Peritoneal cavity

Question 1

what is the peritoneal cavity?

Answer 1

potential space between parietal & visceral peritoneum

Question 2

what does the peritoneal cavity contain?

Answer 2

a thin film of peritoneal fluid, which consists of water, electrolytes, leucocytes, antibodies

Question 3

what are the 2 main functions of the peritoneal cavity?

Answer 3

1. lubricant, enabling free movement of abdominal viscera

2. antibodies fight infection

Question 4

why is the peritoneal cavity referred to as a potential space?

Answer 4

only of capillary thinness

because excess fluid can accumulate in peritoneal cavity resulting in clinical condition of ascites

Question 5

what can the peritoneal cavity be divided into?

Answer 5

greater and lesser peritoneal sacs

Question 6

what constitutes the greater sac?

Answer 6

majority of the peritoneal cavity

Question 7

what is the lesser sac also known as?

Answer 7

omental bursa

Question 8

where is the lesser sac?

Answer 8

smaller & lies posterior to stomach & lesser omentum

Question 9

what is the greater sac divided by and into what?

Answer 9

2 compartments by mesentery of transverse colon (transverse mesocolon) into supracolic and infracolic compartment

Question 10

what is the supracolic compartment and where is it?

Answer 10

lies above the transverse mesocolon

contains stomach, liver, spleen

Question 11

where is the infracolic compartment and what does it contain?

Answer 11

lies below the transverse mesocolon & contains the small intestine, ascending & descending colon

Question 12

what is the infracolic compartment further divided into?

Answer 12

left & right infracolic spaces by the mesentery of the small intestine

Question 13

what is the supra and infracolic compartments connected by?

Answer 13

paracolic gutters - lie between the posterolateral abdominal wall & lateral aspect of the ascending or descending colon

Question 14

what are subphrenic spaces?

Answer 14

subphrenic spaces are rececsses in the greater sac of the peritoneal cavity between the anteriosuperior diaphragmatic surface of the liver and the diaphragm

Question 15

what do subphrenic spaces separated into? what is it separated by?

Answer 15

right and left subphrenic spaces by the falciform ligament of the liver

Question 16

when do subphrenic abscesses occur?

Answer 16

as a result of the accumulation of pus in the left or right subphrenic space as a consequence of peritonitis

Question 17

where is subphrenic abscesses more common? why?

Answer 17

more common on the right side: increased frequency of appendicitis and ruptured duodenal ulcers

Question 18

where is the omental bursa (lesser sac) located and what does it allow?

Answer 18

lies posterior to stomach & lesser omentum

allows stomach to move freely against the structures posterior & inferior to it

Question 19

what is the omental bursa connected with the greater sac through?

Answer 19

the greater sac through an opening in the omental bursa, the epiploic foramen

Question 20

where is the epiploic foramen?

Answer 20

situated posterior to the free edge of the lesser omentum (hepatoduodenal ligament)

Question 21

why does the peritoneal cavity differ between sexes? what is the significance of this area?

Answer 21

due to the pelvic organs (most distal portion of cavity, so any infected fluid is likely to collect here)

Question 22

describe the structure of the peritoneal cavity in males

Answer 22

rectovesical pouch is a double folding of peritoneum between rectum & bladder, peritoneal cavity is completely closed in males

Question 23

describe the rectouterine pouch (pouch of Douglas) in females

Answer 23

a double folded extension of the peritoneum between the rectum & posterior wall of the uterus

Question 24

what is the vesicouterine pouch is females?

Answer 24

a double fold of peritoneum between the anterior surface of the uterus & bladder

Question 25

is the peritoneal cavity closed in females? why?

Answer 25

no, because the abdominal ostia of the uterine tubes opens into the peritoneal cavity, providing potential pathway between the female genital tract and the peritoneum

Question 26

what does the lack of closure in the peritoneal cavity in females mean?

Answer 26

infections of the vagina, uterus & uterine tubes may result in infection & inflammation of the peritoneum (peritonitis).

Question 27

how frequent is peritonitis? why?

Answer 27

rare, due to presence of a mucous plug in the external os (opening) of the uterus which prevents the passage of pathogens but allows sperm to enter the uterus

Question 28

what is culdocentesis?

Answer 28

extraction of fluid from the rectouterine pouch (pouch of Douglas) through a needle inserted through the posterior fornix of the vagina

Question 29

when can a culdocentesis be used?

Answer 29

used to extract fluid from the peritoneal cavity or to drain a pelvic abscess in the rectouterine pouch

Question 30

what is a paracentesis?

Answer 30

a procedure used to drain fluid from the peritoneal cavity

a needle is inserted through the anterolateral abdominal wall into the peritoneal cavity

Question 31

how must the needle be inserted in paracentesis?

Answer 31

superior to the urinary bladder and the clinician must take care to avoid the inferior epigastric artery

Question 32

what is a paracentesis used for?

Answer 32

to drain ascitic fluid, diagnose the cause of ascites and to check for certain types of cancer which may metastasise via the peritoneum e.g. liver cancer

Question 33

what is ascites?

Answer 33

accumulation of excess fluid in the peritoneal cavity

Question 34

when can ascites occur?

Answer 34

in conjunction with infection & peritonitis, however, more commonly caused by portal hypertension secondary to cirrhosis of liver

Question 35

what are other causes of ascites?

Answer 35

malignancies of the GI tract, malnutrition, heart failure, mechanical injuries resulting in internal bleeding

Question 36

how do patients with ascites present?

Answer 36

with distended abdomen, discomfort, nausea, dyspnoea

Question 37

what does the paracolic gutters provide?

Answer 37

a route for the flow ascitic fluid, and for the spread of intraperitoneal infections & cancer metastses

Question 38

how are patients with peritonitis often positioned? why?

Answer 38

in a sitting position (at least 45 degree angle) to encourage the flow of ascitic fluid into the pelvis where toxins are absorbed more slowly

Question 39

what is peritonitis?

Answer 39

infection and inflammation of the peritoneum

Question 40

when can peritonitis occur?

Answer 40

as a result of bacterial contamination during a laparotomy (open surgical incision of the peritoneum) or it can occur secondary to an infection elsewhere in the GI tract, e.g. burst appendix, acute pancreatitis or gastric ulcer eroding through the wall of the stomach

Question 41

what happens during peritonitis?

Answer 41

exudation of fluid into the peritoneal cavity

Question 42

what does the patient experience with peritonitis? what does the body do?

Answer 42

pain and tenderness of the overlying skin

the anterolateral abdominal muscles contract to protect the viscera (guarding)

Question 43

What are other symptoms of peritonitis?

Answer 43

fever, nausea, vomiting, constipation

Question 44

how do patients with peritonitis appear? why?

Answer 44

lie with knees flexed in an effort to relax the anterolateral abdominal wall muscles

Question 45

what is generalised peritonitis?

Answer 45

when peritonitis is widespread in the abdominal cavity

Question 46

what can generalised peritonitis lead to?

Answer 46

sepsis and therefore must be treated as an emergency or it can be fetal