Lecture 11: Peritoneum and Abdominal Organs Flashcards

1
Q

Upper and lower boundaries of the abdominopelvic cavity

A

Cranially: Diaphragm
Caudally: Levator ani and coccygeus muscles

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2
Q

2 divisions of abdominal cavity

A
  • Abdominal cavity proper

- Pelvic cavity

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3
Q

Contents of abdominal cavity

A

Blood vessels, viscera, nerves, and peritoneum

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4
Q

Where does the abdominal cavity extend and why?

A

Into the rib cage to protect abdominal organs (especially forget organs)

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5
Q

Purpose of the greater (or false) pelvis

A

Protect lower abdominal organs

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6
Q

What part of the abdominal wall contains criss-crossing muscles and what are their functions

A

Anterior and lateral abdominal walls. Provides protection to this region, which contains soft and vital viscera.

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7
Q

What are the names of the 2 horizontal planes of the abdomen and their locations

A

Subcostal plane- costal cartilage of 10th rib

Transtubecular plane- iliac tubercles of iliac crest

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8
Q

What are the names of the vertical planes of the abdomen and their location

A

Midclavicular planes- From mid clavicle to between the anterior superior iliac spine and pubic symphysis

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9
Q

What are the six different regions of the abdomen in order (right to left)

A

Right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right inguinal, hypogastric, and left inguinal

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10
Q

What’s found in the right hypochondriac region?

A

Liver

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11
Q

What is found in the epigastric region?

A

Stomach

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12
Q

What is found in the left hypochondriac region?

A

Spleen

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13
Q

What is found in the right lumbar region

A

Right kidney

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14
Q

What is found in the umbilical region

A

Transverse colon

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15
Q

What is found in the Left lumbar region

A

Left kidney

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16
Q

What is found in the right inguinal region

A

appendix

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17
Q

What is found in the hypogastric region

A

Small intestine

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18
Q

What is found in the left inguinal region

A

Sigmoid colon

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19
Q

What are the 2 planes that divide the abdomen into four quadrants used by physicians

A

Median plane and transumbilical

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20
Q

What are the names of the 4 quadrants of the abdomen when divided by the median and transumbilical planes?

A

Upper left/right and Lower left/right quadrants

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21
Q

What was the embryonic precursor of the peritoneal cavity?

A

The intraembryonic coelomic cavity

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22
Q

What organs are contained within the peritoneal cavity

A

none

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23
Q

Are abdominal and peritoneal cavity synonymous?

A

No

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24
Q

Peritoneum

A

Serous membrane (thin layer of CT) covered by simple squamous epithelium (also called mesothelium)

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25
Q

What are the 2 peritoneum that delineated the peritoneal cavity

A

Parietal and visceral peritoneum

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26
Q

Which peritoneum is under extraperitoneal fat and transversals fascia that lies the abdominal wall?

A

Parietal peritoneum

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27
Q

Which peritoneum forms a shiny external covering over the abdominal organs

A

Visceral peritoneum

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28
Q

Mesentery definition

A

Double layer of peritoneum that encloses an organ and connects it to the body wall.

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29
Q

How do organs that are held within mesenteries receive blood?

A

Blood vessels travel through the mesentery to reach the organ

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30
Q

Peritoneal ligament definition

A

Double layer of peritoneum connecting an organ to the body wall or to another organ

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31
Q

Retroperitoneal definition

A

Organ that only slightly protrudes the peritoneal cavity

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32
Q

What doe retroperitoneal organs lack?

A

Mesenteries

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33
Q

Unique characteristics of retroperitoneal organs?

A

immobile and tough to access surgically

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34
Q

Primarily retroperitoneal

A

Never had a mesentery and never will (not gut organs)

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35
Q

Example of primarily retroperitoneal organ

A

Kidney

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36
Q

Secondarily retroperitoneal

A

They developed a mesentery but it was reabsorbed

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37
Q

Examples of secondary retroperitoneal organs

A

pancreas, duodenum, ascending and descending colon

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38
Q

How did the pancreas and duodenum loose their mesentery

A

Growth of the liver forces these two organs against the posterior back wall

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39
Q

How did the ascending and descending colons loose their mesentary

A

gut rotation cement rated the two structures against the posterior back wall

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40
Q

Location of subphrenic recess

A

Between the liver and thoracic wall

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41
Q

What boundaries from the hepatorenal recess

A

Bounded by the right kidney, liver, colon, and duodenum

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42
Q

What is the lowest point of the peritoneal cavity when the patient is laying down

A

The hepatorenal recess

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43
Q

In what recess does the vermiform appendix lie?

A

the retrocecal recess

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44
Q

What are the 2 divisions of the peritoneal cavity

A

The greater and lesser sac (or peritoneal cavity proper and omental bursa)

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45
Q

Location of the lesser sac

A

between the stomach and posterior body wall

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46
Q

What does the lesser sac allow for?

