Peritoneum & Upper Abdomen Viscera Flashcards
What does splanchnic mean?
related to the viscera
What does hepatic mean?
associated with liver
What does cystic mean?
associated with gallbladder
What does pancreatic mean?
associated with pancreas
What does splenic mean?
associated with spleen
What does gastric mean?
associated with stomach
What does colic mean?
associated with the colon
What does recto mean?
associated with the rectum
What does phrenic mean?
associated with diaphragm
What is the peritoneum?
Thin, translucent, serous membrane
Where is the parietal peritoneum?
lines inner abd. wall
Where is the visceral peritoneum?
covers organs
Organs behind the peritoneum are called …
retroperitoneal
True or false: vessels tend to travel between the peritoneal layers
True
What makes up the peritoneal sac?
all visceral & parietal peritoneal membranes
What is the peritoneal cavity?
- a potential space within sac
- contains only a small amount of serous fluid
- allow organs to move freely without friction
What are Marked Ascites & umbilical herniation?
- The potential space of the peritoneal cavity can become an actual space
- May contain up to several liters of fluid (ascites)
- Disease, injury or infection can lead to pooling of fluids (blood, bile, pus, feces)
What are the Double layered Peritoneal Folds & Ligaments?
1) Greater Omentum
2) Lesser Omentum
3) Mesentery Proper
4) Suspensory Ligament of Treitz
5) Mesocolon
6) Falciform Ligament
7) Coronary Ligament
Where is the Greater Omentum?
- attaches to greater curvature of stomach and transverse colon
- Drapes over small intestines like an ‘apron’
- ‘Apron’ = gastrocolic ligament
- 4 layers of peritoneum
- functionally it can wall off infections & inflammation sites
- results in formation of adhesions
What is the Lesser Omentum?
- attaches to lesser curvature of stomach and duodenum
- 2 portions connect these structures to the liver
- Hepatogastric ligament
- connects liver to stomach
- Hepatoduodenal ligament
- connects liver to duodenum
- Contains the portal triad
Portal Triad = hepatic a., portal v., & bile duct
What is the Mesentery Proper?
- Anchors most of the small intestine to posterior abd. wall
- Runs diagonally from duodenojejunal jxn. to ileocecal jxn.
- a distance = 15 to 20 cm in adults
- Note: duodenum anchored by suspensory ligament of Treitz
What is the Suspensory Ligament of Treitz?
- Fibromuscular ligament descends from the R. crus of diaphragm
- Crosses over L. crus & holds distal duodenum in place
- Prevents duodenojejunal jxn. from sagging
What is the Mesocolon?
- Anchors portions of the colon to the posterior abdominal wall
- Ascending & Descending colon have no mesentery
- attached directly to the posterior wall
- Transverse Colon anchored by transverse mesocolon
- Sigmoid colon anchored by sigmoid mesocolon
- Rectum only partially covered with peritoneum
What is the Falciform Ligament?
- Divides liver into R & L lobes
- Anchors liver to diaphragm & anterior body wall
- Round ligament of the liver
*Note: inferior border contains the obliterated umbilical vein.
What is the Coronary Ligament?
- Reflections of peritoneum around the bare area of the liver
- Attach liver to inferior surface of diaphragm
- bare area = upper posterior liver
What are the Single Layered Peritoneal Folds?
1 median umbilical fold
covers fetal urachus
2 medial umbilical folds
covers fetal umbilical aa.
2 lateral umbilical folds
covers inferior epigastric vessels
What are the Infraumbilical peritoneal folds?
median umbilical fold
- from urinary bladder to umbilicus
- covers median umbilical ligament
medial umbilical folds (2)
- covers medial umbilical ligaments
- occuded portions of umbilical aa.
lateral umbilical folds (2)
- covers inferior epigastric vessels
What are Peritoneal Pouches?
- Potential peritoneal spaces in standing patients
- Becomes actual spaces in recumbent patients
- Hepatorenal pouch
- Rectovesical or retrouterine pouch
- Pathological fluids can accumulate in these recesses
What is the Hepatorenal pouch (Pouch of Morrison)?
