Lecture 3- Peritoneum Flashcards

1
Q

Arteries that supply blood to the foregut?

A

Celiac trunk:

-Splenic, left gastric, and common hepatic

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2
Q

Ventral mesentery of the foregut?

A
  • Lesser omentum
  • Falciform ligament
  • Coronary/triangular ligaments
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3
Q

Dorsal mesentery of the foregut?

A
  • Gastrosplenic ligament
  • Splenorenal ligament
  • Gastrocolic ligament
  • Greater omentum
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4
Q

Motor nerve supply of the foregut?

A

Vagus nerve

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5
Q

Organs within the midgut?

A
  • 2nd half of duodenum
  • Jejunum
  • Ileum
  • Cecum (appendix)
  • Ascending colon
  • Proximal 2/3 of transverse colon
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6
Q

Arteries that supply blood to the midgut?

A

Superior mesenteric artery

-Ileocolic, right colic, and middle colic

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7
Q

Ventral mesentery of the midgut?

A

None

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8
Q

Dorsal mesentery of the midgut?

A
  • Mesointestine
  • Mesoappendix
  • Transverse mesocolon
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9
Q

Motor nerve supply of the midgut?

A

Vagus nerve

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10
Q

Organs within the hindgut?

A
  • Distal 1/3 of transverse colon
  • Descending colon
  • Sigmoid colon
  • Rectum
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11
Q

Arteries that supply blood to the hindgut?

A

Inferior mesenteric artery

-Left colic, sigmoid branches, superior rectal

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12
Q

Ventral mesentery of the hindgut?

A

None

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13
Q

Dorsal mesentery of the hindgut?

A

Sigmoid mesocolon

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14
Q

Motor nerve supply of the hindgut?

A

Pelvic splanchnic nerves

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15
Q

Peritoneum

  • What is it?
  • 2 layers?
A
  • A serous membrane

- Parietal and visceral layers (just like pleura and pericardium)

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16
Q

Peritoneum

-Parietal layer?

A
  • Lines the body wall

- Has abundant pain fibers

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17
Q

Peritoneum

-Visceral layer (serosa)?

A
  • Covers viscera

- Lacks pain fibers

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18
Q

Nerve supply to the parietal peritoneum

  • Supplied by?
  • Type of fibers they supply?
  • What type of pain do they conduct?
A
  • Nerves from the adjacent body wall supply parietal peritoneum
  • Supply pain and vasomotor fibers
  • Conduct sharp, stabbing pain-Rigid abdomen/”guarding”
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19
Q

Visceral peritoneum-Invests viscera/organs

-Blood supply, lymphatic vasculature and visceral nerve supply?

A

Same blood supply, lymphatic vasculature, and visceral nerve supply as the organs it covers

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20
Q

Visceral peritoneum

  • Insensitive to?
  • Sensitive to?
A
  • Insensitive to touch, heat, cold, and laceration

- Sensitive to stretching and chemical irritation

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21
Q

Visceral Peritoneum

  • Pain from visceral peritoneum?
  • Type of pain?
  • Type of fibers?
A
  • Poorly localized-e.g. referred pain
  • Crampy, colicky pain
  • Unmyelinated type C fibers
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22
Q

General relations of viscera to peritoneum

  • Intraperitoneal organs
    • Covered by?
    • Suspended by?
A
  • Covered on most sides by visceral peritoneum

- Suspended by mesentery from the body wall

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23
Q

Retroperitoneal organs

  • Position relative to parietal peritoneum?
  • Covered by?
A
  • Lie deep (“retro”) to the parietal peritoneum

- Covered by parietal peritoneum on ONE SIDE ONLY

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24
Q

Organs of the abdomen and pelvis

-Intraperitoneal organs in the abdominal peritoneal cavity?

A
  • Stomach
  • Small intestine (some of superior part of duodenum, all of jejunum and ileum)
  • Spleen
  • Liver
  • Gallbladder
  • Cecum (and appendix)
  • Large intestine (transverse and sigmoid)
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25
Q

Intraperitoneal organs in the pelvic peritoneal cavity?

A

Uterus (fundus and body), ovaries, and uterine tubes

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26
Q

Primarily vs secondarily retroperitoneal?

