Peritoneum And Peritoneal Cavity Flashcards
The —— is a thin serous membrane that line the walls of the abdominopelvic cavity and cover the organs within these cavities.
Peritoneum
The peritoneum consists of two layers:
Visceral
Parietal
- —— peritoneum
• Line the walls of the abdominal and pelvic cavities. - ——- peritoneum
• Covers the organs.
Parietal
Visceral
———Is the potential space between the parietal and visceral layer of peritoneum
Peritoneal cavity
Peritoneal cavity contains organs
T or F
F
The peritoneal cavity is an open sac in males
Tor F
F
It is closed
Peritoneal cavity
In the female, there is a communication with the exterior through the —-—, the —-, and the —-
in the female, there is a communication with the exterior through the uterine tubes, the uterine cavity, and the vagina
Peritoneal cavity is divided into —- and —
• Two sacs communicate with each other through ——-
Peritoneal cavity is divided into greater sac and lesser sac
• Two sacs communicate with each other through epiploic foramen.
——//Fluid lubricates the peritoneal surfaces, enabling the viscera to move over each other without friction and allowing the movements of digestion
• Contains leucokytes and antibodies that resist infection
Peritoneal fluid
Peritoneal fluid is absorbed by ——on the inferior surface of the diaphragm
It is absorbed by lymphatic vessels on the inferior surface of the diaphragm
Parietal peritoneum is Loosely attached to the walls by ——-
Loosely attached to the walls by extraperitoneal connective tissue.
Nerve supply of the parietal peritoneum
Nerve supply is same as those of overlying body wall.
Which peritoneum is pain sensitive
Parietal peritoneum
Which peritoneum cannot be striped
Visceral
Nerve supply of visceral peritoneum
Nerve supply is of those of the underlying viscera.
RELATIONSHIP OF VISCERA TO PERITONEUM
• This can be either —— or ——
RELATIONSHIP OF VISCERA TO PERITONEUM
• This can be either intraperitoneal or retroperitoneal
• Intraperitoneal organs
• Viscera are completely surrounded by peritoneum e.g.
• Retroperitoneal viscera
• Are covered by peritoneum partially on their anterior surfaces only e.g. ——-
• Intraperitoneal organs
• Viscera are completely surrounded by peritoneum e.g. stomach and spleen
• Retroperitoneal viscera
• Are covered by peritoneum partially on their anterior surfaces only e.g. kidney and ureter
PERITONEAL TERMS
• Peritoneum suspending small intestine is called ——.
• Peritoneum suspending large intestine is called ——
• Peritoneum attached to the stomach is called ——-.
• Peritoneum connecting anterior abdominal wall to organs, or organs to each other are called ——.
PERITONEAL TERMS
• Peritoneum suspending small intestine is called mesentery.
• Peritoneum suspending large intestine is called mesocolon
• Peritoneum attached to the stomach is called omentum.
• Peritoneum connecting anterior abdominal wall to organs, or organs to each other are called ligaments e.g. gastrosplenic ligaments.
———Is a double layer of peritoneum that occurs as a result of the invagination of the peritoneum by an organ
Mesentery/mesocolon
-a double fold of peritoneum which connects the transverse colon to the posterior abdominal wall
Transverse mesocolon
The sigmoid mesocolon is —- shaped
Inverted v shaped
-inverted V-shaped, with apex located in front of left ureter and bifurcation of common iliac artery
Sigmoid mesocolon
——- triangular mesentery- extends from terminal part of ileum to appendix
Mesoappendix
• ——- artery runs in free margin of the mesoappendix
Appendicular artery
—— Is a double-layered extension or fold that passes from the stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity or to the abdominal wall
Omentum
types of omentum:
types of omentum: 1. Lesser omentum 2. Greater omentum
———Two-layered fold of peritoneum connects the lesser curvature of the stomach and the proximal part of duodenum to the liver
Lesser omentum
—— is a prominent peritoneal fold that hangs down like an apron from the greater curvature of the stomach and the proximal part of the duodenum
Greater omentum
Greater omentum
After descending, it folds back and attaches to the anterior surface of the ——-and its mesentery
Transverse colon
• The liver is connected to:
1. Anterior abdominal wall by the
—— ligament
2. Stomach by the ——
3. Duodenum by the ——
• The liver is connected to: 1. Anterior abdominal wall by the
falciform ligament
2. Stomach by the gastrohepatic ligament (membranous portion of lesser omentum)
3. Duodenum by the hepatoduodenal ligament (thickened free edge of lesser omentum that conducts portal triads
The stomach is connected to the:
. Inferior surface of the diaphragm by the ——— ligament
. Spleen by the ——- ligament
. Transverse colon by the —— ligament
. Liver by the ——- ligament
. Pancreas by the —— ligament
The stomach is connected to the:
. Inferior surface of the diaphragm by the gastrophrenic ligament
. Spleen by the gastrosplenic ligament
. Transverse colon by the gastrocolic ligament
. Liver by the gastrohepatic ligament
. Pancreas by the gastropancreatic ligament
LIGAMENTS OF THE SPLEEN include
Gastrosplenic ligament
Splenorenal ligament
Phrenicosplenic ligament
Splenocolic ligament
——— is a reflection of peritoneum that is raised from the body wall by underlying blood vessels, ducts and obliterated fetal vessels
Peritoneal fold
————-is a pouch of peritoneum that is formed by a peritoneal fold
Peritoneal recess or fossa
FOLDS AND FOSSAE ANT ABD. WALL.
