Peritoneal Cavity and Mesenteries Flashcards by Sarah Gillen

____ = continuous serous membrane (mesothelium) lining the abdominopelvic cavity and abdominal viscera

Peritoneum

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____ peritoneum lines the internal surface of the abdominopelvic wall

Parietal

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_____ peritoneum invests viscera like the stomach and intestines

Visceral

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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

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What type of epithelium is mesothelium?

Simple squamous

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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

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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

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The embryologic foregut is attached to the dorsal and ventral ______

Mesogastrium (mesentary)

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The embryological foregut eventually rotates so that the ventral mesogastrium swings ____ and the dorsal mesogastrium swings ____

Right; left

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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

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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

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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

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The lesser sac is also known as the …

Omental bursa

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____ organs are completely covered by visceral peritoneum because they have invaginated into the closed sac

Intraperitoneal

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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

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______ organs are located between the parietal peritoneum and posterior abdominal wall

Retroperitoneal

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T/F: kidneys have parietal peritoneum only on their posterior surface

False, only on anterior surface

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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

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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

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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)

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Which periteoneal ligament connects the liver to the anterior abdominal wall?

Falciform ligament

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Which periteoneal ligament connects the liver to the stomach?

Hepatogastric (gastrohepatic) ligament

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Which periteoneal ligament connects the liver to the duodenum?

Hepatoduodenal ligament

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Which peritoneal ligaments make up the lesser omentum?

Hepatogastric + hepatoduodenal ligaments

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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)