Peritoneum and Upper Abdomen Flashcards
What are the two types of peritoneum?
1) Parietal Peritoneum
2) Visceral Peritoneum
What travels between peritoneal layers?
Vessels
What is the collective name for organs behind the peritoneum?
Retroperitoneal organs Duhhh
What is the type of membrane that makes up the peritoneum?
Serous membrane
What is the Peritoneal Sac
It is all of the visceral and parietal peritoneal membranes
What is the peritoneal cavity
It is the potential space within the sac that contains a small amount of serous fluid that allows the organs to move more freely during peristalsis.
What can happen within the peritoneal cavity clinically?
Can become an actual space with the build up of fluids bacteria and gas that leads to a condition called ascites. There can be as much as liters of fluid in the space.
What are the 4 Main bilayer ligaments of the peritoneum?
1) Hepatoduodenal Ligament (contains the Portal triad)
2) Hepatogastric Ligament
3) Gastrosplenic ligament
4) Splenorenal ligament
What is contained in the portal triad?
Hepatic artery, Bile duct and Hepatic portal vein
What are the two components of the Lesser omentum?
1) Portal triad
2) Hepatogastric ligament
What are the attachments of the Greater Omentum
The greater curvature of the stomach and the transverse colon.
How many layers of peritoneum is the Greater omentum composed of?
4 Peritoneal layers
What is the function of the apron like structure?
Wall off infection and inflammation sites
What is the attachment of the Lesser Omentum
Lesser curvature of the stomach and the Duodenum.
What two structures connect the lesser omentum to the Liver
Hepatogastric ligament Hepatoduodenal ligament (portal Triad container)
What is the overall shape of the Mesentery proper and what is its function
It is overall fan shaped and anchors the small intestine to the posterior abdominal wall
What is its span along the small intestine?
Diagonally from the duodenojejunal junction to the ileocecal junction.
What anchors the duodenum?
Suspensory ligament of Trietz
What is the nature of the Suspensory Ligament of Treitz and where does it extend from?
It is a fibromuscular Ligament that descends from the R. crus of the diaphragm. (Crosses over the L. crus)
What are the two portions of the Mesocolon and what do they do?
Transverse mesocolon, anchors the Transverse colon to the posterior wall and the sigmoid mesocolon anchors the sigmoid colon to the posterior wall.
How do the ascending and descending colon attach to the posterior abdominal wall?
Directly
Which Peritoneal double layer divides the liver into Right and Left Lobes?
The Falciform ligament with the round ligament extending off of it (obliterated umbilical vein)
Describe the coronary ligament of the liver.
There is an anterior and a posterior portion, both of which anchor the liver to the diaphragm. There is a space between these two layers that is called the bare area and its located in the upper posterior portion of the liver
What are the 5 single layered peritoneal folds again?
1 Median umbilical Fold (fetal urachus)
2 Medial umbilical Folds (fetal umbilical aa.)
2 Lateral umbilical Folds (inferior epigastric vessels)
What causes the potential spaces to become actual spaces within the abdomen?
The patient laying down
What are the two spaces derived from peritoneal pouches?
Hepatorenal pouch
Rectovesical or the retrouterine pouch (rectouterine)
What is the lowest part of the peritoneal cavity?
Hepatorenal Pouch found right behind the liver (Pouch of Morrison)
What position causes the fluids in the Rectovesicle (retrouterine pouch) to move to the Hepatorenal pouch
Trendelenburg position
What is the general function of the Liver
Detoxifies chemical products and produces bile
What is the general function of the gallbladder
stores bile for the emulsification of fats
What is the general function of the pancreas
Produces enzymes for digestion
What is the general function of the spleen
Produce lymphocytes and filter blood
How is the the anatomical Right and Left Lobe of the liver distinguished?
Cross section of the vena cava
Explain the position of the gall bladder and the path of bile to the duodenum.
The gall bladder is positioned right underneath the liver and drains into the cystic duct. Bile from the liver travels down the right and left hepatic duct into the common hepatic duct which combines with the cystic duct to form the Common bile duct.
What does the common bile duct join as it enters the duodenum?
The main pancreatic duct
What are the 5 parts of the pancreas listed from left to right?
Tail, body, neck, Head, and uncinate process
What are the two ducts of the pancreas and where do they drain?
The main duct drains into the major duodenal papilla with the common bile duct and the accessory duct drains into the duodenum via the minor duodenal papilla.
Which papilla is more superior the Major or Minor duodenal papilla?
Minor Duodenal papilla
What are the ribs along which the spleen lies and what are the 3 regions of the spleen?
The spleen lies on ribs 9 through 11 and the three portions are the Gastric Area, Colic Area and the Renal Area
What is the first major branch off of the Abd. aorta
Celiac Trunk
What 6 Structures does the Celiac trunk supply
Liver, Gall bladder, esophagus, stomach, spleen, and pancreas
What are the three main branches of the celiac trunk?
Common hepatic
Left Gastric
Splenic
What are the Two branches of the Common Hepatic Artery
Proper Hepatic Artery
Gastroduodenal Artery
What are the Characteristics of the proper Hepatic Artery?
Superior branch of the common hepatic artery. Medial to common bile duct and superficial to the Portal vein (with much variation) and splits into the Right and left lobes of the liver.
What are the three branches of the Gastroduodenal A. (inferior branch of the common hepatic artery)
Superior pancreaticoduodenal (to pancreas and duodenum) Right Gastroepiploic artery to the greater curvature of the stomach Supraduodenal a. to the superior duodenum
Where does the Left gastric artery come from and what does it supply?
Branch off of the Celiac trunk that runs to the lesser curvature of the stomach to supply the stomach and the lower esophagus.
Where does the splenic artery come from and what does it supply?
Comes from the left side of the celiac trunk to supply the pancreas and spleen.
What are the branches of the splenic artery?
Short gastric arteries and the Left gastroepiploic artery to supply the greater curvature of the stomach
What does the Cystic Artery come from and what are some common clinical considerations for this artery?
Usually arises from the Right hepatic artery and there is a risk for strangulation and constriction
Where does the R. Gastric Artery arise from and what does it supply?
Usually arises from the proper hepatic artery and anastomoses with the Left Gastric Artery to supply the Lesser (more superior) curvature of the stomach.
