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Abdominal Sonography > Peritoneum > Flashcards

Peritoneum Flashcards

1
Q

What is Abdominopelvic Division?

A

It is divided into 2 major areas (compartments):

  1. Peritoneum
  2. Retroperitoneum
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2
Q

What are the organs within the Peritoneum?

A
  1. Liver
  2. Gallbladder
  3. Spleen
  4. Stomach
  5. Ovaries
  6. 1st part of Duodenum
  7. Transverse Colon
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3
Q

What is the Peritoneal Membrane?

A
  • It is a thin sheet of tissues divides the abdominal cavity into peritoneal and retroperitoneal compartment.
  • It is composed of 2 layers of connective tissue.
  • It creates potential spaces (fluid can accumulate in these spaces)
  • It contains ligaments and folds.
  • It contains fat, blood vessels, lymphatic and nerves.
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4
Q

What are the parts of the Peritoneal Membrane?

A
  1. Parietal Membrane (linings/walls)
    - the peritoneal layer that lines the walls of the abdominopelvic cavity
    - this thin layer coating all surfaces of the peritoneal cavity and its organs secretes a small amount of serous fluid, approximately 50 ml, which acts to lubricate visceral surfaces, allowing them to move without friction.
  2. Visceral Peritoneum
    - peritoneum that envelopes the organs
    - hilum of peritoneal organs are considered BARE AREAS because they lack a peritoneal covering
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5
Q

Describe the Male and Female peritoneum.

A
  • Male Cavity: completely sealed

- Female Cavity: communicates with the external environment via fallopian tubes

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6
Q

What are the five Major Peritoneal Folds?

A

Peritoneal folds are composed of double layer of peritoneum.

  1. Mesentery Folds
  2. Mesocolon
  3. Lesser Omentum
  4. Greater Omentum
  5. Falciform Ligament
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7
Q

What are the Mesentery folds?

A
  • The Mesentery folds are fan-shaped.
  • They connect jejunum and ileum to posterior abdominal wall.
  • Small bowel: duodenum, jejunum and ileum
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8
Q

What is the Mesocolon Fold?

A
  • It connects transverse and sigmoid colon of the large intestine to posterior abdominal wall.
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9
Q

What is the Lesser Omentum Fold?

A
  • It is also knows as: Small Omentum; Gastrohepatic Omentum; Gastrohepatic Ligament.
  • It is a fused double layer of peritoneum stretching between the lesser curvature of the stomach to the duodenum.
    Lesser Curvature (superior to the lesser curvature)
  • This ligament creates the anterior and superior border of the lesser sac.
  • It connects stomach with the liver
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10
Q

What is the Greater Omentum fold?

A
  • It is within the greater sac, a large apron-like double-layered sheet of peritoneum.
  • It is anterior 2 layers descend inferior from the greater curve of the stomach.
  • It extends inferiorly from the greater curvature of the stomach and transverse colon.
  • It extends inferiorly, anterior to the bowel, folds inward and travels superiorly to attach on the transverse colon.
  • Folds are fused in adults and contain a variable amount of fat
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11
Q

What are the Two Omenta?

A
  1. The Greater Omentum attaches the stomach to the transverse colon.
  2. The Lesser Omentum attaches the stomach and duodenum to the liver.
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12
Q

What are the functions of the Greater Omentum?

A
  1. Prevents adhering of the parietal and visceral peritoneum from fusing.
  2. This mesenteric drape is very mobile and moves to areas of inflammation, surrounding the inflamed area by creating adhesions to wall of infection.
  3. It also acts to cushion the abdominal organs to prevent trauma and to prevent the loss of body heat from abdominal organs.
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13
Q

What are the Ligaments?

A
  • Double fold
  • Tethers organs to each other (name is an indication of the organs that are connected)
  • Contains blood, lymphatic vessels and nerves
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14
Q

What is the Falciform Ligament?

A
  • It is a double layer of peritoneum.
  • It ascends from the umbilicus to the liver.
    a. Anterior and superior surface
    b. Splits into 2 layers
  • It houses the Ligamentum Teres
  • It attaches the liver to the anterior abdominal wall and diaphragm.

*Liver is the unique digestive organ that is attached to the anterior abdominal wall.

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15
Q

What are the two layers of Falciform Ligament?

A
  1. Right Leaf (to the coronary ligament)

2. Left Leaf (to the left triangular ligament)

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16
Q

What is the Coronary Ligament?

A
  • It is a fusion of the parietal peritoneum and the splitting of the falciform ligament.
  • It is posterior to the liver.
  • It forms the bare area of the liver.
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17
Q

What is the Ligamentum Venosum?

A
  • It is a remnant of the ductus venosus.

- It attaches to the left portal vein above th IVC.

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18
Q

What is the Ligamentum Teres?