A

Secondarily retroperitoneal is when the organ loses its mesentery during development

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27
Q

Organs that are primarily retroperitoneal?

-Easy way to remember this?

A
  • Kidneys
  • Uretrers
  • Adrenal glands
  • Gonads/uterine cervix
  • Aorta and IVC
    • “Ask yourself if the organ is part of the gut? If the answer is no, then it is primarily retroperitoneal”
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28
Q

Organs that are secondarily retroperitoneal?

A
  • Duodenum (descending, horizontal, and ascending)
  • Pancreas
  • Ascending and descending colon
  • Rectum (upper 2/3)
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29
Q

Organs that are infraperitoneal/subperitoneal?

A
  • Urinary bladder
  • Distal ureters
  • Prostate
  • Seminal vesicle
  • Vagina
  • Rectum (lower 1/3)
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30
Q

Peritoneal reflections in the adult

-Mesenteries

A
  • 2 layered fold of the peritoneum

- THE mesentery

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31
Q

THE mesentery

-What does it attach?

A
  • Attaches the “free” small intestine to the posterior body wall
  • Jejunum
  • Ileum
32
Q

Ventral mesentery

-Mesentery attached to the stomach?

A

Mesogastrium

33
Q

The mesogastrium is the mesentery attached to the stomach

-Associated with the dorsal or ventral mesentery?

A

Ventral mesentery

34
Q

The dorsal aorta and its 3 branches run through which mesentery?

A

The dorsal mesentery

35
Q

The ventral mesentery only extends from what to what?

A

The ventral mesentery only extends from the respiratory diaphragm to the duodenum

36
Q

Subdivisions of mesentery

  • Transverse mesocolon
    • Function?
    • Fuses with?
A
  • Mesentery of the transverse colon
  • Holds the transverse colon to the posterior body wall
  • Fuses with the posterior layer of the greater omentum
37
Q

Sigmoid mesocolon

-Function?

A
  • Mesentery of the sigmoid colon

- Holds the sigmoid colon to the posterior body wall

38
Q

Mesoappendix

A

Mesentery of the vermiform appendix

39
Q

Peritoneal “ligaments”

  • May be subdivisions of a larger structure
  • Usually transmit?
  • Usually lack?
  • 2 examples?
A
  • Usually transmit nerves and vessels
  • Usually lack CT and are not the same as ligaments that join bones
  • Gastrosplenic and splenorenal ligaments
40
Q

Omentum (epiploon)

A

Broad, 2 layered sheet of peritoneum that attaches the stomach to other viscera

41
Q

Lesser omentum

-Develops from?

A

-Develops from the ventral mesogastrium (mesentery)

42
Q

Lesser omentum

-Subdivided into 2 parts?

A
  • Subdivided into 2 parts:
    • Hepatogastric ligament (stomach to liver)
    • Hepatoduodenal ligament (liver to duodenum)
43
Q

Hepatoduodenal ligament contains?

A

Portal triad-proper hepatic artery, hepatic portal vein, and common bile duct

44
Q

Greater omentum

-Develops from?

A

-Develops from the dorsal mesogastrium

45
Q

Organs of the foregut?

A

Stomach, esophagus, liver, gallbladder, pancreas, spleen, and 1st half of duodenum

46
Q

Greater omentum

-3 ligaments?

A
  • Gastrocolic ligament (stomach to transverse colon)
  • Gastrophrenic ligament (stomach to diaphragm)
  • Gastrosplenic ligament (stomach to spleen)
47
Q

Peritoneal ligaments

-3 ligaments associated with the liver?

A
  • Coronary ligaments
  • Right and left triangular ligaments
  • Falciform ligament (ligamentum teres hepatis)
48
Q

“Minor” fold

-definition?

