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1H ANA: GIT PART II > Snell:Peritoneum General Arrangement > Flashcards

Snell:Peritoneum General Arrangement Flashcards

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1
Q

What is a peritoneum?

A

The peritoneum is a thin serous membrane that lines the
walls of the abdominalandpelvic cavitiesandclothes
the viscera (Figs. 5.5 and 5.6).

The peritoneum can be regarded as a balloon against which organs are pressed
from outside.

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2
Q

What does the parietal peritoneum lines?

A

The parietal peritoneum lines the walls of
the abdominalandpelvic cavities.

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3
Q

What does the visceral peritoneum covers?

A

covers the organs

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4
Q

What is the peritoneal cavity?

A

. The potential space between
the parietal and visceral layers, which is in effect the inside space of the balloon, is called theperitoneal cavity.

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5
Q

What is the difference of the pelvic cavity between males and females?

A

​In
males, this is a closed cavity, but in females, there is communication with the exterior through the uterine tubes, the uterus, and the vagina

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6
Q

What is the extraperitoneal tissue?

A

Between the parietal peritoneum and the fascial lining
of the abdominal and pelvic walls is alayer of connective
tissuecalled the extraperitoneal tissue; in thearea of the
kidneys, this tissuecontains a large amount of fat, which
supports the kidneys.

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7
Q

What is the largest cavity in the body?

A

peritoneal cavity

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8
Q

The peritoneal cavity is divided into two parts which are?

A
  1. the greater sac and
  2. the lesser sac (Figs. 5.5 and 5.6).
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9
Q

What is the greater sac?

A
  • *main compartment** and **extends from the diaphragm down into the
    pelvis. **
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10
Q

What is the lesser sac?

A

smaller and lies behind the stomach.

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11
Q

What is the epiploic foramen?

A

The greater and lesser sacs are in free communication
with one anotherthrough anoval window called the opening of the lesser sac, or theepiploic foramen (Figs. 5.5
and 5.7).

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12
Q

What is the function of the peritoneum?

A

The peritoneum secretes a small amount of
serous fluid, the peritoneal fluid, which lubricates the
surfaces of the peritoneum and allows free movement
between the viscera.

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13
Q

What are the terms intraperitoneal and retroperitoneal terms?

A

The terms intraperitoneal and retroperitoneal are used to describe the relationship of various organs to their peritoneal
covering.

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14
Q

When can you say that an organ is intraperitoneal?

A

An organ is said to be intraperitoneal when
it is almost totally covered with visceral peritoneum.

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15
Q

GIve examples of Intraperitoneal organs?

A

The stomach, jejunum, ileum, and spleen are good examples of intraperitoneal organs.

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16
Q

What is a retroperitoneal organ?

A

Retroperitoneal organs lie behind
the peritoneumandare only partially covered with visceral peritoneum.

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17
Q
A
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18
Q

What organs are example retroperitoneal organs?

A

The pancreas and the ascending and descending
parts of the colon are examples of retroperitoneal
organs.

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19
Q

No organ, however, is actually within the peritoneal
cavity.

A

T or F

An intraperitoneal organ, such as the stomach,
appears to be surrounded by the peritoneal cavity,but it iscovered with visceral peritoneumand isattached to other organs by omenta.

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20
Q

What is peritoneal igament?

A

two-layered folds of peritoneum
that connect solid viscera to the abdominal walls.

The liver,
for example, is connected to the diaphragm by the falciform ligament, the coronary ligament, and the right and left triangular ligaments (Figs. 5.8 and 5.10).

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21
Q

What connects the liver to the diaphragm?

A
  • falciform ligament,
  • the coronary ligament,
  • and the right and left triangular ligaments (Figs. 5.8 and 5.10).
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22
Q

What is an omenta?

A

two-layered folds of peritoneum that connect
the stomach to another viscus.

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23
Q

What does the greater omentum connects?

A

The greater omentum connects
the greater curvature of the stomach to the transverse
colon(Fig. 5.2).

