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Anatomy > Abdomen (Peritoneum) > Flashcards

Abdomen (Peritoneum) Flashcards

1
Q

What is the Peritoneum?

A
  • Large, thin, transparent serous membrane that lines that abdominopelvic cavity.
  • Covers most of the viscera.
  • Single layer of squamos epithelium (mesothelium).
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2
Q

Parts of Peritoneum

A
  • Parietal: Outer layer that lines abdominal and pelvic walls, as well as inferior surface of diaphragm.
  • Visceral: Inner layer that covers the external surfaces of most of the viscera.
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3
Q

Arterial of the Peritoneum

A

Parietal:

  • Inferior Phrenic
  • Lower 6 intercostal
  • Lumber and obturator

Visceral:

-Usually from blood vessels that supply the viscera

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4
Q

Innervation of Peritoneum

A

Parietal:

  • Nerves that supply the walls of the phrenic, lower 6 intercostal, lumbar and obturator nerves (pelvic).
  • Sensitive to pain (Somatic Innervation).

Visceral:

  • Nerve to viscera.
  • Insensitive to pain (Autonomic).
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5
Q

Vertical disposition of Peritoneum

A
  1. Umbilicus (Anterior Abdominal Wall)
  2. Liver
  3. Stomach
  4. Transverse colon
  5. Pancreas
  6. Duodenum
  7. Posterior abdominal wall
  8. Small intestine
  9. Posterior abdominal wall
  10. Sigmoid colon
  11. Rectum
  12. Uterus/ Post fornix of the vagina (In females).
    13 Urinary bladder (Seminal vesicles in males)
  13. Returns to umbilicus

NB: Forms loop

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6
Q

Horizontal disposition in Peritoneum

A
  1. 2.
    3.
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7
Q

Peritoneal Ligaments

A

Double layers of peritoneum between:

  • two viscera
  • viscera and diaphragm
  • viscera and abdominal wall

-Falciform Ligament
-Right and Left Triangular Ligaments : liver to diaphragm
-Superior and Inferior Layers of Coronary Ligaments: liver to diaphragm
-Gastrophrenic: Stomach to Diaphragm
-Lienorenal: Spleen to Kidney (Left)
-Gastrosplenic: Stomach to Spleen
-Gastrocolic (Greater omentum): Stomach to Transverse Colon
-Hepatogastric: Liver to Stomach (Lesser curvature)
-Hepatoduodenal: Liver to Duodenum
(Hepatogastric (membranous) + Hepatoduodenal (thickened free edge) = Lesser Omentum)
-Hepatocolic: Liver to Right Colic Flexure of Tranverse Colon (Hepatic Flexure)
-Ligament of Uterus and Urinary Bladder: Broad Ligaments and Sacrogenital folds of Peritoneum.

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8
Q

What is an Omentum?

A

Double layered extension or fold of peritoneum that passes from the stomach and proximal part of duodenum to the adjacent organs in the abdominal cavity.

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9
Q

Greater Omentum

A
  • Fat-filled fold with peritoneum hanging down from greater curvature of stomach.
  • Covers small intestine.
  • Normally fuses and obilterates inferior recess of omental bursa (lessac sac).
  • Policeman of the abdomen: limits spread of infection by moving to sites of infection and sealing it from surrounding area.
  • After descending, it folds back and attaches to the transverse colon and its mesentery.
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10
Q

Lesser Omentum

A

-Liver to lesser curvature of stomach and proximal half of first part of duodenum (Hepatogastric and Hepatoduodenal ligaments).

Contents:

  • Right free edge contains Porta Triad (Common Bile duct (Anterior to the right), Portal Vein (posteriorly), Hepatic Artery (Anterior to the left).
  • Hepatic plexus of nerves.
  • Right and left gastric vessels.
  • Gastric nerves.
  • Lymphatics and lymph nodes.
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11
Q

Peritoneal Cavity

A

Potential space lying between parietal and visceral peritoneum, divided into two parts:

-Greater and lesser sacs which communicate with each other through the Omental Foramen (Epiploic Foramen of Winslow).

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12
Q

Greater Sac

A

-Main peritoneal cavity seen on lifting anterior abdominal wall.

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13
Q

Lesser Sac

A
  • Also known as the omental bursa.
  • Lie behind lesser omentum, stomach.
  • Called stomach bed as it gives room for distension of the stomach.

