Peritoneum Flashcards
What is the peritoneum
The largest serous sac that lines abdominal wall and
covers the abdominal viscera
Name The peritoneum parts
1- Visceral layer
2- parietal layer
3- peritoneal fold
4- peritoneal cavity
What is a peritoneal fold
when peritoneum is in contact to other peritoneal layer to form either ligament, omentum or mesentery
Define The peritoneal cavity
The potential space between the 2 layers
Not shown except when there is carcinoma
Name 5 functions of peritoneum
1- Provides smooth surfaces for viscera to avoid friction
2- Protects against infection as peritoneal fluid contains antibodies
3- Allows rapid healing of abdominal wounds
4- Can localize the spread of infection (policeman of the abdomen)
5- Storage of fat
Why does the peritoneum Allows rapid healing
Because its a serous sac, produces high amounts of fibrous tissue
Intraperitoneal Organs examples
Stomach
Liver
most of small intestine ( jej n ile)
Cecum
appendix
Transverse colon
sigmoid colon
Gall bladder
spleen
Name all the Primary retroperitoneal organs
Aorta, Inferior vena cava, kidneys, Suprarenal glands, urinary bladder, vagina, and rectum
Name all the 2ry retroperitoneal organs
duodenum, pancreas, ascending and descending colon
What are the two peritoneal cavities
- greater sac
- lesser sac
What are the Peritoneal recesses
1-Duodenal recesses
2-Caecal recesses
3-Intersigmoid recess or Other recesses
Peritoneal Reflections Develops into?
What are the terms used to describe it
into a highly folded, complex structures
1- Mesentery
2- Omentum
3-Peritoneal Ligaments
Greater sac and lesser sac extents
Greater sac extends from diaphragm down to the pelvis
Lesser sac; lies behind the stomach
Both peritoneal cavities are interconnected through?
Epiploic foramen (also called the foramen of
Winslow)
Greater Sac is divided by transverse colon & its mesentery into
Supracolic compartment
Infracolic compartment
Where does the Supracolic compartment lies
lies above the transverse mesocolon and contains stomach, liver and spleen
Where does the Infracolic compartment lies?
lies below the transverse mesocolon and contains the small intestine, ascending and descending colon
The infracolic compartment is Subdivided into
into left and right infracolic spaces by the mesentery of the small intestine
Define the Paracolic gutters
grooves or spaces between the abdominal wall and the lateral aspect of the ascending and descending colon
What are the advantages of the paracolic gutters
-These spaces allows communication between supra and infra colic regions of the greater sac
-It is important for peritoneal fluid flow
Where does the Lesser sac lies in?
It is the peritoneal sac that lies behind the stomach and lesser omentum
Other name of the Lesser sac
Omental Bursa
The omental bursa is communicated with the greater sac through an opening in the omental bursa called
the epiploic foramen (foramen of Winslow)
Anterior border of the epiploic foramen
Anterior border : free edge of the lesser
omentum containing the portal tirade:
a- common bile duct
b-portal vein
c-hepatic artery
Posterior border of the epiploic foramen
a- inferior vena cava
b- right crus of diaphragm
Superior border of the epiploic foramen
cuadate lobe of the liver
Inferior border of the epiploic foramen
first part of the duodenum
Define recesses
The peritoneum wraps around the viscera, they
form several fossae or spaces within the peritoneal cavity
These recesses are potential sites for?
internal herniation of the abdomino-pelvic viscera
What are the clinigal significance of the recesses?
because a length of the intestine may enter and be constricted causing hernia
Duodenal recesses site and parts
around the fourth part of duodenum
A-Superior duodenal recess
B- Inferior duodenal recess
C-Retroduodenal recess
D- Paraduodenal recess
Caecal recesses site and parts
are spaces formed by the peritoneum around the caecum
Three caecal recesses are present:
• Superior ileocaecal recess
• Inferior ileocaecal recess
• Retrocaecal recess
Following acute appendicitis, which reccess are common site of abscess formation
paracaecal recesses are common sites for abscess formation
Name the other recesses and their sites
a- Sub phrenic below the diaphragm
b- Sub hepatic below the liver
c - Hepatorenal between the inferior surface of the liver and right kidney
Mention the 3 Types of peritoneal folds
• Omenta.
