Peritoneal Cavity, Stomach, And Spleen Flashcards
Abdominopelvic cavity
. Abdominal cavity plus pelvic cavity
. Entire space bounded by muscular abdominal wall, diaphragm, and pelvic diaphragm
. Extraperitoneal fat, all abdominal and pelvic viscera, peritoneum, and peritoneal cavity inside it
Peritoneal cavity
. Space btw parietal and visceral peritoneum ( thin film watery liquid inside it)
. Space inside peritoneal sac
Parietal peritoneum
. Strong, bonded to body wall
. Includes Diaphragmatic peritoneum on inf. Side of diaphragm
. somatic innervation from ventral rami
Visceral peritoneum
. Less strong
. Bonded to various viscera (tunica serosa)
. Not sensitive to somatic sensations
Peritoneal cavity allows intraperitoneal viscera to ____
Move, change shape and volume freely
As cites
. Abnormal accumulation of serous fluid in peritoneal cavity
. Occurs in heart, kidney, and liver failure
Peritonitis
. Causes by bacterial infection of peritoneal cavity
. Results in adhesions that cause tanking and necrosis of intestines
Mesentery
. Sheet of tissue that suspends structures
. Double layer of peritoneum that begins as extension of visceral peritoneum
. Connects organ to body wall
. Conveys vessels, nerves, and lymph
. Fatty CT btw double layers
. Allows movement of viscera w/o tangling or blocked blood supply
. Include peritoneal ligaments and omenta
Intraperitoneal viscera
. Have mesentery
. Not enclosed in mesentery, visceral peritoneal covering is not part of mesentery but is continuous w/ mesenteric peritoneal layers
Extraperitoneal structures
. Organ external to peritoneum from viewpoint inside peritoneal cavity
Secondarily retroperitoneal structures
. had mesentery at one time but lost it by fusing to abdominal wall and having peritoneum degenerate
. Tunica serosa stuck to paternal peritoneum then both disappeared leaving bare area
. One layer of mesenteric peritoneum stuck to parietal peritoneum and both disappeared leaving single layer of mesenteric peritoneum
Secondarily retroperitoneal viscera
. Duodenum (except 1st part)
. Pancreas
. Cecum
. Ascending and descending colon
Primarily retroperitoneal structures
. Never had mesentery
. External to parietal peritoneum
. Kidney, ureters, suprarenal glands, abdominal aorta, IVC, urinary bladder, prostate, vagina, rectum
Greater omentum
. Gastrophrenic ligament: stomach to diaphragm
. Gastrosplenic (gastro-lienal) ligament: stomach to spleen
. Gastrocolic ligament: stomach to transverse colon
. Omental apron: free flap drooping inf. To transverse colon, often considered part of gastrocolic ligament
Lesser omentum
. From liver to lesser curvature of stomach and 1st part of duodenum
. Hepatogastric ligaments
. Hepatoduodenal ligament: contains portal triad
Splenorenal (lieno-renal) ligament
. Stomach ligament
. Spleen to parietal peritoneum over left kidney
Subdivisions of peritoneal cavity
. Lesser peritoneal sac
. Greater peritoneal sac
. Omental foramen
Lesser peritoneal sac (omental bursa)
. Bounded ant. By lesser omentum, stomach, and greater omentum
Greater peritoneal ac
. Rest of peritonal cavity
Omental (epiploic) foramen
. Also called foramen of Winslow
. Only communication btw greater and lesser sacs
. Bounded by heptoduodenal ligament ant., IVC covered by parietal peritoneum post., liver sup., first part of duodenum inf.
Celiac artery/trunk
. Supplies embryological abdominal foregut (spleen, stomach, duodenum, liver, gall bladder and pancreas)
. From abdominal aorta at T12/L1
. Retroperitoneal
. 1-2 cm long
. Passes sup. To upper margin of pancreas
Branches of celiac a.
. Common hepatic a.
. Splenic a.
. Left gastric a.
Common hepatic a. Branches
. Proper and gastroduodenal aa.
. Proper branches into R gastric a. And R and L hepatic aa. (Cystic a. Branches from R hepatic a.)
. Gastroduodenal branches into R gastroepiploic, sup. Pancreaticoduodenal, and superduodenal aa.
Splenic a. Branches
Pancreatic aa.
Short gastric aa.
Left gastroepiploic a.
Left gastric a. Branch
Esophageal a.
T/F there is a celiac v.
F, all drainage to hepatic portal vein then go to liver, hepatic vv., to IVC
Branches of hepatic portal v.
. Sup. And inf. Mesenteric vv.
. Splenic v.