——- fold covers median umbilical ligament- Remnant of urachus
———/ folds covers medial umbilical ligaments- Remnants of the obliterated umbilical arteries
————folds covers the inferior epigastric vessels= which bleed if cut
FOLDS AND FOSSAE ANT ABD. WALL
• •
•
•
1. 2. 3.
Median umbilical fold covers median umbilical ligament- Remnant of urachus
Medial umbilical folds covers
medial umbilical ligaments- Remnants of the obliterated umbilical arteries
Lateral umbilical folds covers the inferior epigastric vessels= which bleed if cut
FOLDS AND FOSSAE ANT ABD. WALL
• •
•
•
1. 2. 3.
Median umbilical fold covers median umbilical ligament- Remnant of ——
Medial umbilical folds covers
medial umbilical ligaments- Remnants of the ————
Lateral umbilical folds covers the inferior epigastric vessels= which bleed if cut
FOLDS AND FOSSAE ANT ABD. WALL
• •
•
•
1. 2. 3.
Median umbilical fold covers median umbilical ligament- Remnant of urachus
Medial umbilical folds covers
medial umbilical ligaments- Remnants of the obliterated umbilical arteries
Lateral umbilical folds covers the inferior epigastric vessels= which bleed if cut
ANTERIOR ABDOMINAL FOSSAE
- ——— fossae- found between the median and medial umbilical folds
Formed as peritoneum reflects from the anterior abdominal wall onto the bladder
Potential site for external supravesical hernia
2.——— fossae- Found between the medial and lateral umbilical folds
Potential site for the less common direct inguinal hernias
3.———fossae- found lateral to the lateral umbilical folds
Potential site for most common indirect inguinal hernia
ANTERIOR ABDOMINAL FOSSAE
1.
• •
2.
•
3.
•
Surpravesical fossae- found between the median and medial umbilical folds
Formed as peritoneum reflects from the anterior abdominal wall onto the bladder
Potential site for external supravesical hernia
Medial inguinal fossae- Found between the medial and lateral umbilical folds
Potential site for the less common direct inguinal hernias
Lateral inguinal fossae- found lateral to the lateral umbilical folds
Potential site for most common indirect inguinal hernia
ANTERIOR ABDOMINAL FOSSAE
Surpravesical fossae- found between the ——- and ——-folds
Formed as peritoneum reflects from the anterior abdominal wall onto the ——
Potential site for ——— hernia
Medial inguinal fossae- Found between the —— and ——— folds
Potential site for the ——inguinal hernias
Lateral inguinal fossae- found lateral to the ————folds
Potential site for most ——-inguinal hernia
ANTERIOR ABDOMINAL FOSSAE
1.
• •
2.
•
3.
