Peritoneum

Question 1

What is peritoneum?
Its layers?

Answer 1

The peritoneum is a thin, transparent membrane that lines the abdominal cavity and covers the abdominal organs. It is divided into two layers:

1. Parietal Peritoneum: This layer lines the interior of the abdominal wall.
2. Visceral Peritoneum: This layer covers the surfaces of the abdominal organs.

The space between these two layers is known as the peritoneal cavity, which contains a small amount of lubricating fluid that allows the organs to move smoothly against each other.

Question 2

What is peritoneum?
Its layers?

Answer 2

The peritoneum is a thin, transparent membrane that lines the abdominal cavity and covers the abdominal organs. It is divided into two layers:

1. Parietal Peritoneum: This layer lines the interior of the abdominal wall.
2. Visceral Peritoneum: This layer covers the surfaces of the abdominal organs.

The space between these two layers is known as the peritoneal cavity, which contains a small amount of lubricating fluid that allows the organs to move smoothly against each other.

Question 3

What is greater omentum?
Its functions??

Answer 3

The greater omentum is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It drapes over the intestines and other abdominal organs. The greater omentum has several functions, including:

1. Fat Storage: It contains fat deposits that can vary in quantity among individuals.
2. Immune Response: It has milky spots containing macrophages and other immune cells that can help fight infections.
3. Protection: It cushions and protects the abdominal organs.
4. Infection and Wound Isolation: It can move to areas of infection or injury within the abdomen to help isolate and contain the problem.

The greater omentum attaches to the greater curvature of the stomach and extends downwards, covering the intestines before doubling back and attaching to the transverse colon.

Question 4

What is lesser omentum?

Answer 4

The lesser omentum is a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum. It has two main parts:

1. Hepatogastric Ligament: This part connects the liver to the lesser curvature of the stomach.
2. Hepatoduodenal Ligament: This part connects the liver to the first part of the duodenum and contains important structures such as the hepatic artery, portal vein, and bile duct (collectively known as the portal triad).

The lesser omentum helps to stabilize the position of the stomach and liver and provides a pathway for structures such as blood vessels, lymphatics, and nerves to travel between these organs. It also helps to compartmentalize the abdominal cavity, playing a role in the spread and containment of infections within the abdomen.

Question 5

What is lesser omentum?

Answer 5

The lesser omentum is a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum. It has two main parts:

1. Hepatogastric Ligament: This part connects the liver to the lesser curvature of the stomach.
2. Hepatoduodenal Ligament: This part connects the liver to the first part of the duodenum and contains important structures such as the hepatic artery, portal vein, and bile duct (collectively known as the portal triad).

The lesser omentum helps to stabilize the position of the stomach and liver and provides a pathway for structures such as blood vessels, lymphatics, and nerves to travel between these organs. It also helps to compartmentalize the abdominal cavity, playing a role in the spread and containment of infections within the abdomen.

Question 6

What is portal triad?

Answer 6

The portal triad, also known as the hepatic triad, is a group of three important structures that are found within the hepatoduodenal ligament, part of the lesser omentum. These structures are:

1. Hepatic Artery Proper: This artery supplies oxygenated blood to the liver.
2. Portal Vein: This vein carries nutrient-rich blood from the gastrointestinal tract and spleen to the liver for processing.
3. Common Bile Duct: This duct carries bile produced by the liver and gallbladder to the duodenum, the first part of the small intestine.

The portal triad is essential for the liver’s function, as it provides the liver with the blood supply necessary for nutrient processing, detoxification, and bile production.

Question 7

Blood supply of lesser and greater omentum?

Answer 7

The blood supply for the lesser omentum comes from the left and right gastric arteries,

while the blood supply for the greater omentum comes from the right and left gastroepiploic arteries.

Question 8

Both type of peritoneum are made of _____________ epithelial cells called?

Answer 8

simple squamous epithelial cells called mesothelium

Question 9

Parietal peritoneum is derived from?

Visceral peritoneum is derived from?

Answer 9

1.Somatic mesoderm

2. Splanchnic mesoderm

Question 10

Pain is localized in which type of peritoneum?

nerve supply of parietal and visceral peritoneum?

Answer 10

Parietal

Sensitive to pressure
Pain
Laceration
Temperature

Visceral is only sensitive to stretch & chemical irritation

2. Parietal – somatic
   Visceral—autonomic

Question 11

What are dermatomes?

Answer 11

Dermatomes are specific areas of skin that are primarily supplied by a single spinal nerve. The human body is divided into these segments, each associated with a particular nerve root coming from the spine.

Question 12

What are dermatomes?

Answer 12

Dermatomes are specific areas of skin that are primarily supplied by a single spinal nerve. The human body is divided into these segments, each associated with a particular nerve root coming from the spine.

