Lecture 3 - Peritoneum & Upper Abdomen Flashcards
Thin, translucent, serous membrane
consists of two continuous layers
The peritoneum consists of two continuous layers: Parietal peritoneum and visceral peritoneum.
tend to travel between the peritoneal layers
vessels
spleen and stomach : completely covered by visceral peritoneum
Intraperitoneal
Organs behind the peritoneum are retroperitoneal
some examples are
kidney, inferior vena cava, aorta
all visceral & parietal peritoneal membranes create a
peritoneal sac
a potential space within sac
contains only a small amount of serous fluid
allow organs to move freely without friction
peritoneal cavity
cavity is within the abdominal cavity and continues into the pelvic cavity. It is a potential space of capillary thinness.
peritoneal cavity
attaches to greater curvature of stomach and transverse colon
Drapes over small intestines like an ‘apron’
‘Apron’ = gastrocolic ligament
4 layers of peritoneum
greater omentum
functionally it can wall off infections & inflammation sites
results in formation of adhesions
great omentum
greater omentum is a derivative from the
dorsal mesentery
___= gastrocolic ligament (largest portion) + gastrosplenic ligament and gastrophrenic ligament (to diaphragm)
greater omentum
attaches to lesser curvature of stomach and duodenum
2 portions connect these structures to the liver
lesser omentum
-hepatogastric ligament and hepatoduodenal ligament
part of lesser omentum,
connects liver to stomach
Hepatogastric ligament
part of lesser omentum, connects liver to duodenum
Contains the portal triad
Hepatoduodenal ligament
Portal Triad =
hepatic a., portal v., & bile duct
Deep to the Lesser Omentum is the __(cavity)
Omental bursa
less omentum is a derivatives from the
ventral mesenteries.
Anchors most of the small intestine to posterior abd. wall
Runs diagonally from duodenojejunal jxn. to ileocecal jxn.
a distance = 15 to 20 cm in adults
Mesentery Proper
Fibromuscular ligament descends from the R. crus of diaphragm; holds distal duodenum in place
Prevents duodenojejunal jxn. from sagging
Suspensory ligament of duodenum (of Treitz)
Anchors portions of the colon to the posterior abdominal wall
Ascendingand Descending colon have no mesentery
(attached directly to the posterior wall)
Transverse Colon anchored by____
Double Layered Peritoneum: Mesocolon
transverse mesocolon
Transvers mesocolon divides the abdominal cavity into 2 compartments:
_____ – contains stomach, liver and spleen
_______ – contains small intestine and ascending & descending colon.
Supracolic compartment
Infracolic compartment
Divides liver into R and L lobes
Anchors liver to diaphragm & anterior body wall
Falciform Ligament
border contains the obliterated umbilical vein
round ligament of the liver located at inferior border of liver
The left umbilical vein is obliterated after birth and becomes the
ligamentum teres hepatis = round ligament of liver
This then becomes the inferior margin of the falciform ligament.
Reflections of peritoneum around the bare area of the liver
Attach liver to inferior surface of diaphragm
Coronary Ligament
upper posterior liver
bare area, no peritoneal
Potential peritoneal spaces in standing patients
Becomes actual spaces in recumbent patients
Pathological fluids can accumulate in these recesses
Hepatorenal pouch
Rectovesical or rectouterine pouch
the lowest point of the abdominopelvic cavity
hepatorenal recess
Bounded by liver, R kidney, colon and duodenum
lowest part of peritoneal cavity when recumbent
fluids may move down to rectovesical/rectouterine pouch – when in reclining position or sitting up
Hepatorenal Pouch (Pouch of Morrison)
Between rectum and bladder (male)
another low point of peritoneal cavity when recumbent
fluids here may move up to hepatorenal pouch – when in Trendelenburg position
Rectovesical (lowest pouch in male)
Between rectum and uterus (♀)
another low point of peritoneal cavity when recumbent
fluids here may move up to hepatorenal pouch – when in Trendelenburg position
Rectouterine pouch (lowest pouch in female)
detoxifies chemical products & produces bile
liver
stores bile for emulsification of fats
gallbladder
produces enzymes for digestion
pancreas
produces lymphocytes & filters blood
spleen
how many lobes does the liver have
4
Attached to inferior surface of liver
Fundus, body, & neck
Contacts duodenum, colon & anterior abdominal wall
Receives bile produced by liver via bile ducts
Bile then drains into duodenum thru these ducts
gallbladder
Receives, concentrates and stores bile from the liver
gallbladder
The arterial supply is the cystic artery from the right hepatic artery (a branch of the hepatic artery proper.
gallbladder
receives bile from R & L lobes of liver
R & L hepatic ducts
of gallbladder
receives R & L hepatic ducts
common hepatic duct
duct connected to gall bladder
cystic duct
receives cystic & common hepatic ducts
common bile duct
joins with the pancreatic duct & drains into the descending part of the duodenum at the major duodenal papilla
the common bile duct
Common bile duct joins main pancreatic duct
Both empty into
major duodenal papilla
in descending part of duodenum
Consists of a head, neck, body, tail and uncinate process
Retroperitoneal & transverse across posterior abdominal wall
Surrounded by C-shaped duodenum on R & spleen on L
pancreas
_____ drain from pancreas via 1 or 2 ducts
___enters duodenum with bile duct at major duodenal papilla
____may enter duodenum as well
~ 2 cm superior to major papilla
enzymes
Main pancreatic duct
Accessory pancreatic duct
Pattern of pancreatic drainage is ___
variable
contacts diaphragm along ribs 9-11, also contacts stomach, L kidney, pancreas & colon
Diaphragmatic surface of spleen
The spleen is connected to the greater curvature of the stomach by the _____ which contains the short gastric and gastro-omental vessels
gastrosplenic ligament
the spleen is connected to left kidney by the _____ which contains the splenic vessels.
Both these ligaments are parts of the greater omentum.
splenorenal igament
The spleen is surrounded by visceral peritoneum except in the area of the ___ on them medial surface of the spleen.
hilum
The splenic hilum is the entry point for the ___ and occasionally the tail of the pancreas reaches this area.
splenic vessels
The arterial supply of the spleen is the splenic artery from the
celiac trunk.
1st major br. of Abd aorta
Supplies liver, gb, esophagus, stomach, pancreas & spleen
celiac trunk
3 main branches of the celiac trunk
common hepatic a. -
L. gastric a.-(supplies lessser curve of stomach)
splenic a.-(spleen)
Right br. of celiac trunk Runs toward liver & gallbladder 2 terminal branches Proper hepatic a. Gastroduodenal a.
common hepatic a.
Superior br. of common hepatic a.
Runs toward liver & medial to bile duct
R Gastric a.
Splits into R & L hepatic aa
proper hepatic a.
Inferior br. of common hepatic a.
Runs toward junction of stomach & duodenum
sends Supr. pancreaticoduodenal aa. to pancreas/duodenum
sends R gastroepiploic a. (R gastro-omental a.) to greater curvature of stomach
gastroduodenal a.
branch of gastroduodenal a., and supplies greater curve of stomach
right gastroepiploic a.
Superior br. of celiac trunk
Runs L toward lesser curvature of stomach
supplies stomach & esophagus (via esophageal brs.)
L Gastric A.
Left br. of celiac trunk
Runs toward spleen
supplies pancreas & spleen
Sends short gastric aa. & L gastroepiploic a. (L gastro-omental a.)
supply greater curvature of stomach
splenic a.