- Bounded by liver, R kidney, colon & duodenum
- lowest part of peritoneal cavity when recumbent
- fluids may move down to retrovesical/rectouterine pouch – when in reclining position or sitting up
What is the Rectovesical pouch?
- Between rectum & bladder (♂)
- another low point of peritoneal cavity when recumbent
- fluids here may move up to hepatorenal pouch – when in Trendelenburg position
What is the Rectouterine pouch?
- Between rectum & uterus (♀)
- another low point of peritoneal cavity when recumbent
- fluids here may move up to hepatorenal pouch – when in Trendelenburg position
What are the different sides of the liver?
1) Diaphragmatic Liver
2) Visceral Liver - has Porta Hepatis
What/Where is the Gallbladder?
- Attached to inferior surface of liver
- Contacts duodenum, colon & anterior abdominal wall
- Receives bile produced by liver via bile ducts
- Bile then drains into duodenum thru these ducts
What/where are the Bile Ducts?
- R & L hepatic ducts
- receives bile from R & Llobes of liver
- Common hepatic duct
- receives R & L hepatic ducts
- Cystic duct
- connected to gall bladder
- Common bile duct
- receives cystic & common hepatic ducts
Where do the bile ducts drain?
- Common bile duct joins main pancreatic duct
- Both empty into major duodenal papilla in descending part of duodenum
Pancreas
- Consists of a head, neck, body, tail and uncinate process
- Retroperitoneal & transverse across posterior abdominal wall
- Surrounded by C-shaped duodenum on R & spleen on L
Drainage of Pancreatic Ducts
- Enzymes drain from pancreas via 1 or 2 ducts
- Main pancreatic duct
- enters duodenum with bile duct at major duodenal papilla
- Accessory pancreatic duct
- may enter duodenum as well
- ~ 2 cm superior to major papilla
- Pattern of pancreatic drainage variable
What are the surfaces of the spleen?
1) Diaphragmatic surface:
* contacts diaphragm along ribs 9-11
2) Visceral surface
Celiac Trunk
- 1st major br. of Abd aorta
- Supplies liver, gb, esophagus, stomach, pancreas & spleen
- 3 main branches
- Common hepatic
- L. gastric
- Splenic aa.
Common Hepatic A.
- Right br. of celiac trunk
- Runs toward liver & gallbladder
- 2 terminal branches
- Proper hepatic a.
- Gastroduodenal a.
The common hepatic portal run into the ……
- Superior br. of common hepatic a.
- Runs toward liver & medial to bile duct
- Splits into R & L hepatic aa
Gastroduodenal A.
- Inferior br. of common hepatic a.
- Runs toward junction of stomach & duodenum
- sends Supr. pancreaticoduodenal aa. to pancreas/duodenum
- sends R gastroepiploic a to gr. curvature of stomach
L Gastric A.
- Superior br. of celiac trunk
- Runs L toward lesser curvature of stomach
- supplies stomach & esophagus (via esophageal brs.)
Splenic A.
- Left br. of celiac trunk
- Runs toward spleen
- supplies pancreas & spleen
- Sends short gastric aa. & L gastroepiploic a.
- supply greater curvature of stomach
Common variations of Hepatic AA
- variations ~ 40%
- R hepatic a. may arise from SMA
- L hepatic a. may arise from L. gastric a.
- Both R and L hepatic aa. may arise from celiac trunk
- Accessory R & L hepatic aa also common
What is the Cystic A.?
An Additional Hepatic aa. Variation
- usually arises from R hepatic a.
- 75% run post. to common hepatic duct
- 24% run ant. to common hepatic duct
- 1% are double cystic aa.
- Supplies gallbladder & cystic duct
What is the Additional Hepatic aa. Variation?
- usually arises from proper hepatic a.
- May arise from common hepatic or gastroduodenal aa.
- Anastomoses with L. gastric a.
- Supplies lesser curvature of stomach
