Abdominal Organization: Part II Flashcards
peritoneum
serous membranes lining the internal surface of abdominoplevic cavity (parietal layer), and cover the viscera (visceral layer). they secrete serous fluid
peritonealized organs
completely covered with visceral peritoneum, associated with a mesentery (ex. stomach, spleen, parts 1/4 of duodenum, jejunum, ileum, transverse and sigmoid colon)
primary retroperitoneal organs
posterior to peritoneum; no mesentery (ex. kidneys, ureters, suprarenal glands)
secondary retroperitoneal
during development the organ was peritonealized, but later in development the mesentery is pushed against the posterior body wall and fuses with surrounding parietal peritoneum (most of duodenum, ascending, descending colon, pancreas)
- secondary mesenteric attachment = fusion fascia
peritonitis
inflammation of peritoneum. Parietal peritoneum is richly innervated by somatic nerves thus it is very painful and pain is well-localized. Innervation to the visceral peritoneum is autonomic, thus not well localized
peritoneal adhesions
fusion of various parts of peritoneal membranes (due to inflammation, surgery, trauma, ulcers). can limit normal mvmt of viscera and cause chronic pain
peritoneal dialysis
effective structure for blood dialysis
dorsal mesentaries
originally suspends the entire abdominal gut tube to posterior body wall
- mesoesophagus
- greater omentum
- splenorenal ligmanet
- phrenicolic ligament
- mesentary proper
- mesoappendix
- transverse mesocolon
- sigmoid mesocolon
greater omentum
gastrocolic + gastrosplenic + gastrophrenic ligaments
lesser omentum
hepatogastric + hepatoduodenal ligmament
extends from liver to stomach/duodenum
ventral mesentery
- lesser omentum
- falciform ligament
- coronary ligaments
- triangular ligaments
peritonteal cavity divisions?
divided into greater and lesser sac (stomach is dividing line) greater sac includes supracolic and infracolic compartments infracolic compartment (rt/lt. paracolic gutter, rt/lt. infracolic space)
lesser sac
posterior to stomach and lesser omentum
superior recess: bounded superiorly by diaphragm
inferior recess: between two layers of greater omentum
greater sac:
contains supracolic, infracolic and paracolic gutters
supracolic compartment (greater sac)
superior to transverse mesocolon
contains stomach, liver, spleen, gallbladder
infracolic compartment (greater sac)
inferior to transverse mesocolon
contains small intestine, ascending colon, descending colon
seperated into right and left compartments by mesentary proper
paracolic gutters (greater sac)
left and right
between posterolateral body wall and aschending/descending colon
ascites
- excess fluid in the peritoneal cavity: can become purulent and lead to abscesses
- causes: cirrhosis with portal hypertension; kidney failiure; CHF; rutured ulcer; abdominal cancers; internal bleeding
where will fluid collect?
absesses will often form in hepatorenal recess* and also in the subphrenic recess when patient is lying down
how does fluid spread to pelvic cavity?
- fluid from left infracolic compartment freely communicates with pelvic peritoneal cavity
- fluid from right infracolic compartment is prevented from moving into pelvic cavity because of junction of the mesentery proper with cecum and ascending colon. Thus, fluid must first pass to the left infracoloic compartment before draining into the pelvic peritoneal cavity
spread of fluid from paracolic gutters?
- right paracolic gutter is open to hepatorenal and subphrenic recesses superiorly. fluid can pool in these spaces and cause abscesses which can dissect through the diaphragm into the thoracic cavity.
- left paracolic gutter is closed superiorly by the phrenicolic ligament
- fluid within both right and left paracolic gutters can drain into the pelvic peritoneal cavity
foregut artery?
celiac trunk T12
midgut artery?
superior mesenteric artery: L1
hindgut artery?
inferior mesenteric artery: L3
three aa. supplied by celiac trunk?
TV12: artery of the foregut that supplies distal esophagus to second portion of duodenum
- left gastric a, common hepatic a, splenic a.
5 aa. supplied by superior mesenteric aa?
LV1: artery of the midgut: from 3rd part of duodenum to distal 2/3rd of transverse colon Branches: inferior pancreaticoduodenal a. middle colic a. jejunal and ileal branches right colic a. ileocolic
3 aa. supplying inferior mesenteric a?
LV3: artery of hindgut
marginal a. left colic a. sigmoid aa. superior rectal a.
hepatic portal vein
- abdominal viscera drains via vena comitantes to the hepatic portal vein
- all blood drained from gut goes to the liver first. the vein begins and ends in a capillary bed
4 portal-caval anastamoses
- -> venous anastamoses between tributaries of portal vein and IVC: these contain no valves. they are important in cases of portal hypertension (due to liver cirrhosis), because blood flow will reverse through portal system and return to heart via the IVC or SVC, resulting in varicosities in the following regions:
1. submucosa of inferior esophagus
2. paraumbilical region
3. submucosa of anal canal
4. retroperitoneal
esophageal varicies?
tributaries of SVC: esophageal vv.
tributaries of portal system: left gastric vv.
- results in dilated esophageal veins, bleeding from these varicosities can sometimes be severe and fatal
caput medusa?
- dilated veins of the paraumbilical region
tributaries of SVC/IVC: superior and inferior epigastric vv.
tributaries of portal system: paraumbilical vv.
hemorrhoids?
dilated veins of submucosa of anal canal due to portal hypertension
tributaries of IVC: middle and inferior rectal vv.
tributaries of portal system: superior rectal vv.
dilated retroperitoneal vv? “cholic” veins
tributaries of IVC: gonadal and renal vv.
tributaries of portal system: ildeocolic, right, middle, left colic vv.