A

A ridge or elevation in the peritoneum produced by underlying vessels

49
Q

Fossae (fossa) or recesses

A
  • Depressions between folds
  • Superior duodenal fold and fossa, inferior duodenal fold and fossa, paraduodenal fold, retroduodenal fossa
  • Fold is formed by inferior mesenteric vein posterior to peritoneum?
50
Q

Folds and fossa of the internal aspect of the abdominal wall

A

Structures coursing through the extraperitoneal tissue form elevations on the interior abdominal wall called peritoneal (umbilical) folds

51
Q

Median umbilical fold

  • ligament?
  • Obliterated?
  • Midline from?
A
  • Median umbilical ligament
  • Obliterated urachus
  • Midline from bladder
52
Q

Medial umbilical folds (2)

  • Ligaments?
  • Obliterated?
A
  • Medial umbilical ligaments

- Obliterated umbilical arteries

53
Q

Lateral umbilical folds (2)

  • Formed by?
  • Contains?
A
  • Inferior epigastric vessels

- Functional arteries and veins

54
Q

Falciform ligament

-Remnant of?

A

Ventral mesogastrium

55
Q

Falciform ligament

-Contains?

A
  • Ligamentum teres hepatis (round ligament of the liver) in its lower free border
  • Obliterated umbilical vein
56
Q

Peritoneal fossae

  • Supravesical fossa-located between what folds?
    • What can happen here?
A
  • Located between the median (center of the body) and medial umbilical folds
  • Site for supravesical hernias (rare)
57
Q

Medial inguinal fossa

  • Located between what folds?
  • What type of hernia can occur here?
A
  • Located between the medial and lateral umbilical folds

- Direct inguinal hernias occur here

58
Q

Lateral inguinal fossa

  • Where is it located?
  • What type of hernia can occur here?
A
  • Lateral to the lateral umbilical folds

- Indirect inguinal hernias occur here

59
Q

Greater peritoneal sac-Most of the potential space within the abdomen
-Can be subdivided into?

A

Can be subdivided into supracolic (supramesocolic) and infracolic regions by the colon and transverse mesocolon

60
Q

Greater peritoneal sac

  • Supracolic region
    • Location relative to liver and stomach?
    • Includes what spaces/fossae?
A
  • Superior and anterior to the liver and stomach

- Includes hepatorenal and subphrenic spaces and fossae of the anterior abdominal wall

61
Q

Peritoneal cavity

A
  • A closed potential space between parietal and visceral layers of peritoneum
  • Recesses and fossae of the peritoneal cavity-Clinically important because abscesses may develop and excess fluid (ascites) will pool here
62
Q

Greater peritoneal sac

-Infracolic region-which part of the greater sac is it?

A

Inferior and posterior

63
Q

Greater peritoneal sac

-Infracolic region-subdivided by?

A
  • Subdivided by mesenteries and ligaments

- Upper and lower parts are divided by THE mesentery into right and left infracolic spaces

64
Q

Greater peritoneal sac

-Infracolic region-Right and left paracolic gutters are lateral to?

A

Ascending and descending colon

65
Q

Greater peritoneal sac

-Infracolic region-Why is the space clinically important?

A

Intraperitoneal infections spread here

66
Q

Greater peritoneal sac

-Infracolic region-What ligament prevents the spread of fluid superiorly?

A

Phrenicocolic ligament

67
Q

Lesser peritoneal sac

-Location relative to the stomach?

A

Posterior and inferior to the stomach

68
Q

Recesses of the lesser peritoneal sac

-Superior recess-posterior to?

A

Posterior to the liver

69
Q

Recesses of the lesser peritoneal sac

-Inferior recess-Potential space between the?

A

2 layers of the gastrocolic ligament

70
Q

Recesses of the lesser peritoneal sac

-Splenic recess-Location relative to the stomach?

A

Posterior and left of the stomach

71
Q

Greater and lesser peritoneal sacs communicate through?

A

the epiploic foramen (of Winslow)

72
Q

Lesser peritoneal sac has a clinically important relationship to what organs?

A

liver, pancreas, stomach, and spleen

73
Q

Epiploic foramen (of Winslow)

A

-Opening between the greater and lesser sacs

74
Q
Epiploic foramen (of Winslow)
   -anterior?
A

hepatoduodenal ligament with the portal vein, hepatic artery, and bile duct

75
Q
Epiploic foramen (of Winslow)
   -posterior?
A

IVC, diaphragm

76
Q
Epiploic foramen (of Winslow)
   -Superior?
A

Liver, caudate lobe

77
Q
Epiploic foramen (of Winslow)
   -Inferior?
A

Duodenum, 1st part