SDL - Peritoneum Flashcards
What is the parietal peritoneum?
Parietal peritoneum lines the walls of the abdominal cavity. It clothes the anterior and posterior abdominal walls, the under surface of the diaphragm and the cavity of the pelvis.
What is the nerve supply of the parietal peritoneum?
Thoracoabdominal nerves
Intercostal, subcostal, iliohypogastric, ilioinguinal nerves
What are the upper parts of the pelvic organs covered by?
The upper parts of the pelvic organs (rectum, uterus, bladder) project into the abdominal cavity and are covered by visceral peritoneum which hangs down in pouches between them
When in situ, are the following organs are retro/intraperitoneal?:
- Stomach
- Liver
- Gall bladder
- Spleen
- Duodenum
- Pancreas
- Kidneys
- Jejunum and ileum
- Caecum
- Appendix
- Ascending, transverse, descending, sigmoid colon
- Rectum
Intra: Stomach, liver, gallbladder, spleen, tail of pancreas, 1st part of duodenum, jejunum, ileum, appendix, transverse colon, sigmoid colon
Retro: Rest of duodenum, pancreas, kidneys, caecum, ascending colon, descending colon, rectum
What is found at the free edge of the falciform ligament?
Ligamentum teres
What is the ligamentum teres a remnant of?
Umbilical vein
What is an adhesion?
Pathological connection between the GI tract and the parietal peritoneum or another viscus
What is attached to the posterior surface of the greater omentum?
Transverse colon
What does the transverse mesocolon divide?
The greater sac into the supracolic and infracolic compartment
What is found between the liver and the diaphragm?
The subphrenic space (in supracolic compartment)
What is the subphrenic space divided into?
Right and left by the falciform ligament
What space is found under the liver?
Subhepatic channel
What is the inferior limit of the subhepatic channel?
The transverse mesocolon
What space is found to the right of the subhepatic channel? What is this pouch continuous with?
Hepatorenal pouch
With the right paracolic gutter
Why is the hepatorenal pouch of surgical importance?
Fluid can collect here when the individual is supine
Which 3 structures are enclosed within the free border of the lesser omentum?
Portal triad:
Anterior left - hepatic artery
Anterior right - bile duct
Posterior - hepatic portal vein
What is the embryological origin of the lesser omentum?
Ventral mesogastrium
What is the ventral mesogastrium?
A ventral mesentery of the embryonic stomach that persists as the falciform ligament and the lesser omentum
What forms the anterior, inferior, superior and posterior boundary of the epiploic foramen?
Anterior margin: Portal triad
Posterior margin: IVC
Superior margin: Caudate lobe
Inferior margin: First portion of duodenum
Where is the gastrocolic ligament found?
The part of the greater omentum between the greater curvature of the stomach and the transverse colon
How many layers of peritoneum make up the greater omentum as it runs between the greater curvature of the stomach and the transverse colon?
6
How many layers of peritoneum make up the greater omentum inferior to the transverse colon?
4
What is the space enclosed between the anterior and posterior layers of the greater omentum part of?
Lesser sac
Where is the gastrosplenic ligament?
Part of greater omentum, runs from greater curvature to spleen
How is the lienorenal ligament formed?
From the spleen, this same fold continues to the posterior abdominal wall where it attaches in the region of the left kidney
What runs in the lienorenal ligament?
The terminal part of the splenic artery
What does the infracolic compartment contain?
The main mass of intestinal coils.
Where is the beginning of the large intestine?
In the right iliac fossa
Is the splenic or the hepatic flexure higher?
The splenic flexure (due to the great bulk of liver on the right)
What is located between the splenic flexure and the diaphragm?
A small transverse fold of peritoneum –> the phrenico-colic ligamen
N.B. there is NO phrenico-colic ligament on the right
Where are the right and left paracolic gutters located?
On the lateral aspects of the ascending and descending colons
Why are the paracolic gutters clinically important?
Movement of free fluid from compartments within the abdomen
Describe the mesentery of the small intestine
First part of duodenum is intraperitoneal. Rest of duodenum is retroperitoneal. Mesentery begins at the duodenojejunal flexure so the jejunum and ileum are intraperitoneal.
What is the root of the mesentery?
The line of attachment of the mesentery to the posterior wall
What is the infracolic compartment divided into? By what?
Left and right parts by the mesentery of the small intestine
What side of the infracolic compartment communicates with the pelvis?
Left
Where does the small intestine terminate? What is also found here?
Right iliac fossa
The caecum and the appendix and its associated meso-appendix
What does the mesoappendix contain?
Appendicular artery (branch of the iliocolic)
How is ‘normal’ sensory info from an organ generally transmitted?
Through visceral sensory fibres that accompany the parasympathetic motor fibres supplying that organ
What is the parasympathetic motor supply to the foregut and midgut?
Vagus nerve
What is the parasympathetic motor supply to the hindgut?
Pelvic splanchnic
What is the parasympathetic motor supply to the bladder?
Pelvic splanchnic
How is ‘painful’ sensory info from an organ generally transmitter?
Through visceral sensory fibres that accompany the sympathetic motor fibres accompanying the organ
What is the sympathetic motor supply to the abdominal and pelvic viscera?
Greater, lesser, least and lumbar splanchnic nerves
Where are painful sensations from the viscera vaguely localised to?
The median plane
What are the parietal layers innervated by?
Sensory branches of somatic nerves
Why does pain from parietal layers localise well?
As it signals through the somatic systems
Early in acute appendicitis, what is inflamed? Where is pain felt?
Only the vermiform appendix and visceral peritoneum
Pain felt in the central abdomen
As soon as the parietal peritoneum becomes inflamed in appendicitis, where is the pain?
Pain localises to right iliac fossa (pain associated with somatic structures of the abdominal wall as you cannot feel pain ‘in the appendix’)
This is referred pain
Where is cardiac pain felt?
Left arm
Where is gall bladder pain felt?
Right shoulder
Where is ureteric pain felt?
External genitalia