•
Surpravesical fossae- found between the median and medial umbilical folds
Formed as peritoneum reflects from the anterior abdominal wall onto the bladder
Potential site for external supravesical hernia
Medial inguinal fossae- Found between the medial and lateral umbilical folds
Potential site for the less common direct inguinal hernias
Lateral inguinal fossae- found lateral to the lateral umbilical folds
Potential site for most common indirect inguinal hernia
SUBDIVISIONS OF THE PERITONEAL CAVITIES
• The peritoneal cavity is divided into the ——— and ——— peritoneal sacs
• The ——— sac is the main and larger part of the peritoneal cavity
• The lesser sac or omental bursa lies posterior to the ——— and
adjoining structures
• A surgical incision through the anterolateral abdominal wall enters the —— sac
• The transverse mesocolon divides the abdominal cavity into
• ——— and ——— compartments
SUBDIVISIONS OF THE PERITONEAL CAVITIES
• The peritoneal cavity is divided into the greater and lesser peritoneal sacs
• The greater sac is the main and larger part of the peritoneal cavity
• The lesser sac or omental bursa lies posterior to the stomach and
adjoining structures
• A surgical incision through the anterolateral abdominal wall enters the greater sac
• The transverse mesocolon divides the abdominal cavity into
• Supracolic and infracolic compartments
INFRACOLIC COMPARTMENT
• Lies posterior to the greater omentum and is divided into right and left infracolic spaces by the mesentery of the ———
• Free communication exists between the supracolic and infracolic compartments through the ——
INFRACOLIC COMPARTMENT
• Lies posterior to the greater omentum and is divided into right and left infracolic spaces by the mesentery of the small intestine
• Free communication exists between the supracolic and infracolic compartments through the paracolic gutters
Right infracolic space
• Triangular space, lies between——
Left infracolic space
• Lies between ——
• it widens below where it is continuous with the cavity of the ——
Right infracolic space
• Triangular space, lies between
root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolon
Left infracolic space
• Lies between root of mesentery, descending colon, left 1/3 of
transverse colon and transverse mesocolon
• it widens below where it is continuous with the cavity of the pelvis
paracolic gutters
Right paracolic gutter
• Lies lateral to the ——- colon.
• Communicates with the ——- and ——
• Provides a route for the spread of infection between the pelvic and the upper abdominal region.
Left paracolic gutter
• Lies lateral to the ——— colon.
• Separated from the area around the
spleen by the ——- ligament
• A fold of peritoneum that passes from the colic flexure to the diaphragm.
paracolic gutters Right paracolic gutter
• Lies lateral to the ascending colon.
• Communicates with the hepatorenal
recess and the pelvic cavity.
• Provides a route for the spread of infection between the pelvic and the upper abdominal region.
Left paracolic gutter
• Lies lateral to the descending colon.
• Separated from the area around the
spleen by the phrenicocolic ligament
• A fold of peritoneum that passes from the colic flexure to the diaphragm.
———Is an extensive saclike cavity, lies posterior to stomach, and adjacent structures and the lesser omentum
Omental bursa
Walls of omental bursa
• Superior- formed by
• Anterior-formed by
• Inferior-formed by
• Posterior-formed by
Walls
• Superior-peritoneum which covers the
caudate lobe of liver and diaphragm
• Anterior-formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum
• Inferior-conjunctive area of anterior and posterior two layers of greater omentum
• Posterior-formed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland
Give two other names for omental foramen
Epiploic foramen
Foramen of Winslow
OMENTAL FORAMEN
• The omental bursa communicates with the ——— through the omental foramen (epiploic foramen or foramen of Winslow)
• It is an opening situated posterior to the free edge of the ——-(—— ligament)
• It can be located by running a finger along the ——- to the ——
• It usually admits how many fingers
OMENTAL FORAMEN
• The omental bursa communicates with the greater peritoneal sac through the omental foramen (epiploic foramen or foramen of Winslow)
• It is an opening situated posterior to the free edge of the lesser omentum (hepatoduodenal ligament)
• It can be located by running a finger along the gallbladder to the free edge of the lesser omentum
• It usually admits 2 fingers
Boundaries of omental foramen
• Superiorly-formed by
• Inferiorly-formed by
• Anteriorly-formed by
• Posteriorly-formed by
Boundaries of omental foramen
• Superiorly-caudate lobe of liver covered with visceral peritoneum
• Inferiorly-superior part of duodenum, portal vein, hepatic artery and bile duct
• Anteriorly-hepatodudenal ligament containing the portal vein, hepatic artery and bile duct
• Posteriorly-IVC and right crus of diaphragm covered with parietal peritoneum
VERTICAL TRACINGS OF PERITONEUM
• Peritoneum from anterior abdominal wall lines the anterior and posterior surface of liver except ———.
