The peritoneum Flashcards
what are intraperitoneal organs
- these are organs that are completely surrounded by peritoneum
what are the intraperiotenal organs
- Liver
- Stomach
- Ileum
- Jejunum
what are retroperioteonal organs
behind the peritoneal (can be called secondary or pseudo
what are the two types of retroperiotenal organs
can be called secondary or pseudo
what is the difference between retroperiotenal organs and itnraperiotenal organs
• Retroperitoneal organs are static whereas those that are intraperitoneal can move around a lot
- retroperiotenal organs are less prone to trauma
name the retorperitoenal organs
• distal 3 parts of the Duodenum • Pancreas • Ascending and descending colon • Rectum • Great vessels • Kidneys • Ureters p - bladder
what is the nerve supply to the parietal peritoneum
- it is somatic
- Apart from the inferior part which gets its innervation from the phrenic nerve
what is the nerve supply to the visceral periotenaum
takes blood supply and nerve supply from the organ itself, therefore it is autonomic, can’t feel it, any pain is referred pain
what do the folds of the perioteonum do
- they hold the organs and structures in place
describe the development of the foregut
- begins as a get tube, this gut tube has connections to the anterior and posterior walls of the abdomen
- these are the dorsal and ventral mesogastrium
- organs such as the pancreas and liver grow from the gut tube
- the liver is large and moves to the right this pushes organs such as the stomach to the left
- the stomach also rotates therefore ether lesser curvature points inwards rather than forwards
- this divides the peritoneum into two sacs, smaller is with the stomach this is called the lesser sac and is posterior to the stomach
- can enter the lesser sac through he eipiloic foramen
- the falciform ligament connects liver to anterior abdominal wall
- a double fold from the stomach loops down and grows longer into the greater momentum this envelopes the transverse colon
what is the falciform ligament
o Faliciform ligament connects liver to anterior abdominal wall
what envelopes the transverse colon
o Double fold from stomach loops down and grows linger = greater omentum = original dorsal mesogastrium
As it grows down it envelops the transverse colon
what becomes the greater omentum
- Dorsal mesogastrium becomes the greater ometum
what becomes the lesser omentum
- Vental mesogastrium becomes the lesser omentum
what is the gastrocolic ligament
this is once the periotenum moves down and meets with the transverse colon
what is the bare area of the liver
- The liver grows rapidly and there is a bare area on the liver as there is no periotenum of that area of the liver
what are the regions of the lesser sac
- Hepatic recess, Splenic recess, Omental recess
what is the entrance into the lesser sac
epipcolic foarmen
- this is the only connection between the greater sac and the lesser sac
describe how the midgut develops
- Forms a U-shaped intestinal loop which herniates into the umbilical cord (week 6).
- Because there isn’t enough room in the gut it extends into the umbilic cord to do some rotation and then returns back into the abdominal cavity and finishes its rotation
- Inadequate room in abdomen – rotates 90o is the umbilical cord and then it pulls back in
- Returns to abdomen week 10- rotates further 180o (B shows total 180o with 90o still to go)
- The cecum – needs to distend therefore there is still another 90 degree rotation to go
what is omphalocele
failure of central fusion at the umbilical ring causing incomplete closure of the abdominal wall and persistent herniation of the midgut
- Is fixable
what is the difference between omphalocele and gastroschsis
Gastroschsis
- this is when the gut extends to the right umblicisu and is not converted to the peritoneum therefore it is exposed to ammonites fluid and this can cause damage to the gut and inflammation to the gut
Omphalocele
- failure of central fusion at umbilical ring which causes incomplete closure of the abdominal wall and therefore the intestines do not go back into the gut
what are peritoneal folds
- Reflections of periotenum create the greater and lesser sacs
what is the mesentery proper
- Mesentery proper – suspends the small intesitnes and attachs the intestines to the abdominal wall
what does the falciform ligament contain
- Contains ligamentum teres inferiorly
- Remnant of fetal umbilical vein
what does the lesser omentum do
- Suspends the lesser curvature of the stomach to the liver
where does the lesser omentum thicken
- Lesser omentum thickens and attaches between the hepatoliver and the stomach this is called the hepatogastric ligament
- Where it thickens on the left hand side it is called the hepatoduodenal ligament
what does the greater omentum do
- Extends from the greater curvature of the stomach
- Extends to the front of the small intestine and then attaches to the transverse colon
describe the greater omentum
- Large flap of loose CT and fat
- Vascular
- Gastroepiploic arteries
what is the transverse mesocolon
- From transverse colon to the posterior body wall
what is in the mesentery
– From small intestine to posterior body wall
– Anchors small intestine and provides pathway for blood supply (superior mesenteric artery)
– These will have the mesentery arteries such as the superior and inferior mesentery arteries
why can the peritoneum be used in dialysis
- semipermeable membrane to the gut
how is the peritoneum used in dialysis
- It is an option to clean the blood in the abdomen
- Fluid is allowed to go inot the periotenum
- Pulls out toxin of the blood and filters the blood
- Fluid that is put in is removed
what is it called when the peritoneum becomes full of fluid
Ascities
describe how ascites happens
- Associated with the serous fluid of the liver
- Protein albumin that is produced by the liver is no longer produced
- Lack of osmotic pressure in the blood therefore water and fluid is no longer drawn back into the blood
- Therefore leaking of fluid into the interstitial
what are the secondary retroperitoneal structures (because retroperitoneal they did not start out as retorperitoenal)
– Pancreas (except tail)
– Duodenum (distal parts)
– Ascending and descending colon (seen in cross section)
– Upper rectum
what are the primary retroperitoneal structures
– Lower rectum/anal canal
– Great vessels
– Kidneys
– Ureters
why would you put gas into the abdomen
- Gas into the abdomen so you can visualise the structures more visibly
what are the subdivisions of the peritoneal cavity
- Subphrneic – between diaphragm and liver
- Heptaorenal recess – between liver and kidney
- Lesser sac
- Infracolic
- Suprcolic
what is the sub hepatic recess
- Hepatorenal recess pouch of morrison on the right – fluid can build up here
- Lesser sac on the left
what is the transverse mesocolon divided into
- Divides peritoneal cavity onto supracolic and infracolic compartments
- Paracolic gutter right and left – spaces between the descending and ascending colon and the abdominal wall
what happens if you get an infection in the supra colic region
- Infection in the supracolic region and this can go into the paracolic gutters and this takes longer to absorb so intervention can happen more quickly
