Peritoneal Relations Flashcards
what are the layers of the anterior abdominal wall?
- Skin
- Superficial Fascia
2a. Fatty Layer (Camper’s Fascia)
2b. Membranous Layer (Scarpa’s Fascia) - Deep (investing) fascia covering muscles
External Oblique
Internal Oblique
Transversus Abdominis - Transversus Fascia
- Extraperitoneal Fascia
- Parietal Peritoneum
what is the peritoneum?
innermost serous membrane that lines the abdominopelvic cavity
encloses the viscera
consists of two continuous layers: visceral and parietal
what layer of peritoneum lines the internal surface of abdominal wall
parietal peritoneum
what layer of peritoneum encloses the organs
visceral peritoneum
what is the peritoneal cavity? (what is it filled with)
potential space b/w parietal and visceral layers
filled only with fluid
difference b/w peritoneal cavity in males and females
in males: it is completely closed
in females: opening of uterine tubes creates communication with the outside
what are the subdivisions of the peritoneal cavity
greater sac lesser sac (omental bursa)
greater sac (what is it, boundaries)
main and larger part of peritoneal cavity
begins at diaphragm and continues inferiorly to pelvic cavity
supracolic compartment and infracolic compartment
what is entered when the parietal peritoneum is penetrated (what part of the cavity)
greater sac
lesser sac (omental bursa) (where is it, boundaries)
lies posterior to stomach and adjoining structures
has superior and inferior boundaries called recesses
Superior Recess of Lesser Sac (limits)
limited superiorly by the diaphragm and coronary ligament of the liver
Inferior Recess of Lesser Sac (where is it)
b/w superior part of the layers of the greater omentum
the greater and lesser sac communicate through what? (aka the site of continuity b/w the compartment)
epiploic foramen (omental foramen, foramen of Winslow)
intraperitoneal organs (what does this mean)
structures that are completely encased in peritoneum
suspended from abdominal wall by the mesenteries
invaginate into the peritoneal cavity
retroperitoneal organs (what does this mean)
structures that lie outside the peritoneal cavity
only covered by peritoneum on one surface
not suspended in the abdominal cavity
found b/w abdominal wall and parietal peritoneum
two different types: primarily and secondarily
primarily retroperitoneal organs
what does this mean
develop and remain between peritoneum and body wall
secondarily retroperitoneal organs (what does this mean)
develop within peritoneum but later fuse to body wall
intraperitoneal organs (name them)
stomach dodenum (1st and 4th parts) jejunum and ileum cecum appendix transverse colon sigmoid colon spleen liver (except bare area) gall bladder
primarily retroperitoneal organs (name them)
kidneys adrenal glands aorta inferior vena cava testes bladder and ureters uterus rectum
secondarily retroperitoneal organs (name them)
duodenum (middle)
pancreas
ascending colon
descending colon
what structure forms the median umbilical fold
obliterated urachus
what structure forms the medial umbilical folds (both of them)
obliterated umbilical arteries
what structure forms the lateral umbilical folds (both of them)
inferior epigastric vessels
mesentery (what is it)
double layer of peritoneum that suspends viscera from the posterior and part of the anterior body wall
constitute a continuity of visceral and parietal peritoneum
provide mobility for associated viscera
nerves and blood vessels traveling in the mesenteries allows for what?
communication between the organ and body wall
Dorsal Mesentery (where does it attach, where is it)
attaches viscera to posterior abdominal wall
found in foregut, midgut, and most of hindgut
what are the named parts of the dorsal mesentery
greater omentum
“the mesentery” proper
mesocolons
“the mesentery” proper
what is it
term used to describe the mystery of jejunum and ileum
large fan-shaped mesentery that attaches the ~20ft of small intestine to a root that spans 15-20cm on posterior abdominal wall
mesocolons (what are they, name them)
named mesenteries of different parts of the large intestine they are: mesoappendix transverse mesocolon sigmoid mesocolon
ventral mesentery (what is it, what does it develop in association with, what structures is it limited to)
attaches viscera to anterior abdominal wall develops in association with the liver limited to: terminal esophagus stomach and proximal duodenum
what forms the peritoneal covering of the liver?
ventral mesentery
ventral mesentery (named parts)
Lesser omentum
Falciform ligament
Coronary ligament
Left and right triangular ligament
ligamentum teres is formed from what?
