Peritoneum Flashcards
What is the peritoneum?
what kind of pain do you have for each?
this lines the abdominal cavity. continuous sac
2 layers:
parietal peritoneum lining the body wall –> supplied by the same blood nerve and lymphatic structures as the region the wall it lines. sensitive to pressure, pain, temperature (localized pain)
visceral peritoneum –> covers the organs. supplied by the same stuff as before. sensitive to stretch and chemical irritation. (less localized pain)
What does intraperitoneal mean?
retroperitoneal? (2 ways)
most completely covered with visceral peritoneum
outside the peritoneal cavity or only partially covered by peritoneum!
SADPUCKER does what?
tells what is retroperitoneal
suprarenal glands aorta/IVC Duodenum (2-4) Pancreas (not the tail) Ureters Colon (ascending/descending) Kidneys Esophagus Rectum
primary retroperitoneal?
secondary retroperitoneal?
anything that developed on the posterior body wall and wasn’t covered In mesentary:
kidneys, ureters, aorta, IVC
used to be in the mesentary but fused to posterior body wall.
omental bursa/lesser sac?
due to the rotation of the stomach and the pull of the liver its a little space that is created behind that.
it’s a little pouch and space.
Splenorenal ligament does what?
what mesentary is it part of?
part of the dorsal mesentary
goes from spleen to the posterior body wall
Gastrosplenic ligament?
connects stomach and spleen
part of the dorsal mesentary
Lesser omentum is made up of what two ligaments?
where did the lesser omentum come from?
made up of 2 ligaments. hepatoduodenal ligament and hepatogastric ligament.
come from ventral mesentary
Falciform ligament is where?
where does it come from?
liver to the anterior body wall.
comes from ventral mesentary
greater omentum is formed by what 3 ligaments?
gastrophrenic ligament, gastroplenic, gastrocolic ligament (goes down and around to the transverse colon).
what ligament is another support beam for the splenic flexure
phrenicocolic ligament
what arteries runs through the hepatoduodenal ligament?
what else is in this space? key ligament
again, what does this ligament help form?
proper hepatic A, cystic A, and right gastric A.
(also don’t forget bile duct and hepatic portal vein)
LO
what runs through the hepatogastric ligament?
again, what does this ligament help form?
right and left gastric arteries.
LO
what runs in the gastrophrenic ligament?
again, what does this ligament help form?
posterior gastric A
GO
what runs in the gastrosplenic ligament?
short gastric a.
left gastroomental a.
GO
what runs in the gastrocolic ligament?
right gastroomental a.
left gastroomental a.
GO
what artery runs through the splenorenal ligament?
splenic a.
what is the transverse colon connected to the wall with?
what runs with this?
transverse mesocolon
middle colic a.
marginal a.
what runs in the proper mesentary?
where is this located again?
ileal and jejunal arteries.
superior mesenteric artery
ileum and jejunum
What runs in the root of the mesentary?
where is this located?
the root is where the proper mesentary attaches to the posterior body wall
ileocolic a.
What runs in the sigmoid mesocolon?
sigmoid a.
What are the boundaries of the epiploic foramen
what is the epiploic foramen?
the entrance to the lesser sac
communicates with the greater sac through an opening (epiploic foramen)
anteriorly it’s got the hepatoduodenal ligament and portal triad
posteriorly = inferior vena cava and right crus of the diaphragm.
superior = caudate lobe of the liver
inferior = 1st part of the duodenum
where is the lesser omentum?
the lesser sac (or omental bursa) is the cavity in the abdomen that is formed by the lesser and greater omentum!
How can stomach contents enter the lesser sac? why is this significant?
the stomach is anterior to the lesser sac, so if the there’s a posterior rupture, the contents go into the lesser sac.
What happens if you have an inflamed or injured pancreas?
why is it not a bad thing if this happens?
pancreas it’s an anterior area, contents will go into the lesser sac.
it’s okay because it’s now contained. definitely need to get help but you won’t have peritonitis
What happens if you get intestine in the lesser sac?
you can’t cut the anterior border because of the portal triad. you can’t cut the posterior boundary because of the IVC.
you take a needle, insert into the gut contents, aspirate and pull them out.
what does the transverse mesocolon do?
what is in each compartment?
what does one compartment further divide into?
where it’s holding the transverse colon, it will divide the cavity into supra colic compartment and infra colic compartment.
supra = stomach, liver, spleen
infra = small intestine, ascending, descending colon
also separated into right and left infra colic space by root of the mesentary
What’s to note about the paracolic gutters?
what if you have a rupture of the organs and the lesser sac?
what side is more narrow and why?
what’s the deepest portion for men or women?
they communicate between the supra colic and infra colic compartments.
rupture of the organs, this is where fluid will run. so a rupture could go into the epiploic foramen, and then it would go up into the right or left subphrenic space (which is separated by the falciform ligament
patients sitting up, fluid goes down, but due to the phrenicocolic ligament, the left is more narrow.
rectovesicular pouch (deepest space that fluid can go in males)
rectouterine (deepest pouch in females)
any time you go into the abdomen and surgery what happens when you touch it?
forms adhesions, which can cause obstructions but most of the time nothing happens. but try to stay out of the cavity whenever possible.
What’s peritonitis?
infection of the peritoneal cavity. (GSW, stab wound, etc)..
Ascites?
excess fluid of the peritoneal cavity
Drainage (paracentesis)
you want to go to the most inferior. right lower or left lower.
you don’t want to hit any blood vessels.
Explain the parts of the pancreas
head + C shaped uncinate process
neck
body
tail
anterior, posterior, right, left, inferior to pancreas?
what’s the saying to know for this for right, left, and inferior.
lesser sac and stomach
aorta/IVC, splenic vein, bile duct, right crus of diaphragm, left kidney and vessels, left suprarenal gland, SMA, SMV
2nd part of duodenum
spleen
3rd part of duodenum
(The pancreas is cradled by the 2nd part of the duodenum and it tickles the spleen.)
SMA SMV and pancreas importance?
if you have cancer and you have pancreatic tissue growing… you cannot do surgery. because of how close the SMA and SMV.
What are the relationships to the lesser sac?
anteriorly = lesser omentum, stomach, gastrocolic ligament
posteriorly = pancreas, Lef. suprarenal gland / Lf. Kidney, aorta, IVC, splenic a/v
superior: liver, diaphragm
inferior: transverse mesocolon, 1st part of duodenum
left = hilum of spleen, gastrosplenic ligament
right: epiploic foramen opens into greater sac
