Lecture 3- Peritoneum Flashcards
Arteries that supply blood to the foregut?
Celiac trunk:
-Splenic, left gastric, and common hepatic
Ventral mesentery of the foregut?
- Lesser omentum
- Falciform ligament
- Coronary/triangular ligaments
Dorsal mesentery of the foregut?
- Gastrosplenic ligament
- Splenorenal ligament
- Gastrocolic ligament
- Greater omentum
Motor nerve supply of the foregut?
Vagus nerve
Organs within the midgut?
- 2nd half of duodenum
- Jejunum
- Ileum
- Cecum (appendix)
- Ascending colon
- Proximal 2/3 of transverse colon
Arteries that supply blood to the midgut?
Superior mesenteric artery
-Ileocolic, right colic, and middle colic
Ventral mesentery of the midgut?
None
Dorsal mesentery of the midgut?
- Mesointestine
- Mesoappendix
- Transverse mesocolon
Motor nerve supply of the midgut?
Vagus nerve
Organs within the hindgut?
- Distal 1/3 of transverse colon
- Descending colon
- Sigmoid colon
- Rectum
Arteries that supply blood to the hindgut?
Inferior mesenteric artery
-Left colic, sigmoid branches, superior rectal
Ventral mesentery of the hindgut?
None
Dorsal mesentery of the hindgut?
Sigmoid mesocolon
Motor nerve supply of the hindgut?
Pelvic splanchnic nerves
Peritoneum
- What is it?
- 2 layers?
- A serous membrane
- Parietal and visceral layers (just like pleura and pericardium)
Peritoneum
-Parietal layer?
- Lines the body wall
- Has abundant pain fibers
Peritoneum
-Visceral layer (serosa)?
- Covers viscera
- Lacks pain fibers
Nerve supply to the parietal peritoneum
- Supplied by?
- Type of fibers they supply?
- What type of pain do they conduct?
- Nerves from the adjacent body wall supply parietal peritoneum
- Supply pain and vasomotor fibers
- Conduct sharp, stabbing pain-Rigid abdomen/”guarding”
Visceral peritoneum-Invests viscera/organs
-Blood supply, lymphatic vasculature and visceral nerve supply?
Same blood supply, lymphatic vasculature, and visceral nerve supply as the organs it covers
Visceral peritoneum
- Insensitive to?
- Sensitive to?
- Insensitive to touch, heat, cold, and laceration
- Sensitive to stretching and chemical irritation
Visceral Peritoneum
- Pain from visceral peritoneum?
- Type of pain?
- Type of fibers?
- Poorly localized-e.g. referred pain
- Crampy, colicky pain
- Unmyelinated type C fibers
General relations of viscera to peritoneum
- Intraperitoneal organs
- Covered by?
- Suspended by?
- Covered on most sides by visceral peritoneum
- Suspended by mesentery from the body wall
Retroperitoneal organs
- Position relative to parietal peritoneum?
- Covered by?
- Lie deep (“retro”) to the parietal peritoneum
- Covered by parietal peritoneum on ONE SIDE ONLY
Organs of the abdomen and pelvis
-Intraperitoneal organs in the abdominal peritoneal cavity?
- Stomach
- Small intestine (some of superior part of duodenum, all of jejunum and ileum)
- Spleen
- Liver
- Gallbladder
- Cecum (and appendix)
- Large intestine (transverse and sigmoid)
Intraperitoneal organs in the pelvic peritoneal cavity?
Uterus (fundus and body), ovaries, and uterine tubes
Primarily vs secondarily retroperitoneal?
Secondarily retroperitoneal is when the organ loses its mesentery during development
Organs that are primarily retroperitoneal?
-Easy way to remember this?
- Kidneys
- Uretrers
- Adrenal glands
- Gonads/uterine cervix
- Aorta and IVC
- “Ask yourself if the organ is part of the gut? If the answer is no, then it is primarily retroperitoneal”
Organs that are secondarily retroperitoneal?
- Duodenum (descending, horizontal, and ascending)
- Pancreas
- Ascending and descending colon
- Rectum (upper 2/3)
Organs that are infraperitoneal/subperitoneal?
- Urinary bladder
- Distal ureters
- Prostate
- Seminal vesicle
- Vagina
- Rectum (lower 1/3)
Peritoneal reflections in the adult
-Mesenteries
- 2 layered fold of the peritoneum
- THE mesentery
THE mesentery
-What does it attach?
- Attaches the “free” small intestine to the posterior body wall
- Jejunum
- Ileum
Ventral mesentery
-Mesentery attached to the stomach?
Mesogastrium
The mesogastrium is the mesentery attached to the stomach
-Associated with the dorsal or ventral mesentery?
Ventral mesentery
The dorsal aorta and its 3 branches run through which mesentery?
The dorsal mesentery
The ventral mesentery only extends from what to what?
The ventral mesentery only extends from the respiratory diaphragm to the duodenum
Subdivisions of mesentery
- Transverse mesocolon
- Function?
- Fuses with?
- Mesentery of the transverse colon
- Holds the transverse colon to the posterior body wall
- Fuses with the posterior layer of the greater omentum
Sigmoid mesocolon
-Function?
- Mesentery of the sigmoid colon
- Holds the sigmoid colon to the posterior body wall
Mesoappendix
Mesentery of the vermiform appendix
Peritoneal “ligaments”
- May be subdivisions of a larger structure
- Usually transmit?
