Peritoneum, Posterior Abdominal Wall, Blood and Nerve Supply to Abdominal Wall

Question 1

What are the 2 subdivisions of the peritoneum?

Answer 1

1) Parietal
2) Visceral

Question 2

What structures can be formed by the peritoneum?

Answer 2

1) Mesenteries
2) Omenta

Question 3

What is the peritoneal cavity?

Answer 3

A potential space lying between the parietal and visceral peritoneum

Question 4

What are the major divisions of the peritoneal cavity?

Answer 4

1) Greater sac
2) Lesser sac

Question 5

How do these 2 areas of the peritoneal cavity communicate?

Answer 5

Through the epiploic foramen

Question 6

What important structures lie in close relation to the epiploic foramen?

Answer 6

Portal vein

IVC

Question 7

In what ways can viscera be peritonised?

Answer 7

Intraperitonised

Retroperitonised

Question 8

What organs are intraperitoneal?

Answer 8

Stomach

Liver

Spleen

Question 9

What organs are retroperitoneal?

Answer 9

S - Suprarenal glands

A - Aorta/IVC

D - Duodenum

P - Pancreas (except tail)

U - Ureters

C - Colon Ascending + descending

K - Kidneys

E - Eosophagus

R - Rectum

Question 10

What is present within the peritoneal cavity?

Answer 10

Peritoneal fluid ONLY

Question 11

Which layer of the peritoneum is more sensitive to pressure, pain & temperature?

Answer 11

Parietal layer

Question 12

Label the following diagram with the following:

Epiploic foramen

Greater sac

Lesser sac

Greater omentum

Lesser omentum

Question 13

What is the greater omentum attached to?

Answer 13

1) Greater curvature of the stomach
2) Anterior surface of transverse colon

Question 14

What is the lesser omentum attached to?

Answer 14

1) Lesser curvature of the stomach
2) Liver

Question 15

What is the greater omentum commonly refered to as?

Answer 15

Abdominal policeman - it can move to sites of infection in order to localise the infection and prevent spread

Question 16

How is pain in the peritoneum characterized?

Answer 16

Parietal pain - Very well localized and extremely sensitive to stretching (made use of in the clinic by using rebound tenderness), innervated by thoracoabdominal nerves (T6-T12)

Visceral pain - Poorly localized and innervated by ANS, pain is usually refered and is dull and in the midline

Question 17

What muscles are found on the posterior abdominal wall?

Answer 17

1) Quadratus lumborum
2) Psoas major
3) Psoas minor
4) Iliacus

Question 18

What organs are located on the posterior abdominal wall?

Answer 18

• Kidneys
• Pancreas

Question 19

What are the main vessels found in the posterior abdominal wall?

Answer 19

IVC

Abdominal aorta

Question 20

What nerves are found within the posterior abdominal wall?

Answer 20

Femoral nerves

Lumbar nerves

Question 21

What are the 3 major openings of the diaphragm?

Answer 21

T8 - IVC

T10 - Eospohagus

T12 - Aorta

Question 22

What are the 3 major branches of the abdominal aorta that supply the gut tube?

Answer 22

1) Coeliac trunk (T12)
2) SMA (L1)
3) IMA (L3)

Question 23

At what vertebral level does the abdominal aorta divide into 2 common iliac arteries?

Answer 23

L4

Question 24

Which 2 veins join to form the IVC in the abdomen?

Answer 24

Right & left common iliac veins

Question 25

What structures are found in the foregut?

Answer 25

Abdominal part of oesophagus Stomach

Question 26

What structures are found in the midgut?

Answer 26

From Duodenum to 2/3 Transverse Colon

Question 27

What structures are found in the hindgut?

Answer 27

Sigmoid colon Rectum

Question 28

What arteries supply the foregut, midgut and hindgut?

Answer 28

Foregut - Coeliac trunk Midgut - SMA Hindgut - IMA

Question 29

What other organ are derived from the foregut and midgut?

Answer 29

**Foregut:** - Spleen - Pancreas **Midgut:** - Duodenum - Jejunum

Question 30

What is a portal system?

Answer 30

Transports venous blood to the liver for processing

Question 31

From which 2 vessels is the portal vein made up from?

Answer 31

1) Splenic Vein 2) Superior mesenteric vein

Question 32

Where else in the body are portocaval anastamosis found?

Answer 32

1) Distal oesophagus 2) Rectum 3) Retroperitoneum 4) Paraumbilical

Question 33

What is the clinical significance of such portocaval anastamoses?

Answer 33

In portal hypertension, varices can form and if they rupture in the rectum or oesophagus can result in fatal blood loss

Question 34

What happens to GI secretion during sympathetic and parasympathetic innervation?

Answer 34

Sympathetic - decreased GI secretion Parasympathetic - increased GI secretion

Question 35

What happens to GI motility and peristalsis during sympathetic and parasympathetic innervation?

Answer 35

Sympathetic - Motility and peristalsis decrease Parasympathetic - Motility and peristalsis increase

Question 36

What happens to the blood vessels supplying the gut tube during sympathetic and parasympathetic innervation?

Answer 36

Sympathetic - vasocontriction Parasympathetic - Nothing

Question 37

What is the functional difference between the greater, lesser and least splanchnic nerves and the pelvic splanchnic nerves?

Answer 37

Pelvic splanchnic nerve - Parasympathetic fibres Greater, lesser, least splanchnic nerves - Sympathetic nerves

Question 38

How does the arrangement of ganglia differ between sympathetic and parasympathetic nervous systems?

Answer 38

Sympathetic - ganglion are far away from target organ Parasympathetic - ganglion are close to target organ

Question 39

At what vertebral level do the kidneys lie?

Answer 39

T12-L3

Question 40

Why is the right kidney lower than the left?

Answer 40

Presence of the liver on the R.H.S.

Question 41

What are the 3 structures entering the hilum of the kidney?

Answer 41

1) Renal vein 2) Renal artery 3) Pelvis of ureter

Question 42

How are the kidney hilum structures arranged from anterior to posterior?

Answer 42

Anterior - Renal **_V_**ein Middle - Renal **_A_**rtery Posterior - **_P_**elis of Ureter VAP

Question 43

How are the kidneys peritonised?

Answer 43

Retroperitonised

Question 44

How are suprarenal glands peritonised and what is their anatomical relaitonship to the kidneys?

Answer 44

Retroperitoneal Superior and slightly medial to the Kidneys

Question 45

What is the upper expanded area of the ureter called?

Answer 45

Pelvis of Ureter

Question 46

What are the 3 sites where the ureters constrict on its way from the kidney to the bladder?

Answer 46

1) Pelvicoureteric Junction (PUJ) 2) When the ureters cross over the bifurcation of the common iliac arteries 3) Vesicoureteric Junction (VUJ)