Peritoneum and Peritoneal Cavity

Question 1

What are intraperitoneal organs?

Answer 1

• organs almost completely covered in visceral peritoneum

- minimally mobile

Question 2

What are intraperitoneal organs with a mesentery?

Answer 2

• organs covered in visceral peritoneum with peritoneum wrapped behind organ to form double layer (mesentery)
• mesentery suspends organs from posterior abdo wall
• organs very mobile

Question 3

What are retroperitoneal organs?

Answer 3

organs with parietal peritoneum only on anterior surface

Question 4

What are some intraperitoneal organs?

Answer 4

• liver
• gallbladder
• stomach
• spleen
• some parts of small intestine
• some parts of transverse colon

Question 5

What are some retroperitoneal organs?

Answer 5

• kidneys
• adrenal glands
• pancreas
• ascending colon
• descending colon

Question 6

What does it mean if an organ is secondarily retroperitoneal?

Answer 6

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

Question 7

What are peritoneal formations?

Answer 7

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

Question 8

What are the different types of peritoneal formations?

Answer 8

• mesentery (organ to body wall)
• omentum (from stomach to adjacent organs)
• peritoneal ligaments (from organs to one another or body wall)

Question 9

Describe the composition of mesentery and the different types

Answer 9

• core of connective tissue with blood, lymph vessels, nerves, and fat

3 types:

• mesentery proper (small intestine)
• transverse and sigmoid mesocolon
• mesoappendix (appendicular artery runs through it)

Question 10

Describe features of mesentery proper

Answer 10

• connects jejunum and ileum to posterior abdo wall
• base is at L2 and runs obliquely down till just above right sacroiliac joint
• contains superior mesenteric vessels, nerves and lymphatics

Question 11

Describe features of transverse mesocolon

Answer 11

• suspends transverse colon from posterior abdo wall

- root is just inferior to pancreas and carries branches of middle colic vessels

Question 12

Describe features of sigmoid mesocolon

Answer 12

• rooted in left iliac fossa and crosses bifurcation of left common iliac vessels and left ureter

Question 13

Describe the greater omentum

Answer 13

• 4 layered structure of double layer of visceral peritoneum folder upon itself
• attached to greater curvature of stomach and overlies transverse colon and much of small intestines
• contains fat and gastro-epiploic arteries
• has immune function

Question 14

Describe the lesser omentum

Answer 14

• passes lesser curvature of stomach to first part of duodenum and inferior border of liver
• can be subdivided into hepatogastric and hepatoduodenal ligament

Question 15

What is contained the the free edge of lesser omentum?

Answer 15

• portal triad
• hepatic portal vein
• hepatic artery proper
• 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 greater sac by epiploic foramen

Question 17

What are the boundaries of the epiploic foramen?

Answer 17

• anterior: hepatoduodenal ligament
• posterior: IVC
• superior: caudate process of caudate lobe of liver
• inferior: first part of duodenum

Question 18

What is Pringles Manoever?

Answer 18

when the hepatic triad can be compressed to control bleeding by the epiploic foramen

Question 19

What are the different peritoneal ligaments?

Answer 19

• hepatoduodenal ligament
• gastroduodenal ligament
• gastrosplenic ligmanet
• splenorenal ligamenet

Question 20

What are the different peritoneal folds?

Answer 20

• 1 median umbilical fold (remnant of urachus)
• 2 medial umbilical folds (obliterated umbilical artery)
• 2 lateral umbilical folds

Question 21

What are the depressed areas between the peritoneal folds?

Answer 21

• supravesical fossa
• medial umilical fossa
• lateral umbilical fossa

Question 22

What are the supra and infra-colic compartments?

Answer 22

• compartments made by the pleural cavity dividing the transverse mesocolon
• both compartments communicate by the paracolic gutters

Question 23

What is found in the supra and infra - colic compartments?

Answer 23

• supracolic: duodenum, liver, gallbladder, stomach, spleen

- infracolic: duodenum, jejunum, ileum, ascending and descending colon

Question 24

What is the clinical relevance of the hepatorenal recess?

Answer 24

if the patient is recumbent (lying down), fluid can collect here

Question 25

How does the inferior peritoneum form pouches?

Answer 25

• draped over superior aspect of pelvic organs
• 1 pouch in males: rectovesical pouch
• 2 pouches in females: vesico-uterine and recto-uterine pouch

Question 26

What is the nerve supply of the peritoneum?

Answer 26

• T7-L1: anterior abdo wall lining
• IC and phrenic nerves (T7-9 and C3-5): diaphragmatic peritoneum
• obturator nerves (L2-4): pelvic parietal peritoneum

Question 27

What is the difference in visceral and parietal peritoneum pain?

Answer 27

• parietal: sensitive to pain, temp, touch and pressure

- visceral: sensitive to stretch and tearing, only referred to a dermatome