A
  • It is a remnant of the fetal umbilical vein.
  • It runs through the falciform ligament.
  • It joins the left portal vein in the porta hepatis.
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19
Q

What is Hepatogastric ligament?

A

It also called the Lesser Omentum, Smaller Omentum or gastrohepatic.

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20
Q

What are the other ligaments in the liver?

A
  1. Hepatogastric
  2. Gastroduodenal
  3. Falciform Ligament
  4. Coronary Ligament
  5. Left Triangular Ligament
  6. Splenorenal Ligament
  7. Gastrocolic
  8. Gastrosplenic
  9. Hepatoduodenal
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21
Q

What does the Main Lobar fissure attach to?

A

The Main Lobar fissure attaches the Right Portal Vein and the Gallbladder.

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22
Q

What is the Left Triangular Ligament?

A

It forms the left extremity of the bare area of the liver.

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23
Q

What is the Splenorenal Ligament?

A

It is also called Lienorenal Ligament, connects the splenic hilum to the posterior abdominal wall, through which the splenic vein and artery travel.

24
Q

What is Gastrosplenic Ligament?

A

It connects the stomach to the spleen and inferior diaphragm.

25
Q

What is Hepatoduodenal Ligament?

A

It is a thickened free edge of the lesser omentum through which courses the portal triad.
It connects the liver to the duodenum.

26
Q

What are the Peritoneal Spaces?

A
  • These are areas created by the peritoneal layer, reflecting between organs or an organ and the peritoneal wall.
  • It is an empty fold of peritoneum; between parietal and visceral peritoneum.
  • When disease is present, fluid or other material can collect in this space.
27
Q

What are the Peritoneal Spaces?

A
  1. Right and Left Subphrenic Space
  2. Right and Left Subhepatic Space
  3. Lesser Sac
  4. Greater Sac
28
Q

What is the Right Subphrenic Space?

A
  • It also known as Suprahepatic.
  • It is an extension of the greater sac between the right hemidiaphragm and the anterior superior liver rightward of the falciform ligament.
  • Falciform ligament is the medial boundary.
29
Q

What is the Left Subphrenic Space?

A

ANTERIOR

  • Suprahepatic
  • Extension of the greater sac
  • Between the diaphragm and area to the left of the falciform ligament, anterior and superior to liver

POSTERIOR

  • Extension of the lesser sac
  • Between the diaphragm and posterior superior liver
30
Q

What is the Right Subhepatic Space?

A
  • It is also known as the Morison’s pouch
  • it is posterior to the right lobe of the liver.
  • It is anterior to the upper pole of right kidney.
  • Most gravity dependent potential space of the abdominal cavity.
31
Q

What is the Left Posterior Suprahepatic Space?

A
  • It is also called the superior recess of the lesser sac.

- This space is an extension of the lesser sac between the diaphragm and the posterior superior liver.

32
Q

What are the Divisions of the Peritoneal Cavity?

A

The peritoneal cavity is generally divided into two compartments:

  1. Greater Sac
  2. Lesser sac (Omental Bursa)
33
Q

What is the Greater Sac?

A
  • The greater sac contains organs and several potential spaces.
  • It is the largest, housing the liver, spleen, stomach, first of the duodenum, jejunum, ileum, cecum, transverse colon, sigmoid colon and the upper two-thrids of the rectum.
34
Q

What is the Lesser Sac?

A
  • It may be referred to as the Inferior Recess of the Lesser Sac or Omental Bursa.
  • It may be thought of as a diverticulum of the greater sac.
  • It does not contain any organs.
  • It lies immediately posterior to the stomach, extending superiorly to the left suprahepatic recess between the posterior left lobe of the liver and the left hemidiaphragm.
  • Extends inferiorly into the fold of the greater omentum.
  • This fold is patent in infants and small children but generally fuses in adults.
  • The lesser sac’s anterior wall is formed by the posterior stomach, whereas superiorly it is enclosed by the lesser omentum also called as Hepatogastric Ligament.
  • Left Lateral Wall is formed by: Splenorenal and Gastrosplenic Ligaments
  • Right Lateral Wall is formed by: Omental Foramen also called as the Foramen of Winslow or Epiploic Foramen, only communication with the greater sac
35
Q

What are the comparments of the Greater Sac?

A
  • The greater sac is the majority space in the peritoneal cavity.
  • It is divided into 2 compartments by the Transverse Colon:
    1. Supracolic
    2. Infracolic

-They communicate via the paracolic gutters.

36
Q

What is the Supracolic compartment of the Greater Sac?

A
  • Supracolic (Above the colon)
  • It is superior to the transverse colon.
  • It is anterior to the greater omentum and stomach.
  • It is inferior to liver.
37
Q

What is the Infracolic compartment of the Greater Sac?

