intraperitoneal parts of organs (tail of pancreas is in splenorenal ligament)
What can the greater omentum do if an organ is infected?
- migrate and surround it
What is the developing foregut suspended from the anterior and posterior body by?
- anterior : ventral mesogastrium
- posterior : dorsal mesogastrium
Where does the liver develop?
- ventral mesentery
What does the liver split the ventral mesentery into?
- lesser omentum
- falciform ligament
What becomes the falciform ligament?
- parts connecting the developing liver to the anterior abdominal wall becomes the falciform ligament
What structures run in the free edge of the lesser omentum?
- common bile duct
- proper hepatic artery
- hepatic portal vein
What is the lesser omentum divided into?
- two parts :
- The hepatogastric ligament which runs from the liver to the stomach
- Hepatoduodenal ligament which runs from the liver to the duodenum
What organ is attached to the posterior layer of the greater omentum?
- transverse colon
From which embryonic mesentery does the greater omentum arise from?
- dorsal mesentery
Label this image
How do the greater sac and lesser sac form in embryological development?
- The stomach starts to rotate around its axis and as it rotates the peritoneal cavity is divided into two parts : greater sac and lesser sac
Around what axis does the stomach rotate during development and where do the pyloric and cardiac parts move?
- anteroposterior axis
- pyloric part moves to the right and up
- cardiac part moves to the left and down
What is the lesser sac’s function?
- allows stomach to expand
How are the greater and lesser sac connected?
- through the epiploic foramen (of Winslow)