Question 13

What is volvulus?
Can be caused by?

Answer 13

Volvulus is a medical condition in which a loop of the intestine twists around itself and the mesentery that supports it, leading to bowel obstruction. This twisting can cut off the blood supply to the affected part of the intestine, potentially causing tissue death and severe complications if not treated promptly. Symptoms of volvulus include abdominal pain, bloating, vomiting, and constipation. It is considered a medical emergency and often requires surgical intervention to correct.

2. Peritoneal adhesions

Question 14

What are intraperitoneal organs?

Answer 14

Enveloped by visceral peritoneum both anteriorly and posteriorly
- suspended by the mesentery

E.g
Stomach
Liver
Spleen

Question 15

What are retroperitoneal organs?

Answer 15

Covered by parietal peritoneaum only anteriorly
Not suspended by mesentery

E.g
S–suprarenal adrenal glands
A–Aorta/IVC
D–Duodenum
P–Pancreas
U–Ureters
C–Colon (ascending/descending)
K–Kidneys
E–Esophagus
R–Rectum

Question 16

What is mesentary?

Answer 16

-Double layer of visceral peritoneum
-Connects intraperitoneal organs to posterior abdominal wall
-Pathway for nerves & vessels

Question 17

What are omenta?
Types? Which omenta is called the abdominal police?

Answer 17

Sheets of visceral peritoneum from stomach & proximal part of duodenum to other abdominal organs

2. 2 types;

Greater Omentum
Descends from greater curvature of stomach—–proximal duodenum—–transverse colon

Lesser Omentum
Attaches from lesseer curvature of stomach—–proximal duodenum—–liver
Has further 2 parts
• hepatogastric
• hepatoduodenal (has portal triad)

Question 18

What are omenta?
Types? Which omenta is called the abdominal police?

Answer 18

Sheets of visceral peritoneum from stomach & proximal part of duodenum to other abdominal organs

2. 2 types;

Greater Omentum
Descends from greater curvature of stomach—–proximal duodenum—–transverse colon

Lesser Omentum
Attaches from lesseer curvature of stomach—–proximal duodenum—–liver
Has further 2 parts
• hepatogastric
• hepatoduodenal (has portal triad)

Ans 3.
Greater omenta is called abdominal police bcz it can migrate to infected viscera, wrapping around and isolating the are to prevent spread of infection

Question 19

Back pain is presented due to which peritoneal organs?

Answer 19

Retroperitoneal (e g kidneys and pancreas)

Question 20

What are ascites?

Answer 20

Ascites is the abnormal accumulation of fluid in the peritoneal cavity, which is the space within the abdomen that houses the intestines, liver, and other organs. This condition is often associated with liver disease, particularly cirrhosis, but can also result from other conditions such as heart failure, kidney failure, infections, or cancers. Symptoms of ascites can include abdominal swelling, discomfort, shortness of breath, and weight gain. Treatment typically focuses on addressing the underlying cause and may involve dietary changes, medications, and in some cases, procedures to remove the excess fluid.

Question 21

What are the treatments for ascites?

Answer 21

Treatment of ascites focuses on addressing the underlying cause and managing symptoms. Common treatments include:

1. Dietary Changes: Reducing sodium intake can help decrease fluid retention. A low-sodium diet is often recommended.
2. Diuretics: Medications that help the body expel excess fluid through urine. Common diuretics used include spironolactone and furosemide.
3. Paracentesis: A procedure in which a needle is inserted into the abdominal cavity to remove excess fluid. This is often used for severe cases or when diuretics are not effective.
4. Treating the Underlying Cause: Managing the primary condition causing ascites, such as liver disease, heart failure, or infections.
5. Albumin Infusions: In some cases, albumin (a protein) infusions may be given to help maintain blood volume and pressure.
6. Surgical Options: In cases of refractory ascites (ascites that does not respond to other treatments), surgical options like a** transjugular intrahepatic portosystemic shunt (TIPS)** may be considered. TIPS is a procedure that creates a pathway within the liver to reduce pressure in the portal vein.

It’s important for individuals with ascites to work closely with their healthcare provider to develop a treatment plan tailored to their specific condition.

Question 22

What is subphrenic recesses?

What is subphrenic abcess?

Answer 22

subphrenic recesses are spaces located below the diaphragm and above the liver.
They are part of the peritoneal cavity and are divided into right and left subphrenic recesses by the falciform ligament. These recesses play a role in the movement and distribution of fluids within the peritoneal cavity, and they can be sites where fluid accumulates in certain medical conditions, such as abscesses or infections.

Subphrenic abcess
is a collection of pus that forms in the subphrenic recesses, which are spaces located below the diaphragm and above the liver. This type of abscess typically results from an infection and can be caused by conditions such as:

• Post-surgical complications, especially abdominal surgeries.
• Perforation of abdominal organs, such as the stomach or intestines.
• Spread of infection from other parts of the abdomen, such as the appendix or gallbladder.