Inferior recess:

-Potential space, mainly cut off from main part of bursa.

Superior recess:

-Extends towards diaphragm, posterior to caudate lobe of liver.

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14
Q

Epiploic/ Omental Foramen

A

Boundaries:

  • Anterior: Structures in the right free edge of lesser omentum (Portal Triad)
  • Posterior: Inferior Vena Cava, Right Crus of Diaphragm
  • Superior: Caudate lobe of the liver.
  • Inferior: Superior surface of the first part of the duodenum, Portal Triad.

Clinical:

-Internal hernia can occur in omental bursa through Epiploic foramen.

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15
Q

Mesentery

A

-Double layer of peritoneum which encloses viscera and connects it to the abdominal wall.

Mesogastrium:

-Greater and Lesser Omenta.

Mesentery of Small Intestine

  • Mesentery Proper
  • Connects Jejunum and Ileum with posterior abdominal wall.

Tranverse mesocolon:

-Broad, and connects transverse colon to posterior abdominal wall.

Sigmoid mesocolon:

  • Retains sigmoid colon in connection with pelvic wall.
  • Its line of attachment forms a V-shaped curve
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16
Q

Peritoneal recesses

A
  • Blind pouches (cul de sac) formed by peritoneal folds
  • Associated with duodenum, caecum, and sigmoid colon.

Duodenal recesses:

  • Superior Duodenal Recess (50%)
  • Inferior Duodenal Recess (20%)
  • Duodenojejuneal Recess (20%)
  • Rectoduodenal and Mesentericoparietal fold of Waldeyer (10%)

Caecal

  • Superior iliocaecal
  • Inferior iliocaecal
  • Retrocaecal (frequently contains the appendix)

Intersigmoid Fossa

  • Inverted v-shaped attachment of mesosigmoid
  • Apex is surgeon’s guide of left ureter.

These recesses are sites of internal hernias or strangulation of intestines and also do spread pathlogical fluid/ puss, water or blood.

17
Q

Peritoneal Regions

A

-Supra- and Infracolic by transverse colon.

18
Q

Supracolic Region

A
  • Subdivided into smaller recesses by falciform ligament.
  • Right and Left subphrenic recesses which lie directly below the diaphragm.
  • Right subhepatic space (Morrison’s Pouch)
    • Most dependent part of abdomen proper.
    • Commonest site of subphrenic abcess and accumulation of fluid or puss.
  • Left subhepatic space- Lesser sac or omental bursa.
19
Q

Infracolic Region

A

-Right and left by mesentery of small intestine

Paracolic Gutters

  • Medial and lateral
  • Parallel to ascending and descending colon
  • Right paracolic gutter: Continuos superiorly with Morrison’s Pouch and omental bursa, hence its greater clinical significance.
  • Inferiorly with rectouterine pouch in females and retrovesical pouch in males.
20
Q

Retrouterine pouch of Douglas

A

-Most dependent part of peritoneal cavity in standing position and pelvic cavity in supine position in females.

Boundaries:

  • Anterior: Uterus and posterior fornix of vagina.
  • Posterior: Rectum
  • Floor: Retrovaginal fold of peritoneum
21
Q

Extra-peritoneal organs

A
  • Bare area of liver
  • Lower third of rectum
  • Inferolateral surface of urinary bladder
22
Q

Intraperitoneal organs

A
  • Stomach
  • Proximal half of first part of duodenum
  • Jejunum
  • Ileum
  • Appendix
  • Caecum
  • Transverse colon
  • Sigmoid colon
  • Upper third of rectum
  • Liver
  • Spleen
  • Uterus, fallopian tubes, ovaries (females)
23
Q

Retroperitoneal organs

A
  • Rest of duodenum
  • Middle third of rectum
  • Kidneys
  • Pancreas
  • Suprarenal glands
  • Ureters
  • Renal vessels
  • Gonadal vessels
  • Ascending and descending colon (NB)
  • Abdominal aorta
  • Inferior Vena Cava
24
Q

Extraperitoneal subphrenic space

A
  • The right extraperitoneal space corresponds to the bare area of the liver.
  • Left around left suprarenal gland and upper pole of left kidney.

Anatomy (12 decks)

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