• Mesenteries
• Ligaments
The peritoneal ligaments, omenta, and mesenteries function (Generally)
permit blood, lymph vessels, and nerves to
reach the viscera
Define the omenta
Two layered fold of peritoneum connecting the stomach and proximal part of the duodenum to other abdominal organs
What’s the Lesser omentum attachment
It attaches from the lesser curvature of the stomach and the proximal part of the duodenum to the liver
The lesser omentum ascends as a?
Ascends as a double fold to the porta hepatis of liver, and fissure for ligamentum venosum
What are the Contents between the two layers of the
lesser omentum
• Close to the right free margin are the: hepatic
artery, common bile duct, portal vein, lymphatics,
and hepatic plexus of nerves
• At the attachement to the stomach, run the
right and left gastric vessels
Define the Greater omentum
The largest peritoneal fold, with cribriform appearance, contains some adipose tissue
The greater omentum is consisted of
a double sheet of peritoneum, folded on itself so that it is made up of four layers (anterior 2 layers
+ posterior 2 layers).
The two layers which descend from the greater curve pass ……… ?
downward in front of the small intestines, then
turn upon themselves, and ascend to the transverse colon, where they separate and enclose it
Greater omentum contents
the anastomosis between the right and left gastroepiploic
Mesentery structure and attachments
Mesentery is double layer of visceral peritoneum
It connects an intraperitoneal organ to the posterior abdominal wall
Mesentry provides what?
provides a pathway for nerves, blood vessels and lymphatics to travel from the body wall to the viscera
Examples of mesentry
o Mesentery of small intestine
o transverse mesocolon
o sigmoid mesocolons
o the mesoappendix
The root mesentery of the small intestine is known to be? (Length and width wise)
The root is narrow, about 15 cm long, 20 cm in width
The root of the mesentery of the small intestine is directed obliquely from, to?
directed obliquely from the duodenojejunal flexure at the left side of the second lumbar vertebra to the right sacroiliac joint
Define ligaments
It is a double fold of peritoneum that connects viscera together or connects viscera to the abdominal wall and diaphragm
Name 6 examples of ligaments
• Hepatogastric ligament, a portion of the lesser
omentum, which connects the liver to the stomach
• Falciform ligament ,connecting the liver to the anterior abdominal wall
• Coronary and triangular ligaments connecting the liver to the diaphragm
• Gastro phrenic ligament connecting the stomach to
the diaphragm
• Gastro splenic ligament connecting the stomach to
the spleen
• Lienorenal ligament connecting the spleen to the left kidne
Which kind of peritoneum is sensitive to
pain, temperature, touch, and pressure
parietal peritoneum
The parietal peritoneum is supplied by?
lower six thoracic (lower 6 intercostal ) and first lumbar nerves
The visceral peritoneum is supplied by?
Autonomic nerves that supply the viscera or traveling in the mesenteries
The visceral peritoneum is only sensitive only to?
Stretch and tearing
The central part of the diaphragmatic peritoneum (parietal. P) is supplied by?
the phrenic nerves
Peritoneal Pain (as in Peritonitis) symptoms from the Parietal Peritoneum?
Abdominal pain originating from the parietal peritoneum is therefore of the somatic type
It is usually severe, and can be accurately localized
Peritoneal Pain (as in Peritonitis) causes and symptoms from the visceral Peritoneum?
Including the mesenteries, is innervated by autonomic nerves.
It is due to Stretch caused by over distension of a viscus and pulling on a mesentery That gives rise to the sensation of pain leading to abdominal pain; poorly localized, poorly characterized pain. (dull, unclear, cramping )]
The peritoneum is a semi permeable membrane which allows? Used in patients with?
- allows transfer of substances (glucose solution) across itself to remove the waste products.
- It has been used of in patients with acute renal insufficiency
Ascites is
an abnormal accumulation of fluid,more than 25 ml of fluid in the peritoneal cavity of the abdomen
Ascites symptoms
The symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath.