- Usually lack?
- 2 examples?
- Usually transmit nerves and vessels
- Usually lack CT and are not the same as ligaments that join bones
- Gastrosplenic and splenorenal ligaments
Omentum (epiploon)
Broad, 2 layered sheet of peritoneum that attaches the stomach to other viscera
Lesser omentum
-Develops from?
-Develops from the ventral mesogastrium (mesentery)
Lesser omentum
-Subdivided into 2 parts?
- Subdivided into 2 parts:
- Hepatogastric ligament (stomach to liver)
- Hepatoduodenal ligament (liver to duodenum)
Hepatoduodenal ligament contains?
Portal triad-proper hepatic artery, hepatic portal vein, and common bile duct
Greater omentum
-Develops from?
-Develops from the dorsal mesogastrium
Organs of the foregut?
Stomach, esophagus, liver, gallbladder, pancreas, spleen, and 1st half of duodenum
Greater omentum
-3 ligaments?
- Gastrocolic ligament (stomach to transverse colon)
- Gastrophrenic ligament (stomach to diaphragm)
- Gastrosplenic ligament (stomach to spleen)
Peritoneal ligaments
-3 ligaments associated with the liver?
- Coronary ligaments
- Right and left triangular ligaments
- Falciform ligament (ligamentum teres hepatis)
“Minor” fold
-definition?
A ridge or elevation in the peritoneum produced by underlying vessels
Fossae (fossa) or recesses
- Depressions between folds
- Superior duodenal fold and fossa, inferior duodenal fold and fossa, paraduodenal fold, retroduodenal fossa
- Fold is formed by inferior mesenteric vein posterior to peritoneum?
Folds and fossa of the internal aspect of the abdominal wall
Structures coursing through the extraperitoneal tissue form elevations on the interior abdominal wall called peritoneal (umbilical) folds
Median umbilical fold
- ligament?
- Obliterated?
- Midline from?
- Median umbilical ligament
- Obliterated urachus
- Midline from bladder
Medial umbilical folds (2)
- Ligaments?
- Obliterated?
- Medial umbilical ligaments
- Obliterated umbilical arteries
Lateral umbilical folds (2)
- Formed by?
- Contains?
- Inferior epigastric vessels
- Functional arteries and veins
Falciform ligament
-Remnant of?
Ventral mesogastrium
Falciform ligament
-Contains?
- Ligamentum teres hepatis (round ligament of the liver) in its lower free border
- Obliterated umbilical vein
Peritoneal fossae
- Supravesical fossa-located between what folds?
- What can happen here?
- Located between the median (center of the body) and medial umbilical folds
- Site for supravesical hernias (rare)
Medial inguinal fossa
- Located between what folds?
- What type of hernia can occur here?
- Located between the medial and lateral umbilical folds
- Direct inguinal hernias occur here
Lateral inguinal fossa
- Where is it located?
- What type of hernia can occur here?
- Lateral to the lateral umbilical folds
- Indirect inguinal hernias occur here
Greater peritoneal sac-Most of the potential space within the abdomen
-Can be subdivided into?
Can be subdivided into supracolic (supramesocolic) and infracolic regions by the colon and transverse mesocolon
Greater peritoneal sac
- Supracolic region
- Location relative to liver and stomach?
- Includes what spaces/fossae?
- Superior and anterior to the liver and stomach
- Includes hepatorenal and subphrenic spaces and fossae of the anterior abdominal wall
Peritoneal cavity
- A closed potential space between parietal and visceral layers of peritoneum
- Recesses and fossae of the peritoneal cavity-Clinically important because abscesses may develop and excess fluid (ascites) will pool here
Greater peritoneal sac
-Infracolic region-which part of the greater sac is it?
Inferior and posterior
Greater peritoneal sac
-Infracolic region-subdivided by?
- Subdivided by mesenteries and ligaments
- Upper and lower parts are divided by THE mesentery into right and left infracolic spaces
Greater peritoneal sac
-Infracolic region-Right and left paracolic gutters are lateral to?
Ascending and descending colon
Greater peritoneal sac
-Infracolic region-Why is the space clinically important?
Intraperitoneal infections spread here
Greater peritoneal sac
-Infracolic region-What ligament prevents the spread of fluid superiorly?
Phrenicocolic ligament
Lesser peritoneal sac
-Location relative to the stomach?
Posterior and inferior to the stomach
Recesses of the lesser peritoneal sac
-Superior recess-posterior to?
Posterior to the liver
Recesses of the lesser peritoneal sac
-Inferior recess-Potential space between the?
2 layers of the gastrocolic ligament
Recesses of the lesser peritoneal sac
-Splenic recess-Location relative to the stomach?
Posterior and left of the stomach
Greater and lesser peritoneal sacs communicate through?
the epiploic foramen (of Winslow)
Lesser peritoneal sac has a clinically important relationship to what organs?
liver, pancreas, stomach, and spleen
Epiploic foramen (of Winslow)
-Opening between the greater and lesser sacs
Epiploic foramen (of Winslow) -anterior?
hepatoduodenal ligament with the portal vein, hepatic artery, and bile duct
Epiploic foramen (of Winslow) -posterior?
IVC, diaphragm
Epiploic foramen (of Winslow) -Superior?
Liver, caudate lobe
Epiploic foramen (of Winslow) -Inferior?
Duodenum, 1st part
