Peritoneum and Peritoneal Cavity

Question 1

What is the peritoneum?

Answer 1

It is the serous membrane which produces a lubricating fluid and lines the walls of the abdominopelvic cavity and organs. Therefore it creates the peritoneal cavity

Question 2

What are intraperitoneal organs?

Answer 2

Organs which are almost completely covered in visceral peritoneum and are therefore minimally mobile.

Question 3

What are intraperitoneal organs with a mesentery?

Answer 3

Organs covered in visceral peritoneum where the peritoneum wraps behind the organ to form a double layer (mesentery). This mesentery suspends organs from posterior abdo wall making organs very mobile

Question 4

What are retroperitoneal organs?

Answer 4

They only have parietal peritoneum on its anterior surface.

Question 5

Name some of the intraperitoneal organs

Answer 5

Liver, gall bladder, stomach, spleen, parts of small intestine and the transverse colon

Question 6

Name examples of the retroperitoneal organs

Answer 6

Kidneys, adrenal glands, pancreas, ascending colon and descending colon

Question 7

What is secondary retroperitoneal?

Answer 7

These are organs which are initially intraperitoneal but migrate retroperitoneally during embryogenesis and lose their mesentery

Question 8

What are peritoneal formations?

Answer 8

These are condensations of the peritoneum which are double layers that attach organs to each other or the abdominal wall.

Question 9

Name different types of peritoneal formations

Answer 9

• Mesentery (organ to body wall),
• Omentum (passes from stomach to adjacent organs),
• Peritoneal ligaments (connects organs to one another or body wall)

Question 10

Describe features of mesentery and the different types

Answer 10

• It has a core of connective tissue with blood, LVs, nerves, lymph nodes and fat. There are 3 types;
• The mesentery proper (small intestine),
• Transverse and sigmoid mesocolon,
• Mesoappendix ( appendicular artery runs through it)

Question 11

Describe features of the mesentery proper

Answer 11

• Connects jejunum and ileum to posterior abdo wall.
• Base starts at L2 and runs obliquely down till just above the right sacroiliac joint.
• It contains superior mesenteric vessels, nerves and lymphatics

Question 12

Describe features of the transverse mesocolon

Answer 12

It suspends the transverse colon from posterior abdo wall. The root is just inferior to the pancreas and it carries branches of the middle colic vessels

Question 13

Describe features of the sigmoid mesocolon

Answer 13

It is rotted in the left iliac fossa and crosses the bifurcation of the left common iliac vessels and the left ureter

Question 14

What is the greater omentum and what are its features?

Answer 14

It is a four layered structure consisting of a double layer of visceral peritoneum folded upon itself. It is attached to the greater curvature of the stomach and overlies the transverse colon and much of the small intestines. It contains fat and gastro-epiploic arteries. Has immune function

Question 15

Describe feature of the lesser omentum

Answer 15

It passes from the lesser curvature of the stomach to the 1st part of the duodenum and inferior boarder of liver. Therefore it can be subdivided into hepatogastric and hepatoduodenal ligament (free edge of lesser omentum which contains the portal triad; hepatic portal vein, hepatic artery proper and common bile duct)

Question 16

What is the lesser sac?

Answer 16

Peritoneal cavity which lies posterior to stomach and lesser omentum which communicates with the greater sac via the epiploic foramen.

Question 17

Name the boundaries of the epiploic foramen/foramen of winslow

Answer 17

Anteriorly - Hepatoduodenal ligament,

Posteriorly - Inferior vena cava,

Superiorly - caudate process of caudate lobe of liver,

Inferiorly - First part of the duodenum

Question 18

What is pringle’s manover

Answer 18

This is when the hepatic triad can be compressed to controled bleeding via the epiploic foramen.

Question 19

Name the different peritoneal ligaments

Answer 19

• Hepatoduodenal ligament,
• Gastroduodenal ligament,
• Gastrosplenic ligament,
• Splenorenal ligament

Question 20

Name the different peritoneal folds

Answer 20

1x Median umbilical fold (remnant of urachus),

2x medial umbilical folds (obliterated umbilical artery),

2x Lateral umbilical folds

Question 21

Name the depressed areas between the folds and?

Answer 21

Supravesical fossa, medial umbilical fossa and lateral umbilical fossa

Question 22

What are the supracolic and infracolic compartments

Answer 22

The transverse mesocolon divides the peritoneal cavity into supracolic and infracolic compartments and both communicate via the paracolic gutters.

Question 23

Name the contents of the supracolic and infracolic compartments

Answer 23

Supra - Duodenum, liver, gallbladder, stomach and spleen.

Infra - Duodenum, jejunum, ileum, ascending and descending colon

Question 24

What is the clinical significance of the hepatorenal recess

Answer 24

If patient is recumbent then fluid can collect here

Question 25

Describe how the inferior peritoneum forms pouches and name these pouches

Answer 25

• It drapes over the superior aspect of the pelvic organs and forms 1 pouch in males (rectovesical pouch) and two in females (Vesico-uterine pouch and the recto-uterine pouch)

Question 26

Describe the nerve supply of the peritoneum

Answer 26

• Lining the anterior abdo wall is T7-L1.
• Diaphragmatic peritoneum is supplied by intercostal and phrenic nerves (T7-9 and C3-5).
• Pelvic parietal peritoneum is obturator nerves (L2-4)

Question 27

Describe the difference between visceral and parietal peritoneum pain

Answer 27

Parietal - Sensitive to pain, temp, touch and pressure.

Visceral - Only sensitive to stretch and tearing and is poorly localised. It is often referred to a dermatome