A
  • Infracolic ( below the colon)
  • It is inferior to the transverse colon.
  • It is posterior to the greater omentum.
  • It surrounds small bowel and colon.
  • It is divided into right and left by the root of mesentery.
38
Q

What are the Paracolic Gutters?

A
  • They are lateral borders of the Ascending and Descending colon.
  • There are two potential spaces:
    1. Right Paracolic Gutter - between the ascending colon and the right lateral abdominal wall
    2. Left Paracolic Gutter - between the descending colon and left lateral abdominal wall
39
Q

What are the Pelvic Spaces?

A
  1. Space of Retzius/Retropubic
  2. Anterior cul-de-zac/Uterovesical Space
  3. Posterior cul-de-zac/ Pouch of Douglas
40
Q

What is the Space of Retzius?

A
  • It is also known as Retropubic.
  • It is the most anterior space in the pelvic area.
  • It is between the anterior bladder wall and the symphysis pubis.
41
Q

What is the Anterior Cul-de-zac?

A
  • It is also known as the Uterovesical Space.
  • In the female, it is between the uterus and posterior wall of the bladder.
  • Vesical means bladder; posterior wall of the bladder and anterior of the uterus.
42
Q

What is the Posterior Cul-de-zac?

A
  • It is also known as the Pouch of Douglas or Rectouterine space in a female.
  • It is created by the parietal peritoneum draping over the anterior rectum, posterior vaginal wall and posterior uterus.
  • When the female is in a supine position, this space is the most gravity- dependent potential space of the pelvic cavity draining fluid from the infracolic area.
43
Q

What are the male pelvic spaces?

A
  1. Space of Retzius/Retropubic - it is between the anterior bladder wall and symphysis pubis
  2. Vesicorectal (cul-de-zac) - it is between the posterior bladder and rectum; it the most dependent space in supine.
44
Q

What are the female pelvic spaces?

A
  1. Space of Retzius (Retropubic)
    - it is between the anterior bladder wall and symphysis pubis
  2. Anterior cul-de-zac (Uterovesical Space)
    - it is over the uterus
  3. Posterior cul-de-zac (Pouch of Douglas, Rectouterine Space)
    - it is the most dependent space in the pelvic cavity in a supine position
45
Q

What is the sonographic appearance of the Parietal Peritoneum?

A
  • Thin hyperechoic continuous line posterior to the anterior abdominal wall muscles.
  • Bowel peristalsis observed deep to the line
46
Q

What is the sonographic appearance of the mesentery?

A
  • It is typically not visualized.

- With ascites (fluid in the abdomen): folds of peritoneum identified converging toward posterior abdominal wall.

47
Q

What is Retroperitoneum?

A
  • It is the area lying behind the peritoneal membrane.
  • It is a complex abdominal space located between the parietal peritoneum and anterior to the transversalis fascia.
  • It extends from the diaphragm superiorly to the pelvic brim inferiorly.
48
Q

What is the Parietal Peritoneum?

A

It is the outermost of two membranes that enclose most of the intraabdominal contents, including the intestines , liver, pancreatic head, spleen and pelvic organs.

49
Q

What is the Visceral Peritoneum?

A

It lies in direct apposition to the parietal membrane, thus forming a potential space.

50
Q

What are the three Retroperitoneal compartments or spaces?

A
  1. Anterior Pararenal
  2. Perirenal (Perinephric)
  3. Posterior Pararenal
    - These compartments are formed by 2 layers of fascia.
51
Q

What is the Anterior Pararenal Space?

A

Anterior Border: Posterior parietal peritoneum
Posterior Border: Anterior perirenal fascia
- It contains the following;
1. Pancreas
2. Distal common bile duct
3. Second, third and fourth parts of the duodenum
4. Ascending and descending colon

  • It communicates with:
    1. Posterior pararenal space and pelvis
    2. Potentially midline
52
Q

What is the Anterior Renal Fascia?

A

The anterior renal fascia is also called as Gerota Fascia.

53
Q

What is the Posterior Renal Fascia?

A

The posterior renal fascia is called as Zuckerkandl Fascia.

54
Q

What is the Perirenal Space?

A

Anterior Border: Anterior renal fascia (Gerota’s fascia)
Posterior Border: Posterior renal fascia (Zuckerkandl fascia)

  • Fascia fuses superiorly and attaches to the diaphragmatic crura.
  • Inferiorly, perirenal space is open at level of pelvic brim.
  • The space contains the following:
    1. Kidneys
    2. Perinephric Fat
    3. Adrenals (also known as suprarenal or superior to the kidneys)
    4. Aorta and IVC
55
Q

What is the Posterior Pararenal Space?

A

Anterior Border: Anterior renal fascia (Gerota’s fascia)
Posterior Border: Posterior renal fascia (Zuckerkandl fascia)

  • It lies between the posterior renal fascia and the transversalis fascia.
  • It has no organs, only fat.

Abdominal Sonography (4 decks)

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