Peritoneum (Dave's notes)

Question 1

Name six peritoneal folds of the anterior abdominal wall

Answer 1

Falciform ligament, median umbilical fold, two medial umbilical folds, two lateral umbilical folds.

Question 2

Where does the falciform ligament run?

Answer 2

From the umbilicus to the xiphisternum, entering the fissure of ligamentum trees on the visceral surface of the liver. After delivering the ligament to the liver it sweeps right.

Question 3

What does the falciform ligament contain?

Answer 3

The posterior and crescentic free margin of the ligamentum teres

Question 4

What is the origin of the ligamentum trees?

Answer 4

The obliterated remnant of the left umbilical vein

Question 5

What does the median umbilical fold contain and from what did it originate?

Answer 5

The median umbilical ligament which is the obliterated remains of the urachus

Question 6

What do the medial umbilical folds contain?

Answer 6

The obliterated remains of the umbilical artery

Question 7

What do the lateral umbilical folds contain?

Answer 7

The inferior epigastric vessels (these do not reach the umbilicus)

Question 8

What is the main abdominal cavity? How much free fluid does it contain?

Answer 8

The greater sac, a few mLs of fluid.

Question 9

What is the lesser sac?

Answer 9

An invagination of the greater sac behind the stomach through the epiploic foramen

Question 10

Other than being a smaller area, how is the capacity of the lesser sac further reduced?

Answer 10

The posterior layers of the momentum fuse

Question 11

What constitutes the roof of the lesser sac?

Answer 11

The sloping roof is the peritoneum covering the caudate lobe of the liver.

Question 12

What constitutes the lowest part of the posterior wall of the lesser sac?

Answer 12

The transverse mesocolon attached to the lowest part of the pancreas.

Question 13

What constitutes the greater omentum?

Answer 13

Two closely attached layers of peritoneum enclosing blood vessels and lymphatics

Question 14

What are the boundaries of the greater omentum?

Answer 14

The greater omentum is a vascular apron along the greater curvature of the stomach. It reaches from the oesophagus to the duodenum.

Question 15

What is the lesser omentum?

Answer 15

Two layers of peritoneum that extend between the liber and upper border of the stomach

Question 16

Why is the hepatic attachment of the letter omentum L-shaped?

Answer 16

It is L-shaped in the fissure for the ligamentum venous and the portahepatis

Question 17

What happens to the peritoneum of the lesser omentum inferiorly?

Answer 17

Traced downwards it becomes the greater omentum

Question 18

What happens to the peritoneum of the lesser omentum superiorly?

Answer 18

Traced upwards it encloses the liver and spreads over the diaphragm

Question 19

What is the upper boundary of the epiploic foramen?

Answer 19

The caudate process of the liver

Question 20

What is the lower boundary of the epiploic foramen?

Answer 20

The ascending first part of the duodenum

Question 21

What is the anterior boundary of the epiploic foramen?

Answer 21

The right free margin of the lesser omentum and contains the portal vain, hepatic artery (medial) and the CBD

Question 22

What is the posterior boundary of the epiploic foramen?

Answer 22

The IVC covered by the parietal peritoneum

Question 23

What shape and size is the epiploic foramen?

Answer 23

The epiploic foramen is a 2.5cm vertical slit

Question 24

What are the four divisions of the sypracolic compartment and their boundaries?

Answer 24

1. Right upper (right sub diaphragmatic) - Rt of falciform and upper coronary
2. Right lower (right) - between liver and kidney, posteriorly bounded by the lower layer of the coronary ligament = the lowest point when supine
3. Left upper (left sub diaphragmatic) - left of falciform, posterior ???? left triangular ligament
4. Left lower (left sub hepatic compartment) - lesser sac

Question 25

What four things does the transverse mesocolon attach to?

Answer 25

Rt kidney, duodenum, lower border of pancreas, lower part of left kidney

Question 26

How is the infracolic compartment divided?

Answer 26

Into two, by the root of the mesentery which contains the pancinian corpuscles

Question 27

What is a pancinian corpuscle?

Answer 27

Mechanoreceptor

Question 28

What is the course of the root of the mesentery, and over what four items does it pass? How long is it?

Answer 28

15cm long. Passes from left upper to right lower. Passes the DJ junction, aorta, IVC, Rt psoas, Rt ureter

Question 29

What are the boundaries of the upper, right section of the infracolic compartment?

Answer 29

Apex is found at the ileocolic junction, on the right the ascending colon, on the left the attachment of the mesentery, at the base the transverse mesocolon

Question 30

What is found on the floor of the upper right section of the infracolic compartment?

Answer 30

The lower pole of the right kidney crossed by the right colic vessels, the second part of the duodenum, turning to the third part. The DJ flexure lies to the left of the midline on the left psoas L2. The right paracolic gutter lies laterally and is an easy pathway for fluid spread.

Question 31

What are the boundaries of the lower left division of the infracolic compartment?

Answer 31

``` Quadrilateral shape Upper: transverse mesocolon, Right: mesentery Left: descending colon Lower: attachment of sigmoid colon ```

Question 32

What is found on the floor of the lower left division of the infracolic compartment?

Answer 32

The fourth part of the duodenum, and DJ flexure, paraduodenal fossae, inferior pole of the left kidney, shallowest in the midline (2'vertebrae), sigmoidcolon attachment, left ureter running near apex of sigmoid mesentery

Question 33

What limits the upper margin of the left paracolic gutter?

Answer 33

The phrenicocolic ligament

Question 34

The peritoneum is a ........... .............. composted of ............ (well ...............) and .......... (poorly ................) parts. It is a ......... layer of flattened ................. cells with overlying areolar tissue. Over expansile parts it is loose and ..........., and over non-expansile parts it is thick. Retroperitoneal organs have ..... attachments to ............. tissue.

Answer 34

serous membrane, parietal, innervated, visceral, innervated, single, mesothelial, cellular, firm, muscular