L5 - Peritoneum Flashcards
Peritoneum
is a continuous, glistening, transparent serous membrane
What is the Parietal Peritoneum?
internal lining of the abdominopelvic cavity
Anterolateral
mesothelium, fat, connective tissue
(transversalis facia)
Posterior abdominal wall
mesothelium, connective tissue
(endoabdominal facia), muscles
Visceral peritoneum
- invests the organs
3 types of visceral peritoneum
- mesenteries
- omenta
- ligaments
(all consist of double layer of peritoneum)
What do the layers form?
they form the peritoneal sac that encloses the peritoneal cavity
- the viscera lie outside of the peritoneal cavity
Both the parietal and the visceral peritoneum consist of:
- mesothelium, a simple squamous epithelium
- small amount of underlying connective tissue
Visceral peritoneum = “serosa”
What is the blood supply and innervation of the Parietal Peritoneum?
has the same blood supply
and
same innervation as the body wall
What is the blood supply and innervation of the Visceral Peritoneum?
has the same blood supply and innervation as the organs it invests
True or False
Because the visceral peritoneum is thin and very vascular, drugs can be injected intraperitoneally (IP) for rapid delivery
True
The mesenteries, omenta, and ligaments are formed by:
Visceral Peritoneum
Superior part of abdominopelvic cavity
Upper boundary –
Lower boundary –
Upper boundary – thoracic diaphragm
Lower boundary – superior pelvic aperture or pelvic inlet
The abdominal cavity extends to which intercostal space?
What are the contents of the abdominal cavity?
Extends to the 4th intercostal space
Peritoneum
Parietal
Lines the cavity
Visceral
Covers viscera
Abdominal viscera
- Digestive organs
- Spleen
- Kidneys
- Adrenal glands
Peritoneal cavity can be divided into two spaces or sacs, what are they?
Greater sac (cavum peritonei)
- main and larger part of peritoneal cavity
Lesser sac (omental bursa)
- smaller part of the peritoneal cavity
(posterior to the stomach)
- allows free movement of the stomach
Lesser sac is also known as
Omental Bursa
The greater and lesser sac connect via the
Epiploic Foramen
Omental Bursa communicates with Greater sac via
Foramen of Winslow
Omental foramen =
Epiploic Foramen =
all three names mean the same thing
An opening situated posterior to the free edge of the lesser omentum forming hepatoduodenal ligament
Omental (Epiploic) Foramen
What is the connection between the liver and the stomach?
Omental Bursa
(lesser omentum)
What connects the stomach to the transverse colon?
Greater Omentum
True or False
The connection of one organ to another in the abdominal cavity is known as the Omentum
True
The heptodoudenal ligemnt attaches to
Liver and Duodenum
True or False
The lesser omentum is inferior to the greater omentum
False
Lesser omentum is Superior to the Greater omentum
Which of these is posterior to the stomach and anterior to the pancreas?
A. Greater Sac
B. Lesser Sac
C. Greater Omentum
D. A and C
B. Lesser Sac
What are the two subsections of the lesser omentum?
Heptoduodenal Ligament
Heptogastric Ligament
Review
Where is the viscera located?
What does the cavity normally contain?
Organs described as peritoneal or intraperitoneal are surrounded or nearly surrounded by
Viscera are outside the peritoneal cavity
The cavity normally contains a small amount of serous fluid
visceral peritoneum
What are the retroperitoneal organs covered by?
What happens to the secondary retroperitoneal organs during development as they are pushed against the posterior body wall?
Retroperitoneal organs are only covered by peritoneum on their anterior surfaces
Secondary retroperitoneal organs lose their mesenteries during development as they are pushed against the posterior body wall
Identify the Intraperitoneal Organs
- Spleen
- Duodenum: Superior Part
- Liver
- Stomach
- Transverse Colon
- Small Intestine
completely covered with visceral peritoneum
Idetify the Primary Retroperitoneal Organs
Kidneys
Suprarenal (Adrenal) Glands
peritoneum only on their anterior surface
Identify the secondary Retroperitoneal Organs
- Pancreas
- Ascending Colon
- Descending Colon
- Duodenum
(Descending, Horizontal & Ascending Part)
The esophagus enters at and when it gets to the stomach, the the cardiac orifice enters at
T10
T11
Which of these are NOT secondarily retroperitoneal?
A. Pancreas
B. Descending Colon
C. Ascending Colon
D. Kidneys
E. Duodenum (Descending, Transverse and Ascending Parts)
D. Kidneys
Kidneys are Primary retroperitoneal
(never had mesentery)
What is the Cradiac Orfice?
What is the pyloric sphincter?
What is the Gastric rugae?
where the esophagus enters the stomach
connects the stomach to the duodenum
allow to expend gastric volume (stomach to expand and move)
Foregut
Midgut
Hindgut
Foregut
liver, stomach, esophagus
Midgut
small intestines and some of large intestine
Hindgut
large intestine, sigmoid, etc
What arteries directly come off the Celiac Trunk?
Left Gastric Artery
Splenic Artery
Common Hepatic Artery
What branches off of the Splenic Artery?
Splenic Artery → Left Gastroepiploic Artery
What branches off of the Common hepatic artery?
Common Hepatic Artery
→ Gastroduodenal Artery
→ Anterior & Posterior Superior Pancreaticoduodenal Artery
Gastroduodenal Artery turns into the Right Gastroepiploic Artery
The Proper hepatic artery comes off of the
Common Hepatic artery
Common hepatic artery turns into Proper hepatic artery
What comes off of the Proper Hepatic Artery?
