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GIGU > Peritoneal Cavity & Mesenteries > Flashcards

Peritoneal Cavity & Mesenteries Flashcards

1
Q

What supplies blood to the parietal peritoneum?

A

-the same blood supply that services the region of the wall it lines

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2
Q

What innervates parietal peritoneum?

A

-the same somatic nerve supply as the region of the wall it lines

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3
Q

Regarding nerve supply, to what is parietal peritoneum sensitive?

A
  • pressure
  • pain
  • temperature
  • laceration
  • produces localized sensation
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4
Q

What lymphatic vessels are associated with the parietal peritoneum?

A

-the same lymphatic vessels as the region of the wall it lines

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5
Q

What supplies blood to the visceral peritoneum?

A

-the same blood supply as the organ it covers

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6
Q

What innervates the visceral peritoneum?

A

-the same visceral nerve supply as the organ it covers

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7
Q

Regarding nerve supply, to what is the visceral peritoneum sensitive?

A
  • stretch
  • chemical irritation
  • produces sensation that is NOT localized
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8
Q

What lymphatic vessels are associated with the visceral peritoneum?

A

-the same lymphatic vessels as the organ it covers

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9
Q

Technically, what IS mesentery?

A

-double fold of peritoneum

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10
Q

What is the dorsal mesentery in embryonic development?

A
  • connects organs to the dorsal body wall

- runs entire GI tract

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11
Q

What are the adult derivatives of the dorsal mesentery?

A
  • greater omentum
  • small intestine mesentery (“the mesentery”)
  • mesoappendix
  • transverse mesocolon
  • sigmoid mesocolon
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12
Q

What ligaments make up the greater omentum?

A
  • gastrosplenic ligament
  • gastrocolic ligament
  • splenorenal ligament
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13
Q

What is the ventral mesentery in embryonic development?

A
  • found b/w ventral wall and foregut

- runs from septum transversum to umbilical vein

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14
Q

What are the adult derivatives of the ventral mesentery?

A
  • lesser omentum
  • falciform ligament (of the liver)
  • coronary ligament (of the liver)
  • triangular ligaments (of the liver)
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15
Q

What ligaments make up the lesser omentum?

A
  • hepatogastric ligament

- hepatoduodenal ligament

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16
Q

What are the retroperitoneal organs?

A

suprarenal glands, aorta, IVC, anus, duodenum (parts 2-4), pancreas (head and neck), ureters, ascending and descending colon, kidneys, esophagus, rectum

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17
Q

What are the intraperitoneal organs?

A

stomach, spleen, liver, jejunum, ileum, cecum, appendix, sigmoid colon

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18
Q

What arteries are found within the hepatoduodenal ligament?

A

proper hepatic artery

cystic artery

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19
Q

What arteries are found within the hepatogastric ligament?

A

left and right gastric arteries

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20
Q

What arteries are found within the gastrophrenic ligament?

A

posterior gastric arteries

21
Q

What arteries are found within the gastrosplenic ligament?

A

short gastric arteries

22
Q

What arteries are found within the splenorenal ligament?

A

splenic artery

23
Q

What arteries are found within “the mesentery”?

A

jejunal and ileal arteries

24
Q

What arteries are found within the sigmoid mesocolon?

A

sigmoid arteries

25
Q

What arteries are found within the transverse mesocolon?

A

middle colic artery

26
Q

What arteries are found along the lesser curvature of the stomach?

A

left and right gastric arteries

27
Q

What arteries are found along the greater curvature of the stomach?

A

left and right gastro-omental arteries

28
Q

What is the opening from the lesser sac (omental bursa) into the greater sac?

A

epiploic foramen

29
Q

Where is the lesser sac located?

A

b/w the lesser omentum and the greater omentum

30
Q

What are two more common clinical situations that can impact the lesser sac?

A
  • posterior stomach wall ulcer

- injured/inflamed pancreas may cause pancreatic fluid to leak into the omental bursa

31
Q

What is the clinical significance of the paracolic gutters and subphrenic spaces?

A
  • fluid, bacteria, intestinal contents, etc (ex: d/t injury) can get into the paracolic gutters and subprenic spaces
  • causes peritonitis, which can be transported to other portions of the peritoneal cavity
32
Q

What are the pararectal spaces and their importance?