A

Dissension of the stomach

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47
Q

How does the lesser sac communicate with the greater sac?

A

Through the epiploic foramen of Winslow

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48
Q

What is another name for the epiploic foramen of Winslow?

A

Omental foramen

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49
Q

What are the lateral boundaries of the mental bursa

A

Glastrosplenic ligament and lienorenal ligament

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50
Q

What are the structures that are anterior and posterior to the omental bursa

A

Anterior: Stomach
Posterior: Pancreas

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51
Q

What are the 3 parts of the omental bursa

A
  • Superior recess- between the liver and diaphragm
  • Main portion behind the stomach
  • Inferior recess- Between the double layers of the gastrocolic ligament
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52
Q

What recess is obliterated in the omental bursa during adulthood

A

the inferior recess

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53
Q

What forms the median umbilical fold

A

Formed by urachus

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54
Q

What is the urachus an embryonic remanent of

A

allantois

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55
Q

Function of the allantois

A

Connect the urinary bladder to anterior body wall

56
Q

What is the medial umbilical fold a remanent of?

A

Umbilical arteries

57
Q

What artery travels through the lateral umbilical fold?

A

The inferior epigastric artery

58
Q

Where does the falciform ligament extend

A

From the umbilicus to liver

59
Q

What does the falciform ligament contain

A

The ligamentum teres hepatic

60
Q

What is the ligamentum teres hepatis a remanent of?

A

Umbilical v.

61
Q

Which mesentery is the derivative of the falciform ligament

A

Ventral mesentery

62
Q

What are the functions of the mesenteries that attach structures to the posterior body wall?

A

transport vessels, nerves, and lymphatics, and allow for mobility of intestines

63
Q

What are the 3 mesenteries that suspend the intestines to the back wall

A
  • Mesentery proper (suspends the jejunum and ileum)
  • Transverse mesocolon (transverse colon)
  • Sigmoid mesocolon (sigmoid colon)
64
Q

Function of Greater Omentum

A

Attach the stomach and proximal duodenum to body wall

65
Q

What did omentum derive from

A

primitive mesentery

66
Q

Greater omentum location and description

A

Fat-filled apron suspended from the greater curvature of the stomach over intestines

67
Q

Structural derivative of the greater omentum

A

Dorsal mesentery

68
Q

How many layers was the greater omentum in the embryo

A

4 layers

69
Q

How many layers is the greater omentum in the adult

A

2 layers

70
Q

Why is the greater omentum the “policeman of the GI tract”

A

Localizes infection

71
Q

What ligaments make up the major and minor portions of the greater omentum

A

Major- Gastrocolic ligament

Minor- Gastrosplenic and gastrophrenic ligaments

72
Q

Role of the lesser omentum

A

Suspends the stomach (from lesser curvature) from the liver

73
Q

What is the structural derivative of the lesser omentum

A

The ventral mesentery

74
Q

What ligament from the liver attaches to the stomach in the lesser momentum

A

Hepatogastric ligament

75
Q

What are the two ligaments that make up the lesser omentum

A

hepatogastric and hepatoduodenum ligaments

76
Q

What are the four depressions (or pathways) for the conduction of fluid and infections formed by the attachments of mesenteries of the small intestine, ascending and descending colon

A
  • Right paracolic gutter
  • Gutter to the right of the mesentery
  • Gutter to the left of the mesentery
  • Left paracolic gutter
77
Q

How is the right paracolic gutter formed

A

Formed from the fact that ascending colon is secondary retroparitoneal pushed against back wall and there is parietal paritoneum on the outside making an unimpeded path for fluid to travel when you are upright.

78
Q

What is the role of the right paracolic gutter

A

Communication between hepatorenal recess and pelvis

79
Q

What is the direction of fluid movement from the hepatorenal recess when you sit up

A

Fluid from the hepatorenal recess drains into the peritoneal gutter via the right parabolic gutter down to the retrocecal recess.

80
Q

What gutter is the pathway for infection from the hepatorenal pouch into the pelvis?

A

The right paracolic gutter

81
Q

Gastrosplenic ligament

A

Stomach to spleen

82
Q

Gastrophrenic ligament

A

Stomach to diaphragm

83
Q

At what vertebral level does the esophagus pierce the diaphragm

A

T10

84
Q

What is the name of the hole the esophagus enters through the diaphragm

A

Esophageal hiatus

85
Q

What does the abdominal portion of the esophagus “groove” before

A

The left lobe of the liver

86
Q

What region of the stomach does the esophagus enter?

A

Cardiac oriface

87
Q

Where along the esophagus is the structure covered in peritoneum

A

Lateral and anterior borders

88
Q

What nerve plexus surrounds the esophagus

A

Esophageal plexus

89
Q

What arteries supply the esophagus

A

Esophageal artery from left gastric artery of celiac trunk and inferior phrenic a.

