Peritoneum & Upper Abdomen Viscera Flashcards
Associated with liver
Hepatic
Associated with gallbladder
Cystic
Associated with pancrease
Pancreatic
Associated with spleen
Splenic
Associated with stomach
Gastric
Associated with colon
Colic
Associated with rectum
Recto
Thin, translucent, serous membrane
Peritoneum
lines inner abdonimal wall
Parietal peritoneum
Covers organs
Visceral peritoneum
Organs behind the peritoneum
Retroperioneal
Where do vessels travel?
Between peritoneal layers
The peritoneum consists of two continuous layers:
Parietal peritoneum and visceral peritoneum.
Spleen and stomach : completely covered by visceral peritoneum
Intraperitoneal
organs also include portions of the duodenum and pancreas
Retroperitoneal
all visceral & parietal peritoneal membranes
Peritoneal sac
- a potential space within sac
- contains only a small amount of serous fluid
- allow organs to move freely without friction
Peritoneal cavity
Within the abdominal cavity and continues into the pelvic cavity
Peritoneal cavity
Lesser sac
Omental bursa
May contain up to several liters of fluid
Ascites
Disease, injury or infection can lead to pooling of fluids (blood, bile, pus, feces)
Peritoneal cavity
Marked Ascites & umbilical herniation
Problems with peritoneal cavity
Peritoneal membranes enclose and fold around the
Viscera
How many layers in peritoneal cavity
Double layers
Double layers fold forms or ligament
splenalrenal lig, lesser omentum
Omental bursa and greater sac communicate through
Omental foramen
- Attaches to greater curvature of stomach and transverse colon
- Drapes over small intestines like an ‘apron
Greater Omentum
Gastrocolic ligament
4 layers of peritoneum
- functionally it can wall off infections & inflammation sites
- results in formation of adhesions
Greater Omentum
gastrocolic ligament (largest portion) + gastrosplenic ligament and gastrophrenic ligament (to diaphragm)
Greater omentum
Where does the greater omentum originate from?
Dorsal mesentery
- Attaches to lesser curvature of stomach and duodenum
- 2 portions connect these structures to the liver
Lesser Omentum
Connects liver to stomach
Hepagastric ligament
- Connects liver to duodenum
- Contains the portal triad
Hepatoduodenal ligament
What is the portal triad made up of?
hepatic a., portal v., & bile duct
What is deep to the Lesser Omentum
Omental bursa
Hepatogastric ligament (largest portion) + hepatoduodenal ligament (contains the portal triad = hepatic a., portal v., bile duct)
Lesser Omentum
Where does the lesser omentum derive from?
Ventral mesenteries
- Anchors most of the small intestine to posterior abd. wall
- Runs diagonally from duodenojejunal jxn. to ileocecal jxn.
Mesentery proper
What is the duodenum anchored by?
Suspensory ligament of Treitz
Where is the vascular supply to the mesentery proper?
Mesentery root
- Fibromuscular ligament descends from the R. crus of diaphragm
- Crosses over L. crus & holds distal duodenum in place
- Prevents duodenojejunal jxn. from sagging
Suspensory ligament of duodenum (of Treitz)
Important location for surgery
Suspensory ligament of duodenum (of Treitz)
Anchors portions of the colon to the posterior abdominal wall
Mesocolon
What do the ascending and descending colon attach to?
Posterior wall (have no mesentery)
What anchors the transverse colon?
Transverse mesocolon
What anchors the sigmoid colon?
Sigmoid mesocolon
Is the rectum fully covered with peritoneum?
No it’s partially covered
Transvers mesocolon divides the abdominal cavity into 2 compartments:
Supracolic compartment & Infracolic compartment
Contains stomach, liver and spleen
Supracolic compartment
Contains small intestine and ascending and descending colon
Infracolic compartment
Potential space of capillary thinness.
Peritoneal cavity
- Divides liver into R & L lobes
- Anchors liver to diaphragm & anterior body wall
Falciform ligament
inferior border contains the obliterated umbilical vein.
Falciform ligament
At the bottom of the falciform ligament
Round ligament of the liver
What does the left umbilical vein become after birth?
Ligamentum teres hepatis
Round ligament of the liver in embryo
Umbilical vein
- Reflections of peritoneum around the bare area of the liver
- Attach liver to inferior surface of diaphragm
Coronary Ligament
Upper posterior liver
Bare area
Where is the bare area in the cavity
retroperitoneal
from urinary bladder to umbilicus
median umbilical fold
- covers median umbilical ligament
- -Fetal Urachus
median umbilical fold
covers medial umbilical ligaments
medial umbilical folds
occluded portions of umbilical aa
medial umbilical folds
covers inferior epigastric vessels
Lateral umbilical folds
The fossae between the medial and the lateral umbilical folds
Medial inguinal fossae Inguinal triangles (hesselbach triangles
Potential site of inguinal hernias
Inguinal triangles (hesselbach triangles
Lateral to the lateral umbililcal folds, including the deep inguinal rings.