A
  • lateral reflections of the peritoneum from the superior third of the rectum
  • permit the rectum to distend as it fills w/ feces
33
Q

Clinical Box: Patency and Blockage of Uterine Tubes

A
  • a mucus plug blocks the external opening of the uterus to most pathogens (not sperm)
  • patency of uterine tubes can be tested by hysterosalpingography
34
Q

Clinical Box: Peritoneum and Surgical Procedures

A
  • peritoneum is well-innervated

- open incisions are more painful that laparoscopic or vaginal opening surgeries

35
Q

Clinical Box: Peritoneum and Surgical Procedures (serosa)

A
  • serosa (visceral peritoneum) makes watertight anastomoses of intraperitoneal organs (reperitonealization)
  • this is harder for extraperitoneal organs
36
Q

Why do surgeons try to remain outside of the peritoneal cavity, if possible?

A

-the reperitonealization causes an increased risk of adhesions and peritonitis

37
Q

Clinical Box: Peritonitis

A
  • infection or inflammation of the peritoneum
  • exudation of serum, fibrin, cells and pus in the cavity
  • pain in overlying skin
  • increased tone in anterolateral abdominal muscles
38
Q

Clinical Box: Ascites

A
  • excess fluid in peritoneal cavity
  • d/t internal bleeding, portal HTN, metastasis of CA cells to abdominal viscera, and starvation

-can cause subphrenic abscesses d/t diaphragm suction

39
Q

Clinical Box: Peritoneal Adhesions and Adhesiotomy

A
  • damaged peritoneum becomes sticky w/ fibrin
  • abnormal attachments b/w visceral peritoneum
  • abnormal attachments b/w peritoneum and wall
  • cause pain or intestinal volvulus
40
Q

Clinical Box: Abdominal Paracentesis

A
  • most cases of peritonitis are secondary to surgery
  • could be caused by cirrhosis and infected ascites
  • paracentesis to remove fluid and culture it
  • -needle is inserter superior to empty bladder
  • -avoid inferior epigastric A.
41
Q

Clinical Box: Peritoneal Dialysis

A
  • subdiaphragmatic portion of peritoneum overlies extensive blood/lymph capillary beds
  • sterile solution injected into one side of cavity and drained from the other
42
Q

What is the mechanism behind how peritoneal dialysis works?

A

-waste products are transferred rapidly from blood to peritoneum due to the concentration gradient between the two compartments

43
Q

Clinical Box: Functions of Greater Omentum

A
  • prevents visceral peritoneum from adhering to parietal
  • forms adhesions adjacent to inflamed organs
  • -“walls them off” to protect other viscera
  • cushions organs against injury
  • forms insulation against loss of body heat
44
Q

Clinical Box: Flow of Ascitic Fluid and Pus to Pelvis

A
  • purulent material in abdomen can be transported along the paracolic gutters into the pelvis
  • -absorption of toxins is relatively easy to drain from pelvic cavity
  • -facilitate flow by having patient above 45 degrees
45
Q

Clinical Box: Flow of Ascitic Fluid and Pus from Pelvis

A

-infections in pelvis may extend superiorly to a subphrenic recess when a person is supine

46
Q

What is the relevance of paracolic gutters to cancer spread?

A

-paracolic gutters provide pathway for the spread of cancer cells that sloughed from ulcerated tumors and entered peritoneal cavity

47
Q

Clinical Box: Internal Hernia through Epiploic Foramen

A
  • loop of small intenstine may pass through the foramen and into lesser sac
  • -strangulated by edges of foramen, which can’t be cut d/t blood vessels
  • -intestine must be decompressed with a needle
48
Q

Clinical Box: Temporary Control of Hemorrhage from Cystic Artery

A
  • cystic A. can be accidentally severed before adequate ligation during a cholecystectomy
  • surgeon can control hemorrhage by compressing hepatic A. as it goes through hepatoduodenal L.
49
Q

How does a surgeon maneuver to find the hepatic A. within the hepatoduodenal L.?

A
  • index finger through epiploic foramen
  • thumb on anterior of ligament

-compression and release (alternating) to find artery in order to clamp it

GIGU (9 decks)

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