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GI Exam 1 > Peritneum and Mesentaries > Flashcards

Peritneum and Mesentaries Flashcards

1
Q

What is the peritoneum?

A

Peritoneum is a transparent serous membrane that lines the [abdominopelvic cavity] and surrounds the viscera (internal organs)

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2
Q

The peritneum has two different layers. What are these layers?

A
  1. Parietal peritoneum lines the abdominopelvic cavity
  2. Visceral peritoneum surrounds the organs
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3
Q

Describe the parietal peritoneum.

lines:

innervation:

sensitive to:

A
  • lines the abdominopelvic wall
  • innervated by the same [BV, nerves, lymphatics] as the region of the wall it lines
  • sensitive to pressure, pain and temperature; pain here is localized
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4
Q

Describe the visceral peritoneum:

lines:

innervation:

sensitive to:

A
  • Lines: surrounds organs
  • Innervated: same BV, nerves, LN as the organ it surrounds
  • sensitive to: stretch and chemicals; pain here is poorly localized.
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5
Q

What is intraperitoneal?

A

Most completely covered with VISCERAL peritneum

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6
Q

Retroperitoneal means ?

A

outside the peritoneal cavity and are only partially covered with peritoneum.

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7
Q

Retroperitoneal means outside the peritoneal cavity and are only partially covered with peritoneum.

What is the difference between primary and secondary?

A

Primary retroperitoneal means they were NEVER covered in a mesentery

Secondary retroperitoneal USED to be covered in mesentery

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8
Q

what are the organs that are retroperitoneal in SAD PUCKER?

A
  • S- supraadrenal glands
  • A- aorta/IVC *
  • D- duodenum (2-4) +
  • P- pancreas (not the tail)+
  • U- ureters*
  • C- colon (ascending and descending colon) +
  • K- kidneys *
  • E- ESO
  • R-rectum
    • means secondary * means primary
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9
Q

As the stomach rotates, you get the greater omentum (dorsal mesentery folds on itself),

as well as the space behind the liver and stomach called the?

A

Omental bursa (lesser sac)

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10
Q

What does the falciform ligament connect?

A

From the ventral mesentary: connects the liver –> anterior body wall.

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11
Q

What does the splenorenal ligament connect?

A
  • From: dorsal mesentary
  • Connects: posterior body wall (in front of kidney) –> spleen
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12
Q

Lesser omentum is from the ventral mesentary.

What are its 2 ligaments?

A
  1. Heptogastric ligament
  2. Hepatoduodenal ligament (has the portal triad inside: goes from liver–> 1st part of duodenum)
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13
Q

Greater omentum is from the dorsal mesentary.

What are the 3 ligaments from it? (all from dorsal mesentary)

A
  1. Gastrophrenic L: stomach–> diaphragm
  2. Gastrosplenic L : stomach to spleen
  3. Gastrocolic L: stomach–> transverse colon
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14
Q

Lesser omentum ligaments:

  1. hepatoduodenal L (3)
  2. hepatogastric L (2)?

What are their blood supplies?

A
  1. Hepatoduodenal L–> Proper hepatic a with two branches: cystic a and right gastric a
  2. Hepatogastric L–> L and R gastric A (they will anastomose)
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15
Q

Whats the blood supply in the greater omentum ligaments:

  1. Gastrophrenic L
  2. Gastrosplenic L
  3. Gastrocolic L
A
  1. Gastrophrenic L-
    1. Posterior gastric A.
  2. Gastrosplenic L-
    1. Short gastric A
    2. L gastro-omental A (aka L gastroepiploic A)
  3. Gastrocolic L-
    1. L gastro-omental A
    2. R gastro-omental A.
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16
Q

What supplies the splenorenal ligament?

A

splenic A

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17
Q

What supplies the transverse mesocolon? (2)

A

1. Middle colic A

2. Marginal A

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18
Q

What supplies the mesentary?

A
  1. Ileul A.
  2. Jejunal A.
  3. Superior mesentaric A.
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19
Q

What supplies the ROOT of the mesentery?

Also, what is the root of the mesentary?

A

Root is where the mesentary attaches to the posterior abdominal wall.

1. Iliocolic A

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20
Q

What supplies the sigmoid mesocolon?

A

sigmoid A

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21
Q

Where does the lesser sac (omental bursa) sit behind?

A

Lesser omentum, which is made up of the [hepatoduodenal L and the hepatogastric L].

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22
Q

Where does the greater sac sit behind?

A

Greater omentum, which is made up of the

    1. Gastrophrenic L
    1. Gastrosplenic L
    1. Gastrocolic L
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23
Q

The lesser sac (omental bursa) which sits behind the lesser omentum, communicates with the greater sac, which sits behind the greater omentum via the?

A

epiploic foramen (omental foramen)

24
Q

What are the boundaries of the epiploic foramen?

Anterior

Posterior

Superior

Inferior

A
  • Anterior: Hepatoduodenal ligmanet and its portal triad
  • Posterior: IVC and R crus of the diaphragm
  • Superior Caudate L of the liver
  • Inferior: 1st part of the duodenum
25
Q

What does the portal triad consist of? which is inside the hepatoduodenal ligament

A

1. Common bile duct

2. HPV

3. Proper hepatic artery

26
Q

What is the pringle maneuver?

