Peritoneum and Peritoneal Cavity Flashcards
What are intraperitoneal organs?
- organs almost completely covered in visceral peritoneum
- minimally mobile
What are intraperitoneal organs with a mesentery?
- 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
What are retroperitoneal organs?
organs with parietal peritoneum only on anterior surface
What are some intraperitoneal organs?
- liver
- gallbladder
- stomach
- spleen
- some parts of small intestine
- some parts of transverse colon
What are some retroperitoneal organs?
- kidneys
- adrenal glands
- pancreas
- ascending colon
- descending colon
What does it mean if an organ is secondarily retroperitoneal?
organs which are initially intraperitoneal but migrate retroperitoneal during embryogenesis and lose their mesentery
What are peritoneal formations?
condensations of peritoneum which are double layers that attach organs to each other or the abdominal wall
What are the different types of peritoneal formations?
- mesentery (organ to body wall)
- omentum (from stomach to adjacent organs)
- peritoneal ligaments (from organs to one another or body wall)
Describe the composition of mesentery and the different types
- 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)
Describe features of mesentery proper
- 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
Describe features of transverse mesocolon
- suspends transverse colon from posterior abdo wall
- root is just inferior to pancreas and carries branches of middle colic vessels
Describe features of sigmoid mesocolon
- rooted in left iliac fossa and crosses bifurcation of left common iliac vessels and left ureter
Describe the greater omentum
- 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
Describe the lesser omentum
- passes lesser curvature of stomach to first part of duodenum and inferior border of liver
- can be subdivided into hepatogastric and hepatoduodenal ligament
What is contained the the free edge of lesser omentum?
- portal triad
- hepatic portal vein
- hepatic artery proper
- common bile duct
What is the lesser sac?
peritoneal cavity which lies posterior to stomach and lesser omentum which communicates with greater sac by epiploic foramen
What are the boundaries of the epiploic foramen?
- anterior: hepatoduodenal ligament
- posterior: IVC
- superior: caudate process of caudate lobe of liver
- inferior: first part of duodenum
What is Pringles Manoever?
when the hepatic triad can be compressed to control bleeding by the epiploic foramen
What are the different peritoneal ligaments?
- hepatoduodenal ligament
- gastroduodenal ligament
- gastrosplenic ligmanet
- splenorenal ligamenet
What are the different peritoneal folds?
- 1 median umbilical fold (remnant of urachus)
- 2 medial umbilical folds (obliterated umbilical artery)
- 2 lateral umbilical folds
What are the depressed areas between the peritoneal folds?
- supravesical fossa
- medial umilical fossa
- lateral umbilical fossa
What are the supra and infra-colic compartments?
- compartments made by the pleural cavity dividing the transverse mesocolon
- both compartments communicate by the paracolic gutters
What is found in the supra and infra - colic compartments?
- supracolic: duodenum, liver, gallbladder, stomach, spleen
- infracolic: duodenum, jejunum, ileum, ascending and descending colon
What is the clinical relevance of the hepatorenal recess?
if the patient is recumbent (lying down), fluid can collect here
How does the inferior peritoneum form pouches?
- draped over superior aspect of pelvic organs
- 1 pouch in males: rectovesical pouch
- 2 pouches in females: vesico-uterine and recto-uterine pouch
What is the nerve supply of the peritoneum?
- T7-L1: anterior abdo wall lining
- IC and phrenic nerves (T7-9 and C3-5): diaphragmatic peritoneum
- obturator nerves (L2-4): pelvic parietal peritoneum
What is the difference in visceral and parietal peritoneum pain?
- parietal: sensitive to pain, temp, touch and pressure
- visceral: sensitive to stretch and tearing, only referred to a dermatome