It hangs down like an apron in front of
the coils of the small intestine and is folded back on itself
to be attached to the transverse colon(Fig. 5.6).

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24
Q

What does the lesser omentum suspends?

A

The lesser omentum suspends the lesser curvature of the stomach from the fissure of the ligamentum venosum and the porta hepatis on the undersurface of the liver (Fig. 5.6).

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25
Q

What does the gastrosplenic
omentum (ligament) connects?

A

stomach to
the hilum of the spleen(Fig. 5.5).

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26
Q

What are mesenteries?

A

two-layered folds of peritoneum connecting
parts of the intestines to the posterior abdominal
wall, for example, the mesentery of the small intestine,
the transverse mesocolon, and the sigmoid mesocolon
(Figs. 5.6 and 5.13).

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27
Q

What permits the blood vessels and nerves to reach the viscera?

A

peritoneal ligaments, omenta, and mesenteries

The extent of the peritoneum and the peritoneal cavity
should be studied in the transverse and sagittal sections of the abdomen seen in Figures 5.5 and 5.6.

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28
Q

Peritoneal Pouches, Recesses, Spaces,
and Gutters

A
  • Lesser Sac
  • Duodenal Recesses
  • Cecal Recesses
  • Intersigmoid Recess
  • Subphrenic Spaces
  • Paracolic Gutters
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29
Q

Where does the Lesser Sac lies?

A

lies behind the stomach and the lesser omentum
(Figs. 5.5, 5.6, and 5.11).

It extends upward as far as the
diaphragm and downward between the layers of the greater omentum.

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30
Q

What forms the left margin of the lesser sac?

A
  • spleen
  • (Fig. 5.11) and the gastrosplenic omentum
  • and splenicorenal ligament.
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31
Q

Where does the right margin of the lesser sac opens?

A

greater sac (the main part of the peritoneal cavity) through the opening of the lesser sac, or epiploic foramen (Fig. 5.7).

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32
Q

The opening into the lesser sac (epiploic foramen) has
the following boundaries (Fig. 5.7):

A

■■ Anteriorly: Free border of the lesser omentum, the bile
duct, the hepatic artery, and the portal vein (Fig. 5.11)
■■ Posteriorly: Inferior vena cava
■■ Superiorly: Caudate process of the caudate lobe of the liver
■■ Inferiorly: First part of the duodenum

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33
Q

What are the duodenal recesses?

A

Close to the duodenojejunal junction, there may be four
small pocketlike pouches of peritoneumcalled the

  • superior duodenal,
  • inferior duodenal,
  • paraduodenal, and
  • retroduodenal recesses (Fig. 5.12).
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34
Q

What are theCecal Recesses?

A

Folds of peritoneum close to the cecum produce three peritoneal recesses called the:

  • superior ileocecal,
  • the inferior ileocecal, and
  • the retrocecal recesses
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35
Q

Where does the intersigmoid recess situated?

A

Intersigmoid Recess
The intersigmoid recess is situated at the apex of the inverted, V-shaped root of the sigmoid mesocolon (Fig. 5.13); its mouth opens downward.

36
Q

What are the Subphrenic Spaces?

A

The right and left anterior subphrenic spaces lie between the diaphragm and the liver, on each side of the falciform ligament (Fig. 5.14).

37
Q

Where does the right posterior subphrenic space lies?

A

between the right lobe of the liver, the right kidney, and the right colic flexure (Fig. 5.15).

The right extraperitoneal space lies between the layers of the coronary ligament and is therefore situated between the liver and the diaphragm
(see page 196).

38
Q

Where does the paracolic gutters lie?

A

lateral and medial sides of the ascending and descending colons, respectively (Figs. 5.5
and 5.14).

39
Q

The parietal peritoneum is sensitive to what?

A
  • pain,
  • temperature,
  • touch, and
  • pressure.
40
Q

What nerve supplies the parietal peritoneum lining the anterior abdominall wall?

