10. Peritoneum

Question 1

Peritoneum lines the abdominopelvic cavity and has two layers: parietal and visceral. What is specific to parietal?

Answer 1

Lines body wall
Supplied by same BV, N, LN as region is lines
SENSITIVE to pressure, pain, temperature

Question 2

What is specific to visceral peritoneum?

Answer 2

Covers organs
Supplied by same BV, N, LN as organ
Sensitive to stretch/chemical irritation ** not pain

Question 3

Retroperitoneal means outside the peritoneal cavity and are only partially covered with peritoneum. What is the difference between primary and secondary?

Answer 3

Primary retroperitoneal means they were never covered in a mesentery
Secondary: they used to be covered in mesentery

Question 4

what are the organs that are retroperitoneal in

SAD PUCKER

Answer 4

Suprarenal gland
Aorta/ IVC *
Duodenum +
Pancreas except tail +
Ureters *
Colon- ascending/descending +
Kidneys *
Esophagus
Rectum
\+ means secondary
* means primary

Question 5

As the stomach rotates, you get the greater omentum (dorsal mesentery folds on itself), as well as the space behind the liver and stomach called the?

Answer 5

omental bursa

Question 6

What do the falciform and splenorenal ligament connect?

Answer 6

falciform: from ventral mesentary connects ant body wall with liver
splenorenal: posterior body wall (infront of kidney) and spleen

Question 7

What are the two ligaments from the lesser omentum, which is from the ventral mesentery?

Answer 7

gastrohepatic ligament and hepatoduodenal ligament (PORTAL TRIAD INSIDE, goes from gallbladder to 1st part dudoenum)

Question 8

What are the three ligaments from the greater omentum, which is from the dorsal mesentery?

Answer 8

gastrophrenic: stomach to diaphragm
gastrosplenic: stomach to spleen
gastrocolic: stomach to trasnverse colon

Question 9

Whats the blood supply in the lesser omentum ligaments: hepatoduodenal (3) and hepatogastric (2)?

Answer 9

proper hepatic A, cystic A, right gastric A

Right gastric and left gastric
right and left gastric will anastasmos

Question 10

Whats the blood supply in the greater omentum ligaments: gastrophrenic(1), gastrosplenic(2), and the gastrocolic(2)?

Answer 10

Posterior gastric A
Short gastric A, Left gastro-omental/gastroepiploic A
Right gastroepiploic, Left gastroepiploic

Question 11

What supplies the splenorenal ligament?

Answer 11

splenic A

Question 12

What supplies the transverse mesocolon? (2)

Answer 12

middle colic A

Marginal A

Question 13

What supplies the mesentery (3) and the roof of the mesentery(1)?

Answer 13

Superior Mesenteric A, ileal A, jujunal A

Iliocolic A

Question 14

What supplies the sigmoid mesocolon?

Answer 14

sigmoid A

Question 15

The lesser sac (omental bursa) which sits behind the lesser omentum, communicates with the greater sac which sits behind the greater omentum via the?

Answer 15

epiploic foramen (omental foramen)
opening to lesser sac

Question 16

What is anterior and posterior to the omental foramen?

Answer 16

anterior hepatoduodenal ligmanet with portal triad

posterior IVC/right crus of diaphragm

Question 17

What does the portal triad consist of? which is inside the hepatoduodenal ligament

Answer 17

Proper hepatic artery
Bile duct
hepatic portal vein

Question 18

What is superior and inferior to the opening to the lesser sac, epiploic foramen?

Answer 18

superior is caudate lobe of liver

inferior is 1st part of duodenum

Question 19

What is the pringle maneuver?

Answer 19

Placing fingers into epiploic foramen, and cutting off blood supply to portal triad in the hepatoduodenal ligament

Question 20

What is anterior to the lesser sac? (3)

Answer 20

lesser omentum, stomach, gastrocolic ligament

Question 21

What is posterior to the lesser sac? (6)

Answer 21

pancreas, L suprarenal gland and kidney, aorta, IVC, spenic A/V

Question 22

What is superior to the lesser sac or omental bursa? (2)

Answer 22

Liver, diaphragm

Question 23

What is inferior to the omental bursa? (2)

Answer 23

transverse mesocolon, 1st part of duodenum

Question 24

What is to the left of the lesser sac? (2)

Answer 24

hilum of spleen, gastrosplenic ligament

Question 25

What is to the right of the lesser sac? (1)

Answer 25

epiploic foramen into the greater sac

Question 26

Why is the lesser sac good to have if the pancreas were to rupture anteriorly, or if the stomach were to rupture posteriorly?

Answer 26

the contents would be contained within the lesser sac instead of within the entire abdomen

Question 27

What occurs if there is intestine in the lesser sac? Can any of it's boundaries be cut to release the intestines?

Answer 27

NO, because the portal triad, IVC, aorta cannot be cut... you must pull them out with your hands

Question 28

The transverse mesocolon divides the cavity into two compartments... the supracolic and the infracolic compartment. What is contained in each? (3/3)

Answer 28

stomach, liver, spleen | SI, ascending, descending colon

Question 29

The root mesentery of the small intestine further divides the infracolic compartment into the? How do they communicate?

Answer 29

right infracolic space and the left infracolic space Communicate via the left and right paracolic gutters

Question 30

When a patient is lying down, fluid would most likely reside in what two spaces that are divided by the falciform ligament?

Answer 30

right and left subphrenic spaces | from the lesser sac

Question 31

when the patient sits up, fluid will travel on either side via? Why is one side more narrow than the other?

Answer 31

down via the right and left paracolic gutter. | Left side is more narrow due to the phrenicocolic ligament

Question 32

When the patient is sitting / standing all the way up, fluid will collect in the pelvis, what is the space called in males and females?

Answer 32

males: rectovesicular pouch/space females: rectouterine pouch/space

Question 33

Large invasive, open incision are more painful because the peritoneum is exposed. What causes adhesions in the peritoneum?

Answer 33

when the area is touched, it is very sensitive

Question 34

What is peritonitis and how is it caused?

Answer 34

infection of the peritoneal cavity caused by rupture of infected organ or external trauma, leading to abscesses

Question 35

What is acites?

Answer 35

excess fluid in the peritoneal cavity due to cancer/malnutrition

Question 36

Paracentesis is used to drain the extra fluid... where is the best place to place the needle?

Answer 36

AWAY from the inferior epigastric A, at the most inferior point of the rectouterine/vesicular pouch

Question 37

What vertebral level is the head and tail of the pancreas at?

Answer 37

starts at L2 to L1 (transpyloric plane)

Question 38

What is anterior to the pancreas? (2)

Answer 38

lesser sac and stomach

Question 39

What is posterior to the pancreas? (9)

Answer 39

``` Aorta IVC Splenic Vein Bile duct right crus of the diaphragm left kidney and vessels left suprarenal gland superior mesenteric A/V ```

Question 40

What is to the right of the pancreas? (1)

Answer 40

2nd part of the duodenum (it is craddled by it)

Question 41

What is to the left of the pancreas? (2)

Answer 41

spleen, (tail of pancreas is intraperitoneal)

Question 42

What is inferior to the pancreas? (1)

Answer 42

3rd part of the duodenum

Question 43

The superior mesenteric artery and vein run posterior to the pancreas. Why is this a clinical significance?

Answer 43

Due to how the pancreas is located, the uncinate process goes around the SMA/V, if the cancer grows around the vessels, surgery cannot be performed :(