obliterated umbilical veins
gutters (what are they0
channels created by fusion of GI tract to the posterior abdominal wall
what provides a pathway for the flow of ascitic fluid and the spread of intraperitoneal infection
paracolic gutters
Peritoneal Gutters (name them)
right lateral (paracolic)
left lateral (paracolic)
right of the mesentery (infracolic)
left of the mesentery (infracolic)
Pouches or Recesses (what are they)
fossae of peritoneum formed by peritoneal reflections (folds)
what determine the extent and direction of the spread of pathological fluids that enter the peritoneal cavity
peritoneal recesses
Subphrenic Recess
what is it
space in the greater sac b.w the diaphragm and liver on either side of the falciform ligament
Hepatorenal Recess (of Morison) (what is it)
part of the greater sac b/w liver (anteriorly) and right kidney and diaphragm (posteriorly)
what is the lowest part of the adominopelvic cavity when the patient is laying down
hepatorenal recess (of Morison)
infection of the pleural cavity is a common associated complication of what and why?
Infection of Hepatorenal Recess (of Morison)
infection can be absorbed by diaphragmatic lymphatics in this recess and then the infection can spread via systemic circulation
Peritoneal Ligament (what are they)
double layer of peritoneum that connects and organ with another organ or the abdominal wall
Omenta (what are they)
specific peritoneal ligaments of the stomach
pass from stomach and proximal duodenum to adjacent viscera in abdominal cavity or abdominal wall
Omenta (name them and what they are derived from)
Greater Omentum- dorsal mesentery
Lesser Omentum- ventral mesentery
Lesser Omentum (what does it connect)
lesser curvature of the stomach and proximal duodenum to the liver
Lesser Omentum (named parts and contents)
Hepatogastric ligament
Hepatoduodenal Ligament
Contains- portal triad
falciform ligament (what does it connect, what does it contain, what is it derived from)
connection b/w liver and anterior abdominal wall
from ventral mesentery
free interior margin contains legamentum teres (obliterated umbilical vein)
Coronary ligament (what is it derived from, what does it connect)
liver to diaphragm
Left and right triangular ligaments (what are they derived from, what do they connect)
ventral mesentery
liver to diaphragm
Greater Omentum (what is it path and connections)
dorsal mesentery
fused 4 layer sheet
hangs down like an apron from the greater curvature of the stomach and proximal duodenum
descends and then folds back to attach to the anterior part of the transverse colon and its mesentery
Grater Omentum (named parts)
Gastrophrenic ligament
Gastrosplenic Ligament
Gastrocolic Ligament
Splenorenal ligament (derived from what, what does it connect)
dorsal mesentery
spleen to left kidney
Phrenicocolic ligament (derived from what and connects what
dorsal mesentery
extends from left colic flexure to diaphragm
what is the portal triad
hepatic artery, bile duct, portal vein
Peritonitis (what is it, what causes it)
inflammation of peritoneum that occurs form injury or infection
peritoneum secretes fluid and cells in response to trauma, leading to excess fluid accumulation in the peritoneal cavity (ascites)
ascites
when excess fluid accumulates in peritoneal cavity
Peritoneal Adhesions (what are they, what causes them)
fibrous bands of scar tissue that form between abdominal organs and walls, joining them together abnormally
caused by inflammation, injury, infection, and most commonly surgery
most do not cause clinical problems, can be associated w/ intestinal obstruction
Intra-abdominal infections usually stay where?
stay below the diaphragm and do not enter other body cavities
the large surface area of the abdomen allows for what (in terms of infection and malignant cells)
they can spread easily and rapidly throughout the abdomen
anterior boundary of epiploic foramen
portal triade in heptoduodenal ligament
posterior boundary of epiploic foramen
inferior vena cava and right crus of diaphragm
superior boundary of epiploic foramen
caudate lobe of liver
inferior boundary of epiploic foramen
first part of duodenum
depression lateral to the lateral umbilical fold?
lateral inguinal fossa
lateral inguinal fossa is the site of?
deep lingual ring
indirect hernia
why are women at particular risk of infection of the hepatorenal recess?
because of open communication b/w fallopian tubes and peritoneal cavity
where is the opening of the epiploic foramen
lateral edge of hepatoduodenal ligament of the lesser momentum
what must be cut for surgical access to lesser sac
gastrocolic ligament