Proper Hepatic Artery → Right Gastric Artery
Proper Hepatic Artery → Left & Right Hepatic Artery
What comes off of the Right Hepatic Artery?
Right Hepatic Artery → Cystic Artery
Celiac Trunk
Left Gastric Artery (comes off celiac trunk)
Splenic Artery → Left Gastroepiploic Artery
Common Hepatic Artery → Gastroduodenal Artery → Anterior & Posterior Superior Pancreaticoduodenal Artery & Right Gastroepiploic Artery
Proper Hepatic Artery → Right Gastric Artery
Proper Hepatic Artery → Left & Right Hepatic Artery
Right Hepatic Artery → Cystic Artery
Left & Right Gastric Arteries, as well as Left & Right Gastroepiploic Arteries, form , respectively
an anastomosis (cross/connect)
True or False
Right Gastro-Omental = Right Gastroepiploic
True
Splenic artery off the celiac trunk gives off which branch?
A. Gastroduodenal Artery
B. Right Gastric Artery
C. Left Gastroepiploic Artery
D. Left Gastric Artery
Left Gastroepiploic Artery
Where is the spleen found?
Located on left side within the greater sac
It lies against the 9th - 11th ribs
Trauma to the ribs can rupture the spleen causing profuse internal bleeding
What type of circulation does the spleen have?
Spleen: open and closed circulation
RBC have to make it back quickly to the spleen in order to go back to the heat
(RBC has to be fast and quick)
The spleen is an organ
What’s its job?
Immune organ
Highly vascular – filters blood
Pancreas
-Secondarily Retroperitoneal organ
It s an exocrine organ
(within ducts)
- secretes enzymes in a large volume of fluid into duodenum
and
endocrine organ
(within bloodstream)
- secretes hormones insulin and glucagon into the blood
The head of the pancreas is hugged by what structure?
The tail is by the
Duodenum
Spleen
The pancreas is to the stomach
Posterior
The pancreas is exocrine and endocrine in function because of what, respectively?
Secretes enzymes into the duodenum;
Secretes insulin and glucagon into the bloodstream
Hormonal control of exocrine function by what?
enteroendocrine cells in duodenum
enteroendocrine cells in the duodenum regulate the secretion of the enzymes from the pancreas
The minor papillae is ________to the major papillae
Superior
Major Papilla
Minor Papilla
Major papilla
opening of the main pancreatic duct and common bile duct
Minor papilla
Site of _drainage of the accessory pancreatic duc_t
Hepatopancreatic Ampula
Regulates flow of bile and pancreatic juice
What can Obstructive Jaundice be caused by?
- Pancreatic Carcinoma
- Obstruction of Common Bile Duct
True or False
Liver AND Pancreas are exocrine only in function
False
Liver AND Pancreas are
exocrine and endocrine in function
Liver
What supplies deoxygenated blood to the liver?
What supplies oxygenated blood to the liver?
Portal Vein - 75%
Hepatic Artery - 25%
central vein – travels alone
Exocrine & Endocrine Summary
Exocrine:
Pancreas
- Secretory enzymes into the duodenum
Liver
- Bile production and storage in gallbladder
Endocrine
Pancreas
- Production of insulin and glucagon and their release into the bloodstream
Liver
- Production and release of plasma proteins into the bloodstream
Which structure flows through the major papilla?
Main Pancreatic Duct & Common Bile Duct
True or False
The Liver is:
- Intraperitoneal (Peritoneal) organ
- The largest glandular tissue in the body (exocrine and endocrine)
True
What is the Bare area?
Bare area
the site where the original relationship with septum transversum is retained
- The liver is suspended from the diaphragm by the coronary ligament
Coronary ligament suspends the liver from ?
the diaphragm
What separates the left and right lobe of the liver?
Falciform Ligament
Where is the bile produced and stored?
Bile is produced in the LIVER
but
stored in the Gallbladder
Common Hepatic Duct + Cystic Duct
Common Hepatic Duct + Cystic Duct
→ Common Bile Duct
→ Major Papilla
All of the venous drainage from the digestive organs and the spleen enter the to be carried to the liver.
portal venous system
True or False
The liver has a low regenerative capacity
False
The liver has a high regenerative capacity
The Liver: Vascular System
Interlobular vessels
travel in triads
(blood directed toward the sinusoids)
- portal vein 75%
(blood from intestine, spleen, pancreas)
- hepatic artery 25%
(oxygenated blood to the liver)
central vein – travels alone
(receives blood from the sinusoids)
Vascular system – blood flow:
Vascular system – blood flow:
↑
Inferior vena cava
↑
Hepatic veins
↑
Sublobular and collecting veins
↑
Central vein
↑
Sinusoids
↑
Inlet venules
↑
Portal vein and hepatic artery and their branches
Liver Cirrhosis
Progressive Hepatocyte Destruction →
Scarring →
Loss of Connections →
Fibrocollagenous Tissue →→→ Chronic Liver Failure
Gallbladder
Peritoneum completely surrounds the fundus of gallbladder
Gallbladder → Stores Bile
Common Hepatic Duct + Cystic Duct
→ Common Bile Duct
→
Gallstones
Obstructive Jaundice: Obstruction of Common Bile Duct
Cholecystitis: Obstruction of Cystic Duct
Gallbladder: obstructive biliary disease (Obstructive jaundice)
First 6 months:
A constant drip of bile
After 6 months:
Good regulation
Gallstones
- Twice as likely in female than male
- can cause severe epigastric or right upper quadrant pain
- Pain can be referred to right shoulder
- Large gallstones can cause obstructive jaundice