• Anterior and posterior layers form anterior and posterior layers of lesser omentum extending from —— to ——-of stomach.
VERTICAL TRACINGS OF PERITONEUM
• Peritoneum from anterior abdominal wall lines the anterior and posterior surface of liver except bare area.
• Anterior and posterior layers form anterior and posterior layers of lesser omentum extending from liver to lesser curvature of stomach.
VERTICAL TRACINGS OF PERITONEUM • Anterior layer then covers anterior surface of stomach and then forms anterior layer of greater omentum (—— layer of greater omentum) then becomes —— layer of greater omentum.
• Posterior layer lines posterior surface of stomach and forms —— and —— layer of greater omentum passes around the ——- surface of transverse colon and then lines upper part of posterior abdominal wall.
• Anterior layer then covers anterior surface of stomach and then forms anterior layer of greater omentum (first layer of greater omentum) then becomes fourth layer of greater omentum.
• Posterior layer lines posterior surface of stomach and forms second and third layer of greater omentum passes around the anterior surface of transverse colon and then lines upper part of posterior abdominal wall.
VERTICAL TRACINGS OF PERITONEUM
• Anterior layer then passes around the colon to become its posterior layer.
• Lines ——- abdominal wall.
• It is reflected anteriorly as ——- layer of mesentery then passes around small intestine to become ——- layer.
• It lines the posterior abdominal wall and descends into the ——
• Anterior layer then passes around the colon to become its posterior layer.
• Lines posterior abdominal wall.
• It is reflected anteriorly as anterior layer of mesentery then passes around small intestine to become posterior layer.
• It lines the posterior abdominal wall and descends into the pelvis
VERTICAL TRACINGS OF PERITONEUM
• In females, it passes in front of rectum and uterus forming —— pouch and from uterus to urinary bladder forming —— pouch.
• In males, it passes in front of rectum to urinary bladder and forms —— pouch
• Peritoneum then passes from urinary bladder to anterior abdominal wall
• In females, it passes in front of rectum and uterus forming rectouterine pouch and from uterus to urinary bladder forming vesicouterine pouch.
• In males, it passes in front of rectum to urinary bladder and forms rectovesical pouch
• Peritoneum then passes from urinary bladder to anterior abdominal wall
BLOOD SUPPLY OF PERITONEUM
parietal peritoneum:
visceral peritoneum:
BLOOD SUPPLY OF PERITONEUM
parietal peritoneum
• Lumbar vessels
• Branches of the inferior and superior epigastric arteries • Musculophrenic artery
• Deep circumflex arteries
visceral peritoneum
• From the arteries supplying the appropriate viscera
NERVE SUPPLY TO PERITONEUM
parietal peritoneum:
visceral peritoneum:
• The receptors are sensitive to:
NERVE SUPPLY TO PERITONEUM
parietal peritoneum
• Nerves supplying the adjacent body wall and diaphragm visceral peritoneum
• Sympathetic nerves innervating the appropriate visceral • The receptors are sensitive to:
• Overdistension of the hollow viscera
• Traction on the mesenteries which stretch the nerve plexus in
the wall of the organ or mesentery
• Spasm of smooth muscle
• Ischemia (inadequate blood supply)
Give clinical anatomy of peritoneum and peritoneal cavity
CLINICAL ANATOMY
• Blockage of the uterine tubes (hysterosalpinography)
• Peritonitis, Ascites, paracentesis and intraperitoneal injection
• Flow of inflammatory exudates (paracolic gutters)to facilitate flow of exudate, patients with peritonitis are often placed in the sitting position at 45o angle
• Peritoneal adhesions and adhesiotomy (intestinal obstruction)
——— is regarded as the “abdominal policeman”
Greater omentum
Functions of the greater omentum
Functions of the greater omentum
• It is large and fat laden
• Prevents visceral peritoneum from adhering to the parietal
peritoneum lining the anterolateral abdominal wall
• It has considerable mobility and moves around the peritoneal cavity with peristaltic movements of the viscera
• It wraps itself around an inflamed organ e.g. appendix, walling it off and thereby protecting other viscera from it
• Therefore, it is regarded as the “abdominal policeman”
• It cushions the abdominal organs against injury and forms insulation against loss of body heat
