Peritoneum and Peritoneal Cavity Flashcards
where would you perform a paracentesis
RLQ, LLQ
- lateral to rectus sheath to avoid inferior epigastric arteries
or 2 cm below umbillicus
layers you puncture for paracentesis mid clavicular line
Skin superficial fascia ( external oblique internal oblique transversus abdominis fascia transversalis extra peritoneal fat parietal peritoneum ( STOP)
layers to puncture mid sternally
skin superficial fascia linea alba transversals fascia extra peritoneal fat parietal peritoneum (STOP)
greater peritoneal sac
extends from diaphragm to pelvic floor
i
lesser peritoneal sac
aka omental bursa– lies posterior to stomach and liver
mesentery
double layer of peritoneum that encloses an organ and connects it to the abdominal wall (name changes depending on organ involved)
peritoneal ligament
double layer of peritoneum that connects an organ to another organ or abdominal wall - contain vessels or remnants of vessels
omentum
double layered sheet of peritoneum that attaches the stomach to the abdominal wall or other abdominal organs
lesser omentum *
connects the lesser curvature of the stomach to proximal part of the liver
- also referred as hepatogastric ligament (1)
- hepatoduodenal ligament (2)- which has portal triad
-
greater omentum
apron
connects stomach with diaphragm spleen and transverse colon
- gastrocolic, gastrosplenic, gastrophrenic
peritoneal recesses
blind pouches
retrocecal recess- appendix lies
rectouterine- pouch of douglas
what divides supra and infra colic compartments
transverse mesocolon
infra colic compartments creates what, whats the importance**
create lateral and medial parabolic gutters ( R and L) separated by the ascending colon ( R) and descending colon (L)
they slope superiorly and posteriorly* so when fluid accumulates the fluid follows the gutters to the superior part of the abdomen when the patient is supine**
communication of greater sac and lesser sac (omental bursa) ***
through the omental/ epiploic foramen or the foramen of winslow*
it is posterior to the free edge of the lesser momentum ( hepatoduodenal ligament)
boundaries of the epiploic foramen*
anteriorly- the portal triad within the hepatoduodenal ligament
posteriorly - IVC and right crus of diaphragm
superiorly- caudate lobe of liver
inferiorly- superior part of duodenum
contents of portal triad*
Portal vein (posteriorly)
proper hepatic artery (left)
common bile duct (right)
peritoneal organs
mesentery and enclosed in peritoneum- freey movable
retroperitoneal organs
partially covered by peritoneum
immobile
major peritoneal organs *
stomach, liver gallbladder spleen beginning of duodenum tail of pancreas jejunum, ileum, appendix transverse colon
major primary retroperitoneal organs *
kidneys, adrenals, ureter
aorta, IVC
lower rectum anal canal
major secondary retroperitoneal *
most of duodenum most of pancreas ascending descending upper rectum
foregut* area
ends at second portion of duodenum at sphincter of oddi makes: esophagus stomach liver gallbladder biliary passages 1-2 parts of duodenum pancreas
midgut* area
from second portion of duodenum to proximal 2/3 of transverse colon ( L colic flexure)
Duodenum 2 3 4 jejunum ileum cecum appendix transverse colon (proximal 2/3)
Hindgut* area
distal 1/3 of transverse colon to upper part of anal canal
transverse (distal 1/3) descending colon sigmoid colon rectum anal canal
Para, symp, and blood supply of foregut*
Parasympathethic: Vagus
Sympathetic: Greater Splanchnic T5-T9
blood supply: celiac trunk
Para, symp, and blood supply of midgut*
parasympathetic: vagus
sympathetic: lesser splanchnic nerve T10-t11
blood supply: SMA (superior mesenteric artery)
Para, symp, and blood supply of hindgut*
parasympathetic: pelvic splanchnic nerve (s2 s3 s4)
sympathetic: lumbar splanchnic (L1 L2)
blood supply: IMA (inferior mesenteric artery)
where does the esophagus enter the stomach*
at the cardiac orifice
posterior to the 7th costal cartilage
right border is continuous with lesser curvature of stomach (concave)
left border is separated from the fundus by the cardiac notch (convex)
where is the cardiac part of the stomach located*
posterior to 7th left cartilage 2-4 cm from medial plane at the level of T11
where is the fundus of the stomach located*
lies posterior to the 5th rib in the mid clavicular plane
location of pyloric sphincter supine *
9th CC at level of L1 1.25 cm right of the midline
location of pyloric sphincter in erect position*
from L2-L4
branches of the celiac trunk?*
L gastric artery
Common hepatic artery
Splenic artery
branches of splenic
- pancreatic branches
- L gastroomental– greater curvature of stomach
- short gastric– fundus of stomach
- splenic - spleen
branches of common hepatic
- hepatic proper
- gastroduodenal a
- R gastric a
R and L gastric veins drain into
portal system
right gastro omental vein drains into
superior mesenteric vein
L gastro Omental vein and short gastric veins drains into
splenic vein – eventually into portal vein
1st part of duodenum* A/ P
superior
Anteriorly- liver and gallbladder
posteriorly- bile duct and portal vein
2nd part of duodenum
descending
lies anterior to renal vessels
the posterior wall receives the main pancreatic duct and common bile duct into the hepatopancreatiic ampulla (ampulla of vader) controlled by hepatopancreatic sphincter (sphincter of oddi)
3rd part of duodenum*
Horizontal lies anterior to IVC aorta right ureter right gonadal artery
what is the suspensory ligament of Treitz*?
band that extends from upper aspect of ascending part of duodenum (4th part)
to the right crus of the diaphragm and tissue around the celiac trunk
Jejunum and ileum
jejunum proximal 2/5 of small intestine
ileum distal 3/5 of small intestine-
enters ascending colon at the iliocolic junction
Venous supply of jejunum and ileum*
Portal vein is made by: SMV and splenic vein- joined in the posterior aspect of the neck of the pancreas
difference of blood supply between jejunum and ileum
jejunum has few large loops of arcades and NO lymphoid tissue
ileum has small many loops of arcades and lymphoid
