Abdominal Cavity general arrangement

Question 1

What structure forms behind the stomach?

Answer 1

The lesser sac - forms due to the stomach’s rotation 90 degrees during embryo formation.

Question 2

What is the lesser sac?

Answer 2

it is a diveritculum or recess of peritoneum behind the stomach -

the lesser sac contains the epiploic foramen or the foramen of winslow where you could palpate three major structures

The anterior wall of the lesser sac is the lesser omentum which is a fold of peritoneum between the stomach and liver

Question 3

What three structures can be palpated in the foramen of winslow?

Answer 3

the portal vein most anteriorly

the bile duct most laterally

the hepatic artery most medially

Question 4

What are the boundaries of the foramen of winslow?

Answer 4

superior, the caudate lobe of the liver. anterior, the hepatoduodenal ligament, containing the components of the portal triad. inferior, the first part of the duodenum.

Question 5

What level does the oesophagus enter the abdomen behind the diaphragm?

Answer 5

T10 slightly to the left of midline - surrouded by fiberse from the right diaphgragmatic crus forming a sphincter mechanism

Question 6

What is a hiatus hernia?

Answer 6

arises when part of the stomach pushes its way up into the thorax through the oesophageal opening in the diaphragm.

Question 7

What are the five regions of the stomach and where are they located?

Answer 7

• Cardia (around oesophageal opening)
• fundus (above the level of the oesophagela opening)
• body
• antrum (lower part)
• pylorus (most distal part) - thickened sphincter mechanism controls the passage of food from the stomach to the duodenum.

Question 8

find the lesser and greater curvatures of the stomach

Answer 8

Question 9

What is the opening to the lesser sac called?

Answer 9

The foramen of Winslow

Question 10

What ligament is attaches the spleen to the kidney?

Answer 10

splenorenal ligament or lienorenal ligament

* bonus points - this arises from the dorsal mesogastrium in development*

Question 11

What are two names the mesentery that spans from the spleen to the stomach is known by ?

Answer 11

Upper region = gastrosplenic ligament

lower region = forms a double layer of mesentery called the greater omentum- falls down like a curtain covering the intestines

Question 12

The transverse mesocolon is attached to the undersurface of what major structure?

Answer 12

The greater omentum

Question 13

What is a mesentery ?

Answer 13

a fold of peritoneum that connects some viscera to the posterior wall of the abdomen

Question 14

What is the root of the mesentery?

Answer 14

Where the mesentery attaches to the posterior wall

Question 15

What is an omentum?

Answer 15

The omentum is a membranous double layer of peritoneum that covers and supports the intestines and organs in the lower abdominal area. The omentum is made up of the greater omentum which is an important storage for fat deposits and the lesser omentum which connects the stomach and intestines to the liver.

Question 16

What is the relationship between the inferior epigastric artery to the deep inguinal ring?

Answer 16

The inferior epigastric artery lies medial to the deep inguinal ring

Question 17

From which embryological structure does the falciform ligament develop?

Answer 17

It is a remnant of the embryonic ventral mesentery.

Question 18

what is the ligamentum teres? What did it convey?

Answer 18

Ligamentum teres (or round ligament) of the liver is a cord-like ligament found within the falciform ligament on the inner surface of the anterior abdominal wall and represents a remnant of the umbilical vein, which is a connecting venous structure between the placenta and the umbilical portion of the left portal vein.

Question 19

Which embryological structures are represented in the median and medial umbilical ligaments?

Answer 19

In the median umbilical ligament - the remains of the urachus

in the medial umbilical ligament (or lateral umbilical ligament) -the remains of umbilical arteries

Question 20

Where do we find the appendix on clinical inspection?

Answer 20

McBurney’s point

1/3 of the way from the ASIS to the umbilicus

Question 21

To which costal cartilage is the gall bladder related?

Answer 21

the 9th costal cartilage and its intersection wih the semilunaris

Question 22

from which embryological structures do the greater and lesser omentum develop?

Answer 22

The greater omentum develops from the dorsal mesentery that connects the stomach to the posterior abdominal wal

The lesser omentum is formed, by a thinning of the mesoderm or ventral mesogastrium, which attaches the stomach and duodenum to the anterior abdominal wall.

Question 23

What are the lesser and greater sac?

Answer 23

see photo

Question 24

What are the supra and infra colic compartments?

Answer 24

The supracolic compartment lies above the transverse mesocolon and contains the stomach, liver and spleen.

The infracolic compartment lies below the transverse mesocolon and contains the small intestine, ascending and descending colon. The infracolic compartment is further divided into left and right infracolic spaces by the mesentery of the small intestine.

Question 25

What is a paracolic gutter? How far superiorly would fluid in the right paracolic gutter extend in the supine position? Would it extend as far on the left?

Answer 25

The supracolic and infracolic compartments are connected by the paracolic gutters which lie between the posterolateral abdominal wall and the lateral aspect of the ascending or descending colon.

The right (lateral) paracolic gutter runs from the superiolateral aspect of the hepatic flexure of the colon, down the lateral aspect of the ascending colon, and around the cecum. It is continuous with the peritoneum as it descends into the pelvis over the pelvic brim. Superiorly, it is continuous with the peritoneum which lines the hepatorenal pouch and, through the epiploic foramen, the lesser sac.

The right paracolic gutter is larger than the left, which together with the partial barrier provided by the phrenicocolic ligament, may explain why right subphrenic collections are more common than left subphrenic collections.

These gutters are clinically important because they allow a passage for infectious fluids from different compartments of the abdomen. For example; fluid from an infected appendix can track up the right paracolic gutter to the hepatorenal recess.

Question 26

What is a subphrenic recess?

Answer 26

The subphrenic space is a peritoneal space between the anterior part of the liver and the diaphragm, separated into right and left by the falciform ligament, and postero-superiorly bounded by the coronary ligament.