Peritoneal Cavity and Mesenteries Flashcards
____ = continuous serous membrane (mesothelium) lining the abdominopelvic cavity and abdominal viscera
Peritoneum
____ peritoneum lines the internal surface of the abdominopelvic wall
Parietal
_____ peritoneum invests viscera like the stomach and intestines
Visceral
Compare parietal and visceral peritoneum in terms of sensitivity to various stimuli and its innervation
Parietal is sensitive to pressure, temperature, and pain is well localized. Supplied by same neurovasculature as the region of the wall it lines
Visceral is sensitive to stretch and chemical irritation, and pain is poorly localized. Supplied by same neurovasculature as the organ
What type of epithelium is mesothelium?
Simple squamous
The peritoneal cavity is the potential space between the parietal and visceral peritoneum and contains _____ _____ which provides lubrication to reduce frction from movement of organs
Peritoneal fluid
The embryological foregut forms what major structures within the peritoneal cavity?
Primordial pharynx, esophagus, and stomach
Duodenum (near opening of bile duct)
Liver, biliary apparatus, and pancreas
The embryologic foregut is attached to the dorsal and ventral ______
Mesogastrium (mesentary)
The embryological foregut eventually rotates so that the ventral mesogastrium swings ____ and the dorsal mesogastrium swings ____
Right; left
The _____ mesogastrium runs along the lesser curve of the stomach and on top of the proximal duodenum
The ____ mesogastrium runs along the greater curve of the stomach and under the proximal duodenum
Ventral
Dosral
Which part of the mesogastrium does the liver develop in? The spleen?
The liver develops in the ventral mesogastrium
The spleen develops in the dorsal mesogastrium
During embryologic development, the ____ grows rapidly in the ventral mesogastriuim, pressing against the body wall and obliterating that portion of the peritoneum and producing a separate pocket behind the stomach called the _____ ____
Liver; lesser sac
The lesser sac is also known as the …
Omental bursa
____ organs are completely covered by visceral peritoneum because they have invaginated into the closed sac
Intraperitoneal
Which organs are considered retroperitoneal (either primarily or secondarily)?
S = suprarenal gland A = aorta/IVC D = duodenum (second and third portions only)
P = pancreas U = ureter C = ascending+descending colon only K = kidney E = esophagus R = rectum
______ organs are located between the parietal peritoneum and posterior abdominal wall
Retroperitoneal
T/F: kidneys have parietal peritoneum only on their posterior surface
False, only on anterior surface
What is the difference in primarily vs. secondarily retroperitoneal organs in terms of mesentery?
Primarily retroperitoneal = no mesentery
Secondarily retroperitoneal = initially had a mesentery but it was lost during development
Describe greater omentum
4-layered peritoneal fold
Hangs like an apron from greater curvature of the stomach and proximal duodenum
Folds back and attaches to the transverse colon
Describe lesser omentum
Double-layer peritoneal fold
Connects lesser curvature of stomach/proximal duodenum to the liver
Connects the stomach to the portal triad (within the hepatoduodenal ligament)
Which periteoneal ligament connects the liver to the anterior abdominal wall?
Falciform ligament
Which periteoneal ligament connects the liver to the stomach?
Hepatogastric (gastrohepatic) ligament
Which periteoneal ligament connects the liver to the duodenum?
Hepatoduodenal ligament
Which peritoneal ligaments make up the lesser omentum?
Hepatogastric + hepatoduodenal ligaments
Which peritoneal ligament is found at the free edge of the lesser omentum and conducts the portal triad, portal vevin, hepatic artery, and bile duct?
Hepatoduodenal ligament
Which periteoneal ligament connects the stomach to the inferior diaphragm?
Gastrophrenic ligament
Which periteoneal ligament connects the stomach to the spleen?
Gastrosplenic ligament
Which periteoneal ligament connects the stomach to the transverse colon?
Gastrocolic ligament
Which peritoneal ligaments make up the greater omentum?
Gastrophrenic + gastrosplenic + gastrocolic ligaments
[all have attachment along the greater curvature of the stomach]
What are peritoneal folds?
Peritoneum raised from body wall due to vasculature, ducts, and ligaments
What are peritoneal recesses/fossae?
Pouches of peritoneum formed by a peritoneal fold
The peritoneal cavity gets divided into what 2 portions after foregut rotation?
Greater sac = main, larger part
Omental bursa (lesser sac) = posterior to stomach and lesser curvature
Which organs are found in the supracolic compartment of the abdomen?