90
Q

What partially covers the stomach

A

ribs

91
Q

Greater curvature of the stomach

A

Left boarder of the stomach notched where the esophagus enters (cardiac notch). Greater momentum attaches here

92
Q

Lesser curvature of the stomach

A

Right border at the pyloric end contains the angular notch

93
Q

What are the 4 different regions of the stomach

A

Cardiac antrum, fundus, body, and pylorus

94
Q

Cardiac antrum

A

region joining esophagus

95
Q

Fundus

A

Region superior and left of cardiac antrum demarcated by a horizontal plane through the cardiac oriface

96
Q

Body

A

Major portion of the stomach

97
Q

Pylorus

A

separate from the body by the angular notch of the stomach Divided into the pyloric antrum (wider) and pyloric canal which ends with a very thick band of smooth muscle the pyloric sphincter

98
Q

Duodenum shape

A

C shaped loop

99
Q

4 parts of duodenum

A
  • Superior
  • Descending
  • Horizontal
  • Ascending
100
Q

What parts of the duodenum are secondarily retroperitoneal?

A

The superior and descending

101
Q

What are the vertebral levels for each region of the duodenum

A
  • Superior L1
  • Descending L3
  • Horizontal L3
  • Ascending L2
102
Q

What regions of the duodenum are forgut derivatives? What are the remaining regions a part of?

A

-Superior and descending are forget derivatives the remainder are midgut

103
Q

What is the blood supply to the superior and descending portion of the duodenum?

A

Celiac trunk

104
Q

What are the horizontal and ascending regions of the duodenum supplied by?

A

Superior mesenteric artery

105
Q

What is another name for the superior region of the duodenum?

A

The duodenal bulb

106
Q

Ampulla of Vater location

A

Descending suodenum

107
Q

Ampula of Vater: What is it?

A

Region where the common bile duct and main pancreatic duct enter the descending duodenum

108
Q

Major duodenual papilla

A

Marks the opening of the common bile and main pancreatic duct inside the duodenum

109
Q

Where do duodenal ulcers typically occur

A

Superior and descending region above the major duodenal papilla

110
Q

What mesentery suspends the jejunum and ileum

A

Mesentery proper

111
Q

Location of the mesentery proper

A

Obliquely, inferior, and to the right of the duodenaljejunal fleecer to the left side of L2 vertebrae and to the right sacroiliac joint (next to midbody of L5)

112
Q

What covers the jejunum and ilium anteriorly?

A

Greater omentum

113
Q

What region of the abdomen contains the jejunum

A

Unbilical region

114
Q

What region of the abdomen contains the ileum

A

Hypogastric and inguinal regions

115
Q

Which is more muscular the jejunum or ileum?

A

Jejunum

116
Q

What do the intestinal arteries from the superior mesenteric artery form

A

Arterial arcades and vasa recta

117
Q

Differences in arterial arcades and vasa recta between the jejunum and ileum

A

The ileum has more complicated arterial arcades and shorter vasa recta

118
Q

Pilcae circulares

A

Spiral folds of mucous membrane

119
Q

Which has more pronounced plicate circulates the jejunum or ileum?

A

Jejunum

120
Q

What are the different regions of the large intestine

A

Cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

121
Q

What parts of the large intestine have a mesentery

A

The transverse and sigmoid colon

122
Q

Where does the large intestine begin

A

At the ileoceccal junction

123
Q

At what point does the descending colon become the sigmoid colon

A

When it crosses the pelvic brim

124
Q

Taenia Coli

A

Longitudinal muscle layer forms 3 stripes on surface of large intestine

125
Q

Haustra

A

Sacculations of large intestine (can see well in radiographs)

126
Q

Appendicies epiploicae

A

Fat-filled peritoneal sacs become filled with waste in dicerticulosis

127
Q

What are the 2 fluxures present in the large intestine

A

Hepatic fluxure and splenic fluxure

128
Q

Hepatic fluxure

A

Ascending to transverse colon

129
Q

Splenic fluxure

A

Transverse to descending colon

130
Q

Arterial supply to the large intestine

A

Branches off the inferior and superior mesenteric a.a

131
Q

Where does the rectum start and end?

A

Starts: S3 and ends at anal canal

132
Q

Gastric ulcer

A

Lesions of the wall of the stomach that may disrupt the splenic a. causing sever hemorrhage. Gastric juices can also be released into the omental bursa and cause periontitis

133
Q

Appendicitis

A

Acute inflammation of the appendix

134
Q

Ascites

A

Effusion of peritoneal cavity with fluid

135
Q

Peritonitis

A

Inflammation of pariteoneal cavity

136
Q

Adhesions

A

Scar tissue connecting parietal and visceral paritoneum