Symptoms of a subphrenic abscess may include fever, abdominal pain, difficulty breathing, and a general feeling of illness. Diagnosis is often made using imaging studies like ultrasound, CT scans, or MRI. Treatment usually involves antibiotics and may require drainage of the abscess, either surgically or with a needle under imaging guidance.

Question 23

1.Give the division of peritoneal cavity?

2.Supracolic and infracolic compatments are connected by?

3. The omental bursa (lesser sac) is connected with greater sac via?

Answer 23

1. Greater Sac
Divided into;
• supracolic compartment
(Above transverse mesocolon, contains;
Stomach
Liver
Spleen

2. Lesser sac (omental bursa)
Lies posterior to stomach & lesser omentum

• infracolic compartment
(Below the transverse mesocolon has;
Small intestine
Colon (ascending & descending)

2. Paracolic gutters
3. An opening in the omental bursa (lesser sac) - the epiploic foramen (of winslow)

Question 24

What is epiploic foramen of winslow?

Answer 24

The epiploic foramen of Winslow, also known simply as the omental foramen, is an anatomical opening located in the peritoneal cavity. It is a passage between the greater sac (the main part of the peritoneal cavity) and the lesser sac (also known as the omental bursa or omental sac).

• Location: It is situated posterior to the free edge of the lesser omentum.
• Boundaries:
  • Anteriorly:
    Hepatoduodenal ligament (which contains the portal triad: portal vein, hepatic artery, and bile duct).
  • Posteriorly:
    Inferior vena cava.
  • Superiorly:
    Caudate lobe of the liver.
  • Inferiorly:
    First part of the duodenum.

The epiploic foramen of Winslow allows communication between these two peritoneal spaces, facilitating the movement of structures such as blood vessels, nerves, and lymphatics. It is important in surgical anatomy as it provides a route for herniation or pathological conditions like volvulus (twisting) of the stomach or small intestine.

Pathological conditions involving the epiploic foramen include:
- Internal hernias: Such as herniation of small bowel or omentum through the foramen.
- Volvulus: Twisting of the stomach or small intestine around structures passing through the foramen.
- Fluid collections: Infections or collections of fluid (ascites) can potentially pass through this foramen.

Understanding the anatomy and function of the epiploic foramen is crucial for surgeons and clinicians managing abdominal conditions that involve this anatomical structure.

Question 25

What is epiploic foramen of winslow?

Answer 25

The epiploic foramen of Winslow, also known simply as the omental foramen, is an anatomical opening located in the peritoneal cavity. It is a passage between the greater sac (the main part of the peritoneal cavity) and the lesser sac (also known as the omental bursa or omental sac).

• Location: It is situated posterior to the free edge of the lesser omentum.
• Boundaries:
  • Anteriorly:
    Hepatoduodenal ligament (which contains the portal triad: portal vein, hepatic artery, and bile duct).
  • Posteriorly:
    Inferior vena cava.
  • Superiorly:
    Caudate lobe of the liver.
  • Inferiorly:
    First part of the duodenum.

The epiploic foramen of Winslow allows communication between these two peritoneal spaces, facilitating the movement of structures such as blood vessels, nerves, and lymphatics. It is important in surgical anatomy as it provides a route for herniation or pathological conditions like volvulus (twisting) of the stomach or small intestine.

Pathological conditions involving the epiploic foramen include:
- Internal hernias: Such as herniation of small bowel or omentum through the foramen.
- Volvulus: Twisting of the stomach or small intestine around structures passing through the foramen.
- Fluid collections: Infections or collections of fluid (ascites) can potentially pass through this foramen.

Understanding the anatomy and function of the epiploic foramen is crucial for surgeons and clinicians managing abdominal conditions that involve this anatomical structure.

Question 26

Difference between culdocentesis and paracentesis in simple words?

Answer 26

Both are used for sampling of peritoneal fluid

• Culdocentesis:
  Getting fluid from a small space behind the uterus rectouterine pouch of douglas to check for problems like ectopic pregnancy or infections.
• needle inserted thru the posterior fornix of vagina
• Paracentesis:
  Getting fluid from the belly to find out what’s causing issues like swelling or infections there.
  -needle inserted into anterolateral abdominal wall

Question 27

Main difference between mesentery and omenta?

Answer 27

Both are folds of visceral peritoneum

• Mesentery: Attaches the small intestine to the back of the abdominal wall and supports it with blood vessels and nerves.
  (Attached visceral organs to posterior abdominal wall)
• Omentum: Hangs from the stomach and covers the abdominal organs like a protective apron, with roles in immune defense and fat storage.
  (Attaches visceral abdominal organs to each other)