Spleen
. Largest lymph organ
. Soft and purplish
. Sharp ant. And sup. Notched borders w/ rounded inf. And post. Borders
. Hilus for entrance and exit of blood
Spleen functions
. Blood filtration and storage
. Hematopoiesis during fetal development
. Lymphopoiesis
Anatomical relations of spleen
. Ant: stomach . Post: L kidney ad part of diaphragm . Inf: L colic flexure and phrenicocolic ligament . Lat: diaphragm . Med: tail of pancreas and L kidney . Lies deep to ribs 9-11 . Doesn’t extend below costal margin
Ligaments of spleen
. Gastrosplenic (gastrolienal)
. Splenorenal
. Arteries found in these
Spleen innervation
. Post-ganglionic sympathetic nn. From celiac plexus to blood vessels
. Vasomotor
Spleen blood supply
Splenic a.
Spleen rupture
. Easy w/ blow to left upper quadrant because of thin capsule
. May need to be removed
. Remember close relationship to pancreas tail to spleen hilus during removal
Accessory spleens
. In 10% of people
. 1 cm in diameter
. In hilus, tail of pancreas, gastrosplenic ligment
. Need to look for them is removing spleen because of splenic anemia
Esophagus
. 23-25 cm long (1.5-2.5 cm in abdominal cavity
. Enters stomach through diaphragmatic opening (esophageal hiatus) that has physiological sphincter
. Enters stomach in cardiac region at cardiac orifice
. Lower esophageal sphincter surrounds cardiac orifice (damage can cause GERD)
Stomach curvatures
. Lesser: right side, concave, blends w/ esophagus, attachment to lesser omentum
. Greater: left side, convex, junction w/ esophagus via cardiac notch, 4-5x longer than lesser, atttached to ant. Layer of greater omentum
Stomach areas
. Cardia: around cardiac orifice
. Fundus: bulge sup. To horizontal line drawn to left from cardiac notch, rests against left dome of diaphragm, filled w/ gas on X-ray
. Body (corpus): largest area, below cardia and fundus to vertical line dropped from angular incisure
. Pyloric: below angular incisure line, pyloric antrum (wider area next to body), canal (narrower region leading to pyloric sphincter)
. Pyloric sphincter
. Junctionof stomach and duodenum
. Anatomical: actual thickening of muscle inf ut wall
. Controls rate of stomach emptying
. Constantly in tonic contraction unless emitting stomach contents
Rugae
Gross folds of mucosa in stomach
Shape of stomach varies according to __
. Stature
. State of digestion (lower when full)
. Body position (higher supine, 1-16 cm lower when upright)
Stomach functions
. Distension, holds 2-3 L, blender and reservoir
. Food enters as bolus, mixes w/ enzymes to form chyme
. Gastric peristalsis moves chyme to intestine
. Empties 2-3 hrs after eating
Hiatal hernia
. Herniation of fundus of stomach trough esophageal hiatus into thorax
Stomach anatomical relations
. Ant: diaphragm, liver, ant. Abdominal wall
. Post: stomach bed(diaphragm, spleen, kidney, adrenal, pancreas, transverse mesocyclone)
. Cardiac orifice post. To 7th left costal cartilage 2-4 cm from midline
. Highest point in fundus post. To 5th left rib in midclavicular line
. Pyloric at level of transpyloric line through lower L1 body (L1-3 when supine, L2-4 when erect)
Stomach sympathetic preganglionic innervation
. From T5-9, coalesces to form greater splanchnic n.
. Synapse in celiac ganglion
Stomach sympathetic postganglionic innervation
. Fibers carried on branches of celiac a.
. Dec. motility and secretion, vasoconstriction, stimulates pyloric sphincter to stay closed
Stomach sympathetic sensory afferent
. Carried back to CNS in greater splanchnic n.
. Senses pain and violent contraction
. Referred to epigastric region
Stomach parasympathetic innervation
. Preganglionic: L/R vagus nn., enters as ant. And post. Vagal trunks tat synapse on wall of stomach in myenteric or submucosal ganglia
. Postganglionic: shooter w/in stomach wall, inc. motility, secretion, vasodilator, inhibits tonic contraction of pyloric sphincter
Stomach blood supply to lesser curvature
. R gastric a. 9branch of proper hepatic a.)
. L gastric a. (Branch of celiac a.)
Stomach blood supply to greater curvature
. R gastroepiploic a. (Branch of gastroduodenal)
. L gastroepiploic a. (Branch of splenic a.)
. Short gastric aa. (Branches of splenic a.)
Stomach venous drainage
. L/R gastric vv. Drain lesser curvature which go into hepatic portal v.
. Prepyloric v. Ascends over pyloric to R gastric v.
. Short gastric, L/R gastroepiploic vv. Drain greater curvature
. R gastroepiploic v. Drains to sup. Mesenteric v.
. L gastroepiploic and short gastric vv. Drain into splenic v.
Stomach lymph drainage
. Follows arterial pattern
. Abundant along greater and lesser curvatures
Vein of Mayo
. Area of pyloric sphincter
. Surgical landmark
Congenital hypertrophic pyloric stenosis
. Enlargement of pyloric sphincter in infants
