Peritoneum

Question 1

What is the peritoneum?

what kind of pain do you have for each?

Answer 1

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)

Question 2

What does intraperitoneal mean?

retroperitoneal? (2 ways)

Answer 2

most completely covered with visceral peritoneum

outside the peritoneal cavity or only partially covered by peritoneum!

Question 3

SADPUCKER does what?

Answer 3

tells what is retroperitoneal

suprarenal glands
aorta/IVC
Duodenum (2-4)
Pancreas (not the tail)
Ureters
Colon (ascending/descending)
Kidneys
Esophagus
Rectum

Question 4

primary retroperitoneal?

secondary retroperitoneal?

Answer 4

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.

Question 5

omental bursa/lesser sac?

Answer 5

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.

Question 6

Splenorenal ligament does what?

what mesentary is it part of?

Answer 6

part of the dorsal mesentary

goes from spleen to the posterior body wall

Question 7

Gastrosplenic ligament?

Answer 7

connects stomach and spleen

part of the dorsal mesentary

Question 8

Lesser omentum is made up of what two ligaments?

where did the lesser omentum come from?

Answer 8

made up of 2 ligaments. hepatoduodenal ligament and hepatogastric ligament.

come from ventral mesentary

Question 9

Falciform ligament is where?

where does it come from?

Answer 9

liver to the anterior body wall.

comes from ventral mesentary

Question 10

greater omentum is formed by what 3 ligaments?

Answer 10

gastrophrenic ligament, gastroplenic, gastrocolic ligament (goes down and around to the transverse colon).

Question 11

what ligament is another support beam for the splenic flexure

Answer 11

phrenicocolic ligament

Question 12

what arteries runs through the hepatoduodenal ligament?

what else is in this space? key ligament

again, what does this ligament help form?

Answer 12

proper hepatic A, cystic A, and right gastric A.

(also don’t forget bile duct and hepatic portal vein)

LO

Question 13

what runs through the hepatogastric ligament?

again, what does this ligament help form?

Answer 13

right and left gastric arteries.

LO

Question 14

what runs in the gastrophrenic ligament?

again, what does this ligament help form?

Answer 14

posterior gastric A

GO

Question 15

what runs in the gastrosplenic ligament?

Answer 15

short gastric a.
left gastroomental a.

GO

Question 16

what runs in the gastrocolic ligament?

Answer 16

right gastroomental a.
left gastroomental a.

GO

Question 17

what artery runs through the splenorenal ligament?

Answer 17

splenic a.

Question 18

what is the transverse colon connected to the wall with?

what runs with this?

Answer 18

transverse mesocolon

middle colic a.
marginal a.

Question 19

what runs in the proper mesentary?

where is this located again?

Answer 19

ileal and jejunal arteries.
superior mesenteric artery

ileum and jejunum

Question 20

What runs in the root of the mesentary?

where is this located?

Answer 20

the root is where the proper mesentary attaches to the posterior body wall

ileocolic a.

Question 21

What runs in the sigmoid mesocolon?

Answer 21

sigmoid a.

Question 22

What are the boundaries of the epiploic foramen

what is the epiploic foramen?

Answer 22

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

Question 23

where is the lesser omentum?

Answer 23

the lesser sac (or omental bursa) is the cavity in the abdomen that is formed by the lesser and greater omentum!

Question 24

How can stomach contents enter the lesser sac? why is this significant?

Answer 24

the stomach is anterior to the lesser sac, so if the there’s a posterior rupture, the contents go into the lesser sac.

Question 25

What happens if you have an inflamed or injured pancreas?

why is it not a bad thing if this happens?

Answer 25

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

Question 26

What happens if you get intestine in the lesser sac?

Answer 26

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.

Question 27

what does the transverse mesocolon do?

what is in each compartment?

what does one compartment further divide into?

Answer 27

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

Question 28

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?

Answer 28

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)

Question 29

any time you go into the abdomen and surgery what happens when you touch it?

Answer 29

forms adhesions, which can cause obstructions but most of the time nothing happens. but try to stay out of the cavity whenever possible.

Question 30

What’s peritonitis?

Answer 30

infection of the peritoneal cavity. (GSW, stab wound, etc)..

Question 31

Ascites?

Answer 31

excess fluid of the peritoneal cavity

Question 32

Drainage (paracentesis)

Answer 32

you want to go to the most inferior. right lower or left lower.

you don’t want to hit any blood vessels.

Question 33

Explain the parts of the pancreas

Answer 33

head + C shaped uncinate process

neck
body
tail

Question 34

anterior, posterior, right, left, inferior to pancreas?

what’s the saying to know for this for right, left, and inferior.

Answer 34

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.)

Question 35

SMA SMV and pancreas importance?

Answer 35

if you have cancer and you have pancreatic tissue growing… you cannot do surgery. because of how close the SMA and SMV.

Question 36

What are the relationships to the lesser sac?

Answer 36

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