A

lower six thoracic and 1st lumbar nerves—that is, the same nerves that
innervate the overlying muscles and skin.

41
Q

What nerve supplies the central part of the diaphragmatic peritoneum?

A

phrenic nerves

42
Q

What nerve supplies the diaphragm peripherally?

A

lower six thoracic nerves.

43
Q

What nerve mianly supplies the parietal peritoneum in the pelvis?

A

obturator nerve

(a branch of the lumbar plexus.)

44
Q

The visceral peritoneum is sensitive only to what?

A

stretch and tearing and is not sensitive to touch, pressure, or temperature.

45
Q

What nerve supplies the visceral peritoneum?

A

It is supplied by autonomic afferent nerves that supply
the viscera or are traveling in the mesenteries.

46
Q

What leads to the pain of the visceral peritoneum?

A

Overdistention
of a viscus leads to the sensation of pain.

47
Q

The mesenteries
of the small and large intestines are sensitive to what?

A

mechanical stretching.

48
Q

Describe the apperance of the peritoneal fluid

A

pale yellow and somewhat viscid, contains leukocytes.

49
Q

What secretes the peritoneal fluid?

A

It is secreted by the peritoneum
and ensures that the mobile viscera glide easily on one
another.

50
Q

What is the reason why the peritoneal fluid is not static?

A

As a result of the movements of the diaphragm
and the abdominal muscles, together with the peristaltic movements of the intestinal tract, the peritoneal fluid is not static.

51
Q

Experimental evidence has shown that particulate
matter introduced into the lower part of the peritoneal cavityreaches the subphrenic peritoneal spaces rapidly,whatever the position of the body.

A
52
Q

It seems that intraperitoneal
movement of fluid toward the diaphragm is continuous
(Fig. 5.14), and there it is quickly absorbed into the
subperitoneal lymphatic capillaries.

Why?

A

This can be explained on the basis that the area of peritoneum is extensive in the region of the diaphragm and the respiratory movements of the diaphragm aid lymph flow in the lymph vessels.

53
Q

What happens in the peritoneal coverings as a result of infection?

A

The peritoneal coverings of the intestine tend to stick
together in the presence of infection.

The greater omentum, which is kept constantly on the move by the peristalsis of theneighboring intestinal tract, may adhere to other peritoneal surfaces around a focus of infection.

In this manner, many of the
intraperitoneal infections are sealed off and remain localized.

54
Q

What is the important role of peritoneal folds?

A

The peritoneal folds play an important part in suspending
the various organs within the peritoneal cavity and
serve as a means of conveying the blood vessels, lymphatics, and nerves to these organs.

Large amounts of fat are stored in the peritoneal ligaments and mesenteries, and especially large amounts can be found in the greater omentum

55
Q

What is the division of peritoneal cavity?

A

Movement of Peritoneal Fluid

The peritoneal cavity is divided into an upper part within the abdomen and a lower part in the pelvis.

The abdominal part is
further subdivided by the many peritoneal reflections into important recesses and spaces, which, in turn, are continued into the paracolic gutters (Fig. 5.15).

56
Q

What provied the natural peritoneal barriers that may hinder the movement of infected peritoneal fluid?

A

The attachment of the transverse
mesocolon and the mesentery of the small intestine to the posterior abdominal wall provides natural peritoneal barriers from the upper
part to the lower part of the peritoneal cavity.

57
Q

In supine position what are the lowest areas of the peritoneal cavity?

A
  • right subphrenic peritoneal space and the
  • pelvic cavity
58
Q

What is the highest area in pelvic cavity when the patient is in supine position?

A

region of the pelvic brim is the highest area (Fig. 5.15).

59
Q

How does infection may gain entrance to the peritoneal cavity?

A

through several routes:

  • from the interior of the gastrointestinal tract and gallbladder,
  • through the anterior abdominal wall, via the uterine tubes in females (gonococcal peritonitis in adults and pneumococcal peritonitis in children occur through this route), and
  • from the blood.
60
Q

Collection of infected peritoneal fluid in one of the subphrenic spaces is often accompanied by infection of the pleural cavity.

