The Peritoneum Retroperitoneum Flashcards
The thorax is separate from the abdominopelvic cavity by what?
Diaphragm
Within the abdominopelvic cavity the peritoneal cavity is separated from the retroperitoneal cavity by what?
Peritoneal membrane
What is the peritoneal membrane?
Thin layer that lines the abdominal cavity and produces serous fluid
What does the peritoneal membrane contain? 4
- Fat
- Blood vessels
- Lymphatics
- Nerves
What does the peritoneal membrane create? 2
1. Potential space/ cavity
2. Ligaments and folds (which anchor organs)
What does the peritoneal membrane allow?
Free movement between organs and decreases friction
What are the two layers of the peritoneal cavity? 2
- Parietal
- Visceral
During fetal development structures move into the abdominal cavity form the posterior abdominal wall. Some organs become enclosed within folds of the peritoneum? What are these organs?
Intraperitoneal organs
During fetal development structures move into the abdominal cavity form the posterior abdominal wall. Some do not migrate into the cavity so only their surfaces are covered with peritoneum? What are these organs?
Retroperitoneal
What are four types of peritoneal folds?
- Mesentery
- Mesocolon
- Greater omentum
- Lesser omentum
What is the mesentary?
Peritoneal folds connecting small bowel to the posterior abdominal wall
What is the mesentary shaped like?
Large and fan shaped
What is the mesocolon?
Peritoneum attached to the colon
What does the mesocolon connect?
Transverse colon and sigmoid to the posterior abdominal wall
What does the mesocolon connect?
Transverse colon and sigmoid to the posterior abdominal wall
What is the lesser omentum? and what does it connect?
- Double layer of mesentery
- Connects lesser curve of stomach and 1st part of duodenum to the visceral surface of the liver
What is the greater omentum? What does it connect?
Apron like fold that connects the greater curvature of the stomach and the transverse colon
What are the ligaments of the peritoneum?
Double folds of peritoneum
The names of the ligaments of the peritoneum relates to what?
Organs they are attached to
What three things does the ligaments of the peritoneum convey? 3
- Blood
- Lymphatics
- Nerves
Where does the falciform ligament travel? What does it conduct?
From umbilicus to liver and conducts the ligamentum teres.
How does the Falciform ligament travel? What does the falciform ligament splits into?
Anterior, superior liver and splits into
1. Triangular ligaments
2. Coronary ligaments
What part are the coronary ligaments attached to? 2
- Parietal peritoneum
- Posterior liver
What is the ligamentum teres? Where does it run and join?
- Remnant of the fetal umbilical vein
- Runs in the falciform ligament and joins the LPV at the porta hepatis
What is the ligamentum venosum? what does it attach to?
- Remnant of the fetal ductus venosum
- Attaches to the LPV
What does the triangular ligaments?
Corners of the bare area
What does the hepatoduodenal ligaments conduct? 3
MPV, CD and HA
What are peritoneal spaces?
- Potential spaces which exist between the parietal and visceral layers of peritoneum
What can collect in the peritoneal sac space? 4
- Pathology
- Fluid
- Blood
- Pus
What is included in the right subhepatic space?
Morisons pouch
Where is the right subhepatic space located? 2
- Posterior to the right lobe of the liver
- Anterior to the upper pole of the right kidney
What is the most dependent portion of the subhepatic space?
Morisons pouch
Where is the left subhepatic space located? And what does it include?
Anterior and posterior recesses, includes lesser sac
What is the subphrenic space defined by?
Liver and diaphragm
What divides the subphrenic space into left and right ligaments?
falciform ligaments
What is another name for the lesser sac?
Omental bursa
What does the lesser sac communicate with? 3
- Epiploic
- Foramen/ foramen of winslow
- Omental foramen/ neck
Where is the IVC and the caudate lie in conjunction to the Lesser sac?
The IVC lies posterior to the opening and the caudate lies superior
Where does the lesser sac lie in relation to the Stomach and the pancreas?
The Stomach lies anterior to the lesser sac and the pancreas lies posterior
Where does the lesser sac lie in relation to the Stomach and the pancreas?
The Stomach lies anterior to the lesser sac and the pancreas lies posterior
How much of the peritoneal cavity does the greater sac account for?
Most of the space in the peritoneal cavity
Where does the lesser sac lie in relation to the greater sac?
Anterior superiorly and posterior inferiorly
The transverse mesocolon divides the greater sac into what?
Supramesocolic and inframesocolic comportments
The inframesocolic compartment is divided into left and right by what?
The root of the mesentery
The right and left compartments of the inframesocolic are divided into medial and lateral areas by what? 2
- The ascending colon (right)
- The descending colon (left)
How many paracolic gutters do we have?
Two
1. Right paracolic
2. Left paracolic
What is the right paracolic gutter?
Space between the ascending colon and right lateral abdominal wall
What is the left paracolic gutter?
Space between the descending colon and left lateral abdominal wall
Sonographically what does the parietal peritoneum appear? 2
- Thin smooth echogenic line (peritoneal line)
- Deep layer of anterior abdominal wall
Sonographically what does the small bowel mesentery look like? 3
- Seen with ascites
- Free floating smooth leaves
- Directed towards the center of the abdomen
What does this image demonstrate in terms of the peritoneium?
The peritoneal line
What does this image demonstrate?
Morrisons pouch/ ascites
What does this image demonstrate?
Gallbladder/ ascites
What does this image demonstrate?
Ascites/ bowel
Where is the retroperitoneum located in relation to the peritoneum?
Posterior
Where is the retroperitoneum located in relation to the transversalis fascia
Anterior
What is the superior boundary and inferior boundary of the retroperitoneum?
Superior is the diaphragm and inferior is the pelvic brim
What are the three compartments of the retroperitoneum?
- Anterior pararenal
- Perirenal
- Posterior pararenal
What is the anterior boundary of the Anterior pararenal space?
Peritoneum
What is the posterior boundary of the Anterior pararenal space?
Gerota’s fascia
What are the structures in the anterior pararenal space? 3
- Ascending/descending colon
- Duodenum
- Pancreas
What is communication like for the anterior pararenal space? 2
- Communicates across midline
- Communicates with posterior pararenal space and pelvis
What encloses the perirenal space?
Renal fascia
What are the structures in the perirenal space? 4
- Kidneys
- Adrenals
- Ureters
- Great vessels
What is communications like for the perirenal space? 2
- Communications with pelvic space
- No communication across midline
What is posterior to the posterior pararenal space?
Renal fascia
What is the posterior pararenal space anterior to?
Transversalis fascia
What are structures in the posterior pararenal space? 2
- No solid organs
- Contains fat
What are scanning techniques used to see the peritoneal/ retroperitoneal cavity? 3
- Use a 3.5 to 5 MHz probe
- Patients should fast overnight to decrease bowel gas
- Graded compression can be applied to displace gas
What is the role of ultrasound for the peritoneal/ retroperitoneal cavity? 6
Identify and characterize lesions in
1. Pancreas
2. Kidneys
3. Adrenals
4. Duodenum
5. Colon
6. Lymph nodes
What does ultrasound allows us to asses in terms of the peritoneal/retroperitoneal cavity? 2
- Assess aortic aneurysms
- Provide guidance for interventional procedures