Stomach
Liver
Spleen
What is the divider between the supracolic and infracolic compartments of the abdomen?
Transverse mesocolon
Which compartment of the abdomen lies posterior to the greater omentum and is divided into right and left sides?
Infracolic compartment (divided into right and left infracolic spaces with mesentery of small intestine)
Which organs are found in the infracolic compartment of the abdomen?
Small intestine
Ascending/descending colon
Which major gutters and spaces are found in the infracolic compartment?
Right paracolic gutter
Right infracolic space
Left infracolic space
Left paracolic gutter
______ _____ = grooves between lateral aspect of ascending/descending colon and posterior abdominal wall
Paracolic gutters (R/L)
Communication of the ____ infracolic space/gutter is slightly smaller due to anchoring by phrenicocolic ligament
Left
T/F: free communication of peritoneal fluid exists between compartments and paracolic gutters
True
What are the named divisions/parts of the lesser sac/omental bursa?
Superior recess = limited superiorly by diaphragm and coronary ligament of liver
Inferior recess = between superior parts of layers of greater omentum
Omental/epiploic foramen = allows communication with greater sac
Who has a larger lesser sac, infants or adults?
Infants, because organs have not yet grown to full size. Some of the lesser sac gets obliterated as organs mature into adulthood
Which important anatomical structure is contained within the epiploic foramen within the hepatoduodenal ligament?
Portal triad
What are the anterior, posterior, superior, and inferior borders of the epiploic foramen?
Anterior = hepatoduodenal ligament (free edge of lesser omentum)
Posterior = IVC and right crus of diaphragm
Superior = liver
Inferior = proximal duodenum
Anterior relationships of lesser sac
Lesser omentum
Stomach
Gastrocolic ligament
Posterior relationships of lesser sac
Pancreas L suprarenal gland L kidney Aorta IVC Splenic a./v.
Superior relationships of lesser sac
Liver
Diaphragm
Inferior relationships of lesser sac
Transverse mesocolon
1st part of duodenum
Left relationships of lesser sac
Hilum of spleen
Gastrosplenic ligament
Right relationships of lesser sac
Epiploic foramen opens into greater sac
What are 2 major complications associated with abdominal surgeries that involve entry into the peritoneum?
Peritonitis
Adhesions
What is peritonitis? What causes it?
Infection in peritoneal cavity
Caused by rupture of infected organ or from external wound
Localization of infections can lead to abscesses
____ = excess fluid in peritoneal cavity (multiple causes)
Ascites
Abdominal _____ = puncture of cavity for aspiration/drainage of fluid
Paracentesis
Fluid flow is affected by the angle of a patient, because paracolic gutters provide route into the _______ recess and _______ pouch
Subphrenic/hepatorenal
Recto-uterine
What are some potential causes of fluid in the omental bursa?
Perforation of posterior wall of the stomach —> contents enter the lesser sac and cause general peritonitis
Inflamed/injured pancreas —> passage of pancreatic fluid into bursa forming a pancreatic pseudo-cyst
How might intestines end up in the omental bursa?
Loops of small intestine can pass through epiploic foramen and become strangulated
Can you cut any of the boundaries of the epiploic foramen?
No, because the boundary is primarily hepatoduodenal ligament which has the portal triad in it!
The ____ is a retroperitoneal, elongated accessory digestive gland
Pancreas
What are the parts of the pancreas?
Head + uncinate process
Neck
Body
Tail (distal tip within splenorenal ligament)
Anterior relationships of pancreas
Lesser sac
Stomach
Posterior relationships of pancreas
Aorta IVC Splenic v. Bile duct R crus of diaphram L kidney and vessels L suprarenal gland Superior mesenteric a./v.
Right relationship to pancreas
2nd part of duodenum
Left relationship of pancreas
Spleen
Inferior relationship of pancreas
3rd part of duodenum
Position and associated mesentery/ligament of splenic a./v.
Retroperitoneal
Splenorenal ligament
Position and associated mesentery/ligament of left gastric a.
Retroperitoneal
Hepatogastric ligament (lesser omentum)
Associated mesentery/ligament of R gastric a.
Hepatoduodenal ligament
Associated mesentery/ligament of proper hepatic a.
Hepatoduodenal ligament
Why is patient position important when draining ascitic fluid?
Patient should be sitting up to get fluid into pelvic cavity, where absorption of toxins will be slower, whether the infection is in te supracolic (to get fluid to move to pelvis) or infracolic region (to prevent infection from spreading upwards)