A

Placing fingers into epiploic foramen, and cutting off blood supply to portal triad in the hepatoduodenal ligament

-helps control bleeding of the liver

27
Q

What are the 6 general boundaries of the lesser sac?

A
  1. Anterior
  2. Posterior
  3. Superior
  4. Inferior
  5. L
  6. R
28
Q

What is anterior to the lesser sac? (3)

A
  1. lesser omentum
  2. stomach,
  3. gastrocolic ligament
29
Q

What is posterior to the lesser sac? (6)

A
  1. IVC
  2. Aorta
  3. Splenic A and V
  4. L kidney
  5. L supradrenal gland
  6. Pancreas
30
Q

What is superior to the lesser sac or omental bursa? (2)

A
  1. Liver
  2. Diaphragm
31
Q

What is inferior to the omental bursa? (2)

A
  1. transverse mesocolon,
  2. 1st part of duodenum
32
Q

What is to the left of the lesser sac? (2)

A
  1. hilum of spleen,
  2. gastrosplenic ligament
33
Q

What is to the right of the lesser sac? (1)

A
  1. epiploic foramen into the greater sac
34
Q

Why is the lesser sac good to have if the pancreas were to rupture anteriorly, or if the stomach were to rupture posteriorly?

A

the contents would be contained within the lesser sac instead of within the entire abdomen

35
Q

What occurs if there is intestine in the lesser sac? Can any of it’s boundaries be cut to release the intestines?

A

NO, because the portal triad, IVC, aorta cannot be cut… you must pull them out with your hands

36
Q

The transverse mesocolon divides the cavity into two compartments.

What are they?

A

1. Supracolic compartment

2. Infracolic compartment

37
Q

The transverse mesocolon divides the cavity into two compartments… the supracolic and the infracolic compartment. What is contained in each? (3/3)

A
  • Supracolic compartment–> stomach, liver and spleen
  • Infracolic compartment–> SI, ascending colon and descending colon
38
Q

The infracolic compartment can then be further divided.

By what and how do these two parts comunicate?

A
  • Infracolic compartment can be divided by the root of the mesentary of the small intestine into: right infracolic space and left infracolic space.
  • Communicate via the left and right paracolic gutters
39
Q

When a patient is lying down, fluid would most likely reside in what two spaces that are divided by the falciform ligament?

A

right and left subphrenic spaces (from the lesser sac)

40
Q

when the patient sits up, fluid will travel on either side via?

Why is one side more narrow than the other?

A
  • down via the right and left paracolic gutter.
  • Left side is more narrow due to the phrenicocolic ligament
41
Q

When the patient is sitting / standing all the way up, fluid will collect in the pelvis, what is the space called in males and females?

A

Deepest space it can accumulate in.

  • males: rectovesicular pouch
  • females: rectouterine pouch
42
Q

Large invasive, open incision are more painful because the peritoneum is exposed. What causes adhesions in the peritoneum?

A

when the area is touched, it is very sensitive; try to stay out of peritoneum

43
Q

What is peritonitis and how is it caused?

A

infection of the peritoneal cavity caused by rupture of infected organ or external trauma, leading to abscesses

44
Q

What is acites?

A

excess fluid in the peritoneal cavity due to cancer/malnutrition

45
Q

Paracentesis is used to drain the extra fluid…

where is the best place to place the needle?

A

AWAY from the inferior epigastric A,

at the most inferior point of the rectouterine/vesicular pouch

46
Q

What vertebral level is the head and tail of the pancreas at?

A

starts at L2 to L1 (transpyloric plane)

47
Q

what are the areas of the pancrease

A

1. Head (uncinate process)

2. Neck

3. Body

4. Tail

48
Q

What is anterior to the pancreas? (2)

A

lesser sac and stomach

49
Q

What is posterior to the pancreas? (8)

A
  1. Aorta
  2. IVC
  3. Splenic Vein
  4. Bile duct
  5. right crus of the diaphragm
  6. left kidney and vessels
  7. left suprarenal gland
  8. superior mesenteric A/V
50
Q

What is to the R of the pancreas

A

2nd part of the duodenum (it is craddled by it)

51
Q

What is to the left of the pancreas? (2)

A

spleen,

52
Q

What is inferior to the pancreas? (1)

A

3rd part of the duodenum

53
Q

The superior mesenteric artery and vein run posterior to the pancreas. Why is this a clinical significance?

A

Due to how the pancreas is located, the uncinate process goes around the SMA/V.

if the cancer grows around the vessels, surgery cannot be performed :(

54
Q

What are the primary retroperitoneal structures?

A

1. aorta/IVC

2. kidneys

3. ureters

55
Q

What are the secondary retroperitoneal structures?

A
  1. ascending and descending colon
  2. duodenum 2-4
  3. pancreas (not the tail because it is intraperitoneal)

GI Exam 1 (13 decks)

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