What is common to find a in a patient with subphrenic abscess?

A

localized empyema

It is believed that the infection spreads from
the peritoneum to the pleura via the diaphragmatic lymph vessels.

A patient with a subphrenic abscess may complain of pain over the shoulder. (This also holds true for collections of blood under the diaphragm, which irritate the parietal diaphragmatic peritoneum.)

The skin of the shoulder is supplied by the supraclavicular nerves (C3 and 4), which have the same segmental origin as the phrenic nerve, which supplies the peritoneum in the
center of the undersurface of the diaphragm.

61
Q

What is the reason why when there is a subphrenic abscess there is a referred pain over the shoulder?

A

A patient with a subphrenic abscess may complain of pain over the shoulder. (This also holds true for collections of blood under the diaphragm, which irritate the parietal diaphragmatic peritoneum.)

The skin of the shoulder is supplied by the supraclavicular nerves (C3 and 4), which have the same segmental origin as the phrenic nerve, which supplies the peritoneum in the center of the undersurface of the diaphragm.

62
Q

To avoid the accumulation of infected fluid in the subphrenic spaces and to delay the absorption of toxins from intraperitoneal infections, what is the common nursing practice done to the patient?

A

it is common nursing practice to sit a patient up in
bed with the back at an angle of 45°.

In this position, the infected
peritoneal fluid tends to gravitate downward into the pelvic cavity,where therate of toxin absorption is slow (Fig. 5.15).

63
Q

What is referred by the surgeons as the abdominal policman?

A

greater omentum

The lower and the right and left margins are free, and it moves about the peritoneal cavity in response to the peristaltic movements of the neighboring gut.

In the first 2 years of life,
it is poorly developedand thus isless protective in a young child.

Later, however, in an acutely inflamed appendix, for example, the inflammatory exudate causes the omentum to adhere to the appendix and wrap itself around the infected organ (Fig. 5.16).

By this
means, the infection is often localized to a small area of the peritoneal cavity, thus saving the patient from a serious diffuse peritonitis.

64
Q

Explain the Greater Omentum as a Hernial Plug

A

The greater omentum has been found to plug the neck of a hernial sac and prevent the entrance of coils of small intestine.

65
Q

Greater Omentum in Surgery
Surgeons sometimes use the omentum to buttress an intestinal anastomosis or in the closure of a perforated gastric or duodenal
ulcer

T or F

A

True

66
Q

What happens when there is Torsion of the Greater Omentum

A

The greater omentum may undergo torsion, and if extensive, the blood supply to a part of it may be cut off, causing necrosis

67
Q

What is Ascites?

A

Ascites is essentially an excessive accumulation of peritoneal fluid within the peritoneal cavity.

68
Q

How can Ascites occur?

A
  • Ascites can occur secondary to hepatic cirrhosis (portal venous congestion),
  • malignant disease (e.g., cancer of the ovary), or
  • congestive heart failure (systemic venous congestion).
69
Q

How many ml before ascites can be recognized in thin patients clinically?

A

1500 mL has to

accumulate before ascites can be recognized clinically.

In obese
individuals, a far greater amount has to collect before it can be detected. The withdrawal of peritoneal fluid from the peritoneal cavity is described on page 148.

70
Q

What is important to be remembered in the parietal peritoneum in the pelvis?

A

It should always be remembered that the parietal peritoneum in the pelvis is innervated by the obturator nerve and can be palpated by means of a rectal or vaginal examination.

71
Q

An inflamed
appendix may hang down into the pelvis and irritate the parietal peritoneum.

How

A

A pelvic examination can detect extreme tenderness
of the parietal peritoneum on the right side (see page 268).

72
Q

What is the reason why the referred pain in the GIT is in the midline?

A

The visceral peritoneum, including the mesenteries, is innervated by autonomic afferent nerves.

