GI Section II: Peritoneal Cavity

Question 1

What is the peritoneal cavity?

Answer 1

The peritoneal cavity is the space between the various coverings (parietal and visceral peritoneum) in the abdomen. It can be both a conduit for disease and a source of anatomic trivia.

Question 2

What are the two primary “sacs” of the peritoneal cavity?

Answer 2

Greater and Lesser

Question 3

The “sac” behind the stomach

Answer 3

Lesser sac

Question 4

Lesser sac is a.k.a.?

Answer 4

Omental bursa

Question 5

What is the conduit (channel) between the Greater and LEsser sac?

Answer 5

Epiploic foramen (of Winslow)

Question 6

The greater sac can be divided into parts:

Answer 6

Above (supracolic)

——– TRANSVERSE MESOCOLON —-

Below (infracolic)

Question 7

supracolic and infracolic compartments are connected by these

Answer 7

The right and left paracolic gutters along the lateral aspects of the ascending and descending colon

Question 8

Which paracolic gutter is wider?

Answer 8

the right one

Question 9

How does the femal peritenoeum communicate with the extraperitoneal pelvis?

Answer 9

Via the fallopian tubes

(male peritoneum does not communicate)

Question 10

Barium in HSG =

Answer 10

peritonitis

Question 11

Disease may spread through the abdomen and pelvis by

Answer 11

(1) the bloodstream
(2) Lymphatic extension
(3) Direct invasion
(4) Intraperitoneal seeding

Question 12

allows spread from the stomach, esophagus, and liver

Answer 12

Gastrohepatic Ligament

Question 13

allows spread from the stomach to the splenic hilum

Answer 13

Gastrosplenic Ligament

Question 14

allows spread from the right colon to nodes around the duodenum / pancreas

Answer 14

Duodenocolic Ligament

Question 15

occurs from spread along the peritoneal ligaments and mesenteries

Answer 15

(2) Lymphatic extension / (3) Direct invasion

Question 16

this occurs via the natural flow of fluid

Answer 16

Intraperitoneal seeding

Question 17

The natural intraperitoneal fluid mostly flows upward from the pelvis to the upper abdomen via

Answer 17

The right (more than left) paracolic gutters

Question 18

Anywhere the fluid tends to spend more time / get caught up (shown by the stars) will be predisposed for serosal-based metastases in the setting o f peritoneal carcinomatosis.

Answer 18

Question 19

Pus and ascites tends to flow away from the liver (the opposite of normal flow). As a result the dependent areas

Answer 19

right posterior subphrenic recess (RPSA)
anterior subheptic space (ASH)
posterior sub hepatic space / hepatorenal recess / Morrison (M) and pelvic cavity

tend to be involved.

Question 20

This is a gelatinous ascites

Answer 20

Pseudomyxoma Peritonei

Question 21

Answer 21

Pseudomyxoma Peritonei

“scalloped appearance of the liver.”

Question 22

Causes of Pseudomyxoma Peritonei

Answer 22

a. Ruptured mucocele (usually appendix)
b. Intraperitoneal spread of a mucinous neoplasm (Ovary, colon, appendix, pancreas)

It’s usually the appendix (least common is the pancreas).

Question 23

dictates the location of implants

Answer 23

natural flow of ascites

Question 24

why is the retrovesical space is the most common spot for peritoneal carcinomatosis?

Answer 24

it’s the most dependent part of the peritoneal cavity.

Question 25

“posterior displacement of the bowel from the anterior abdominal wall.”

Answer 25

Omental Seeding/Caking

Question 26

Answer 26

Omental Seeding/Caking

Question 27

occurs 30-40 years after the initial asbestosis exposure.

Answer 27

Primary Peritoneal Mesothelioma

mesothehoma involving the pleura (and it does 75% of the time), but the other 25% of the time it involves the peritoneal surface.

Question 28

Barium Peritonitis

Answer 28

The pathology is an attack of the peritoneal barium by the leukocytes which creates a monster inflammatory reaction (often with massive ascites and sometimes hypovolemia and resulting shock).

Question 29

If barium ends up in the systemic circulation it kills via

Answer 29

Pulmonary embolism (50% of the time)

Risk is increased in patients with inflammatory bowel or diverticulitis (altered mucosa).

Question 30

Mesenteric Lymphoma

Answer 30

is usually NHL

Question 31

Answer 31

Mesenteric lymphoma

“Sandwich sign”

lobulated confluent soft tissue mass encasing the mesenteric vessels “sandwiching them.”

Question 32

Answer 32

Mesenteric panniculitis

+ Retroperitoneal nodes = lymphoma

Misty mesentery

increased mesenteric fat density centered around the jejunal root, often with a few small nodes

6 month follow up