Lecture 3: Peritoneum Flashcards
Discuss the location, neurovasculature, sensitivity, and pain localization of the parietal peritoneum
Location = lines body wall
Neurovasculature = supplied by same blood, nerve, and lymphatics as the region of the wall it lines
Sensitivity = to pressure, pain, and temperature
*Pain is well localized
Discuss the location, neurovasculature, sensitivity, and pain localization of the visceral peritoneum
Location: covers the organs
Neurovasculature: same blood, nerve, and lymph supply as the organ it covers
Sensitivity: stretch and chemical irritation
*Pain is poorly localized
How do we differentiate intraperitoneal vs. retroperitoneal?
Intraperitoneal: completely covered w/ visceral peritoneu
Retroperitoneum: outside the peritonal cavity and are only partially covered w/ peritoneum
Describe the greater omentum (layers, ligaments)
- Four-layered peritoneal fold
- Gastrophrenic lig.
- Gastrosplenic (gastrolienal) lig.
- Gastrocolic lig.
Describe the lesser omentum (layers, ligaments).
- Double-layered peritoneal fold
- Hepatoduodenal lig.
- Gastrohepatic lig.
How is the liver connected to the anterior abdominal wall, stomach, and duodenum?
Anterior abdominal wall –> Falciform lig.
Stomach –> Hepatogastric lig.
Duodenum –> Hepatoduodenal lig.
What’s significant about the hepatoduodenal lig?
Conducts the portal triad: portal vein, hepatic artery, bile duct
How is the stomach attached to the inferior diaphragm, spleen, and transverse colon?
Inferior diaphragm –> Gastrophrenic lig
Spleen –> Gastrosplenic lig
Transverse colon –> Gastrocolic lig
What is the Pringle Manuever?
To stop blood in the portal triad during a liver procedure you stick your fingers into the epiploic foramen and this will ligate the blood supply to the liver
How does the lesser sac (omental bursa) communicate w/ the greater sac?
Via the epiploic foramen (omental foramen/foramen of Winslow)
What are the anterior, posterior, superior, and inferior boundaries of the epiploic foramen (aka foramen of Winslow)?
Anterior: hepatoduodenal lig and portal triad
Posterior: IVC and Rt. crus of diaphragm
Superior: Caudate lobe pf liver
Inferior: 1st part of duodenum
What is found anterior and posterior to the lesser sac?
Anterior: Lesser omentum, stomach, gastrocolic lig
Posterior: Pancreas, Lf. suprarenal gland, Lf. kidney, aorta, IVC, splenic a. and v.
What is found superior and inferior to the lesser sac?
Superior: Liver and diaphragm
Inferior: Transverse mesocolon, 1st part of duodeum
What is found to the left and right of the lesser sac?
Left: hilum of spleen, gastrosplenic lig
Right: Epiploic foramen
If you had a peptic ulcer and the stomach ruptured posteriorly, where would the contents spill?
Into the lesser sac
With a stomach rupture is it better to be anterior or posterior?
A posterior rupture is ideal, because the stomach contents will be confined in the lesser sac.
Where will pancreatic enzymes go if the pancreatic pseudo-cyst ruptured anteriorly?
Into the lesser sac, because the pancreas sits posterior to this area.
Can any of the boundaries of epiploic foramen be cut to release a hernia within the lesser sac?
No, instead you would need to try and do a needle decompression of the lesser sac
There are subdivisions of the peritoneal cavity, what structure divides the cavity and into what compartments?
Transverse mesocolon divides cavity into:
- Supracolic compartment
- Infracolic compartment
Root of mesentery of small intestine divides infracolic compartment into:
- Left and Right infracolic space
Contents of the supracolic compartment?
Stomach, liver and spleen
Contents of the infracolic compartment?
Small intestine, ascending and descending colon
How are the supracolic and infracolic compartments able to communicate?
Freely via the paracolic gutters
How do the sizes of the paracolic gutters differ and why is this significant?
- Left paracolic gutter is narrowed due to phrenicolic ligament
- Compresses and kind of limits the movement of substances on the left
Significance of the rectouterine pouch (females) and rectovesical pouch (males)?
- Lowest part of the peritoneal cavity
- Peritoneal fluid and other fluids that enter the peritoneal cavity, including ascites, blood and pus, tend to collect in this pouch.
Why is large invasive surgery more painful in the peritoneum; can result in?
- Well innervated by the thoraco-abdominal nerves
- Can result in adhesions (we saw this is lab)
What is ascites?
Excess fluid in the peritoneal cavity
Where is a good location for Paracentesis?
- Rectouterine pouch
- Drainage of abcesses possible w/o causing generalize peritonitis
What is the clinical significance of the SMA and SMV being posterior to the pancreas?
If these vessels are compromised due to pancreatic cancer, you CANNOT remove the pancreas surgically, and will have to opt for chemo/radiation therapy.
What is found anterior to the pancreas?
Lesser sac and stomach
What is found posterior to the pancreas?
Aorta and IVC, splenic vein, bile duct, right crus of diaphragm, left kidney/vessels, left suprarenal gland, SMA/SMV
What is found to the right and left of the pancreas?
Right = 2nd part of duodenum
Left = spleen
What is found inferior to the pancreas?
3rd part of the duodenum
What kind of periotneum is the pancreas?
All retroperitoneum, EXCEPT the tail (intraperitoneal)
