Module 6 : Peritoneum and Retroperitoneum Flashcards
what structure separates the thorax from the abdominal cavity
the diaphragm
what structure separates the peritoneum from the retroperitoneum
peritoneal membrane
peritoneal membrane
- thin layer of loose connective tissue lines abdominal cavity
- produces a serous fluid
- contains fat, blood vessels, lymphatics and nerves
- creates ligaments and folds
+ anchors organs - allows free movement between organs
+ decreases friction
what are the 2 layers of the peritoneum
- parietal and visceral
what do the 2 layers of the peritoneum create
- create a potential space/cavity where fluid can collect
creation of peritoneum
- during fetal development some organs become enclosed with double folds of peritoneum
- others do not migrate into the cavity but remain with only the anterior surfaces covered
intraperitoneal organs
- enclosed within the double folds of peritoneum
retroperitoneal
- remain outside the cavity with only anterior surfaces covered
peritoneal folds
- mesentery
- mesocolon
- lesser omentum
- greater omentum
mesentery
- peritoneal folds connecting small bowel to posterior abdominal wall
- large and fan shaped
mesocolon
- peritoneum attached to colon
- connects transverse colon and sigmoid to posterior abdominal wall
lesser omentum
- double layer of mesentery
- connects lesser curvature of stomach and 1st part of duodenum to visceral surface of liver
greater omentum
- apron like fold that connects greater curvature of the stomach and transverse colon
ligaments
- double folds of peritoneum
- name generally relate to the specific organ they are attached
- convey blood, lymphatic vessels, nerves to organs
falciform ligament
- travels from the umbilicus to the liver
- passes over the anterior superior liver surface and splits
what structure runs through the falciform ligament
- ligamentum teres
what other ligaments are formed from the splitting of the falciform ligament
- triangular and coronary ligament
coronary ligaments
- parietal peritoneum
- posterior aspect of liver
- DEFINE BARE AREA OF LIVER
ligamentum teres
- remnant of fetal umbilical vein
- runs in falciform ligament and joins left portal vein at the porta hepatis
legamentum venosum
- remnant of fetal ductus venosum
- attaches to left portal vein above IVC
triangular ligaments
- corners of bare area
hepatoduodenal ligaments
- conducts MPV, CBD, HA
hepatogastric ligament
- forms lesser omentum with hepatoduodenal
other ligaments
- gastrocolic
- gstrosplenic
- splenorenal
peritoneal spaces
- potential spaces created between the parietal and visceral layers
- CLOSED ACCEPT IN FEMALES (Fallopian tubes)
- in pathological state, fluid and pus can collect in some spaces
right sub hepatic space
- MORISONS POUCH
- posterior to right lobe of liver
- anterior to upper pole of right kidney
- MOST DEPENDENT PORTION OF SUBHEPATIC SPACE
left sub hepatic space
- anterior and posterior recess
- lesser sac is part of it
subphrenic space
- anterior and posterior sections
what structures define the subphenic space
- liver and diaphragm
what ligament divides this space into right and left
- falciform ligament
lesser sac
- communicates with the greater sac
what is an alternate name for lesser sac
- mental bursa
what are the terms for the opening of the lesser sac
- epiploic foramen / foramen of of Winslow
- mental foramen / omental neck
what structure lies posterior to opening
IVC
what structure lies superior to opening
caudate
what structure lies anterior to opening
stomach
what retroperitoneal structure lies posterior to lesser sac
pancreas
greater sac
- accounts for most of space in peritoneal cavity
- ANTERIOR to LESSER SAC SUPERIORLY
- POSTERIOR to LESSER SAC INFERIORLY
what structure divides the greater sac into supramesocolic and inframesocolic compartments
- fold of peritoneum
\+ TRANSVERSE MESOCOLON
- supramesocolic
\+ subphrenic and subhepatic
- inframesocolic
\+ paracolic gutter and pelvic reflectioninframesocolic compartment
- divided into right and left by the root of the mesentery
right and left compartments
- divided into medial and lateral areas by
+ the ascending colon (right)
+ the descending colon (left)
paracolic gutters - right
- space between the ascending colon and the right lateral abdominal wall
paracolic gutters - left
- space between the descending colon and left lateral abdominal wall
which portion of the inframesocolic compartment does not communicate with the pelvic cavity directly
right medial compartment
which ligament prevents the left lateral gutter from communicating with the left supramesocolic area
phrenocolic ligament
sonographic appearance
- parietal peritoneum = thin smooth echogenic line deep to abdominal wall muscle = peritoneal line
- mesentery = seen with ascites, free floating smoot leaves directed toward centre of abdomen
the retroperitoneum
- posterior to peritoneum
- anterior to transversals fascia
- diaphragm form superior boundary
- pelvic brim inferior boundary
- 3 compartments/spaces formed by 2 layers of fascia
anterior pararenal space - anterior and posterior boundry
- anterior = peritoneum (parietal)
- posterior = gerotas fascia/ renal fascia
anterior pararenal space - major structures
- ascending and descending colon
- duodenum (except for 1st)
- pancreas
anterior pararenal space - communication
- potential midline communication
- communicates with the posterior pararenal space and pelvis
perirenal space - borders
- enclosed by renal fascia
perirenal space - major structures
- kidneys
- adrenals
- ureters
- great vessels
perirenal space - communication
- communicates with pelvic space
- no communication across midline (great vessels get in the way)
posterior pararenal space
- posterior renal fascia to the transversalis fascia
- no solid organs
- contains fat
posterior pararenal space - communication
- anterior pararenal
- pelvis
- pro peritoneal space
+ pontential space between peritoneum and transversals fascia
retroperitoneum - role of ultrasound
- characterize legions
- assess aortic aneurysms
- provide guidance for interventional procedures
