Peritoneum

Question 1

Describe embryologic development of peritoneal cavity

Answer 1

intermediate mesoderm –> somatic (parietal)+ splanchnic (visceral) mesoderm

Question 2

what is the space enclosed by the somatic and splanchnic mesoderm?

Answer 2

coelom

Question 3

What passes through the inguinal canal?

Answer 3

vaginal process, spermatic cord, round ligament; external pudendal vessels, genital nerve

Question 4

What passes through vascular lacunae

Answer 4

femoral artery and vein, lymphatics, saphenous nerve

Question 5

What passes thorugh paired slit-like openings dorsal to diaphragm and ventral to psoas muscles?

Answer 5

sypmathetic trunck and splanchnic nerves

also air, chlye, peritoneal fluid, other dz processes

Question 6

What is the Cullen sign?

Answer 6

ring of SQ hemorrhage around umbilicus –> from hemoperitoneum or peritonitis

Question 7

What is a mesentery?

Answer 7

wide serous folds by which vessels and nerves reach the organs

Question 8

Name 3 portions of greater omentum

Answer 8

bursal
splenic
veil

Question 9

What are the boundaries of the epiploic foramen? what part of the greater omentum is it found?

Answer 9

dorsal: caudal VC
ventral: portal vein//hepatic artery
Cranial: liver
Caudal: mesoduodenum/celiac artery
Bursal portion

Question 10

Which of the following is true?
A. The veil portion forms the gastrosplenic ligament
B. Milky spots are a sign of diseased omentum
C. Parts of the lesser omentum –> hepatoduodenal ligament and hepatogastric ligament
D. Normal peritoneal protein concentration is > 3d/dL < 15 g/dL and the colloid osmotic pressure is about 35 mm Hg

Answer 10

A. The veil portion contains the left limb of the pancreas (dorsal leaf); splenic portion –> gastrosplenic ligament
B. Milky spots = source of WBC and important for defense
C true
D. < 3 d/dL; 28 mm Hg

Question 11

What size particles can drain through peritoneal lymphatics?

Answer 11

<10 um

bacteria = 0.5-2 um and RBC 7-8 um

Question 12

What rate of fluid can be absorbed per hour?

Answer 12

3-8% of body weight/hr

Question 13

What is the normal intraabdominal pressure?

Answer 13

2-7.5 cm H2O or mean 4.5 cm H2O

Question 14

Which of the following is true?
A. Renal failure can be caused by intra-abdominal pressures > 20 mm Hg
B. Dogs with MODS have a mortality rate of 70% versus 25% without the syndrome
C. Sclerosing encapsulating peritonitis is an acute reaction to a gossipyboma
D. Alpha-hemolysin is produced by streptococcal organisms and increases patient mortality

Answer 14

B true
A. 24 mm Hg or 32.6 cm H2O –> renal failure
C. Chronic response with a “coccoon” layering; humans peritoneal dialysis complications, infectious, chylous
D. a-Hemolysin from E.coli or Baceroides fragilis = toxic to many mammalian cells

Question 15

What are known adjuvants in peritonitis?

Answer 15

gastric mucin
bile salts
hemoglobin
barium

Question 16

Name causes aseptic periotonitis

Answer 16

chemical(abx), peritoneal FB/mechanical, starch granulomatous, sclerosing encapsulating
urine or bile(usually)

Question 17

What volume of fluid can be detected on PE by ballottement?

Answer 17

10 ml/kg Body weight