Stretch caused by overdistension
of a viscus or pulling on a mesentery gives rise to the sensation of pain.

The sites of origin of visceral pain are shown in Figure 5.17.
Because the gastrointestinal tract arises embryologically as a midline structure and receives a bilateral nerve supply, pain is
referred to the midline.

73
Q

Describe the pain arising from an abdomina viscus?

A

Pain arising from an abdominal viscus is dull and poorly localized (see Abdominal Pain, page 224).

74
Q

Where is the peritoneal cavity derived embyrologically?

A

Once the lateral mesoderm has split into somatic and splanchnic layers, a cavity is formed between the two, called the intraembryonic coelom.

The peritoneal cavity is derived from that part
of the embryonic coelomsituatedcaudal to the septum transversum.

In the earliest stages, the peritoneal cavity is in free communication with the extraembryonic coelom on each side (Fig.
4.36B).

Later, with the development of the head, tail, and lateral folds of the embryo, this wide area of communication becomes restricted to the small area within the umbilical cord.

75
Q

What is the dorsal mesentery?

A

Early in development, the peritoneal cavity is divided into right and left halves by a central partition formed by the dorsal mesentery, the gut, and the small ventral mesentery (Fig. 5.18).

76
Q

What is the reason why abdominal cavity becomes greatly reduced at about the 6th week of development.

A

However, the ventral mesentery extends only for a short distance along the gut (see below), so that below this level the right and left halves of the peritoneal cavity are in free communication
(Fig. 5.18).

As a result of the enormous growth of the liver
and the enlargement of the developing kidneys, the capacity of the abdominal cavity becomes greatly reduced at about the 6th week of development.

It is at this time that the small remaining
communication between the peritoneal cavity and extraembryonic coelom becomes important.

An intestinal loop is forced out of the abdominal cavity through the umbilicus into the umbilical
cord.

This physiologic herniation of the midgut takes place duringthe 6th week of development.

77
Q

When does the physiologic herniation of the midgut takes place ?

A

6th week of development.

78
Q

From where does the peritoneal ligaments are developed?

A

ventral and dorsal mesenteries.

79
Q

From where does the ventral mesentery is formed?

A

mesoderm of the septum transversum (derived from the cervical somites, which migrate downward).

The ventral mesentery
forms the falciform ligament, the lesser omentum, and the coronary
and triangular ligaments of the liver (Fig. 5.18).

80
Q

The ventral mesentery forms what structures?

A
  • falciform ligament,
  • the lesser omentum, and the
  • coronary ligament
  • triangular ligaments of the liver (Fig. 5.18).
81
Q

How is the dorsal mesentery formed?

A

fusion of the splanchnopleuric mesoderm on the two sides of the embryo.

It extends from the posterior abdominal wall to the posterior border of the abdominal part of the gut (Figs. 4.36 and 5.18).

82
Q

The dorsal
mesentery forms what structures?

A
  • gastrophrenic ligament,
  • the gastrosplenic omentum,
  • the splenicorenal ligament,
  • the greater omentum, and
  • the mesenteries of the small and large intestines.
83
Q

What causes the rotation of the stomach and duodenum?

A

The extensive growth of the right lobe of the liver pulls the ventral mesentery to the right and causes rotation of the stomach and duodenum (Fig. 5.19).

By this means, the upper right part of the peritoneal cavity becomes incorporated into the lesser sac.

The right free border of the ventral mesentery becomes the right border of the lesser omentum and the anterior boundary of the entrance into the lesser sac.

84
Q

Where is the spleen developed from?

A

upper part of the dorsal mesentery,

85
Q

How is the greater omentum formed?

A

result of the rapid and extensive growth of the dorsal mesentery caudal to the spleen.

To begin with, the greater omentum extends from the
greater curvature of the stomach to the posterior abdominal wall superior to the transverse mesocolon.

With continued growth,
it reaches inferiorly as an apronlike double layer of peritoneum anterior to the transverse colon

86
Q
A

1H ANA: GIT PART II (2 decks)

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