Lateral inguinal fossae
Most common type of hernia
Indirect
original allantoic diverticulum that persists throughout much of development as a stalk which extends from the bladder and is continuous (the allantois) to the umbilical region
Fetal Urachus
As the allantois constricts and becomes the thick fibrous cord, the urachus. It extends from the apex of the bladder to the umbilicus
Median Umbillical ligament
Potential peritoneal spaces in standing patients
Peritoneal pouches
Becomes an actual space in recumbent patients
- Hepatorenal pouch
- Rectovesical or rectouterine pouch
Pathological fluids can accumulate in these recesses
Peritoneal pouches
Lowest point of the abdominal cavity
Hepatorenal recess
Morrisons pouch
aka hepatorenal pouch
Lowest point of pelvic cavity
Rectovesical pouch or rectoutero (female)
Bounded by liver, R kidney, colon & duodenum
Hepatorenal Pouch
Fluids may move down to rectovesical/rectouterine pouch from this – when in reclining position or sitting up
Hepatorenal Pouch
Fluids here may move up to hepatorenal pouch – when in Trendelenburg position
Rectovesical & Rectouterine pouch
detoxifies chemical products & produces bile
Liver
Stores bile for emulsification of fats
Gallbladder
produces enzymes for digestion
Pancreas
produces lymphocytes & filters blood
Spleen
stores food prior to entering duodenum
Stomach
1° for chemical digestion
Small intestine
2° for chemical digestion
Large intestine
filter waste products out of blood
Kidneys
Cortices produce steroid hormones & medullas act as sympathetic ganglia (release Epinephrine & NE)
Adrenal glands
Associated with diaphragm
Phrenic
- Adjacent to diaphragm
- Smooth and dome shape
Diaphramatic surface
Entrance for portal triad & is found inferiorly
Porta hepatis
Attached to inferior surface of liver
–Fundus, body, & neck
Gallbladder
- Contacts duodenum, colon & anterior abdominal wall
- Receives bile produced by liver via bile ducts
- Bile then drains into duodenum thru these ducts
Gallbladder
Receives bile from R & L lobes of liver
R & L hepatic ducts
Receives R & L hepatic ducts
Common hepatic duct
Connected to gall bladder
Cystic duct
Receives cystic & common hepatic ducts
Common bile duct
Joins with the pancreatic duct & drains into the descending part of the duodenum at the major duodenal papilla
Common bile duct
What does the common bile duct join to
Main pancreatic duct
Bile duct and main pancreatic duct empty to
Major duodenal papilla
Collect enzymes and joins inferiorly at bile duct at major duodenal papillae
Main pancreatic duct
Indicates junction between foregut and midgut
Major duodental papillae
Consists of a head, neck, body, tail and uncinate process
Pancreas
- Retroperitoneal & transverse across posterior abdominal wall
- Surrounded by C-shaped duodenum on R & spleen on L
Pancreas
Enters duodenum with bile duct at major duodenal papilla
Main pancreatic duct
may enter duodenum as well
~ 2 cm superior to major papilla
Accessory pancreatic duct
Pancreas draining digestive enzymes
Exocrine function
Contacts diaphragm along ribs 9-11
Diaphragmatic surface
Connected to the greater curvature of the stomach by the gastrosplenic ligament which contains the short gastric and gastro-omental vessels and left kidney by the splenorenal igament which contains the splenic vessels.
Spleen
What is the spleen surrounded by?
Visceral peritoneum except the area of the hilum
Where is the arterial supply of the splenic artery from?
Celiac trunk
Branches of celiac trunk
Common hepatic
Left gastric
Splenic artery
Supplies liver, gb, esophagus, stomach, pancreas & spleen
Celiac trunks
1st unpaired major branch of aorta
Ciliac trunk
- Right br. of celiac trunk
- Runs toward liver & gallbladder
- 2 terminal branches
Common hepatic Artery
Terminal branches of common hepatic artery
Proper hepatic a
Gastroduodental a
- Superior br. of common hepatic a.
- Runs toward liver & medial to bile duct
- R Gastric a.
- Splits into right and left hepatic aa
Proper heptatic artery
What does the right gastric artery anastomoses with?
Left gastric artery
Arteries are named for
Where they supply
- Inferior br. of common hepatic a.
- Runs toward junction of stomach & duodenum
Gastroduodenal A
- sends Supr. pancreaticoduodenal aa. to pancreas/duodenum
- sends R gastroepiploic a. (R gastro-omental a.) to greater curvature of stomach
Gastroduodenal A
- Superior br. of celiac trunk
- Runs L toward lesser curvature of stomach
Left gastric artery
-Supplies stomach & esophagus (via esophageal brs
Left gastric artery
- Left br. of celiac trunk
- Runs toward spleen
-supplies pancreas & spleen
Splenic Artery
- Sends short gastric aa. & L gastroepiploic a. (L gastro-omental a.)
- -supply greater curvature of stomach
Splenic Artery