Lecture 11: Peritoneum and Abdominal Organs Flashcards
1
Q
Upper and lower boundaries of the abdominopelvic cavity
A
Cranially: Diaphragm
Caudally: Levator ani and coccygeus muscles
2
Q
2 divisions of abdominal cavity
A
- Abdominal cavity proper
- Pelvic cavity
3
Q
Contents of abdominal cavity
A
Blood vessels, viscera, nerves, and peritoneum
4
Q
Where does the abdominal cavity extend and why?
A
Into the rib cage to protect abdominal organs (especially forget organs)
5
Q
Purpose of the greater (or false) pelvis
A
Protect lower abdominal organs
6
Q
What part of the abdominal wall contains criss-crossing muscles and what are their functions
A
Anterior and lateral abdominal walls. Provides protection to this region, which contains soft and vital viscera.
7
Q
What are the names of the 2 horizontal planes of the abdomen and their locations
A
Subcostal plane- costal cartilage of 10th rib
Transtubecular plane- iliac tubercles of iliac crest
8
Q
What are the names of the vertical planes of the abdomen and their location
A
Midclavicular planes- From mid clavicle to between the anterior superior iliac spine and pubic symphysis
9
Q
What are the six different regions of the abdomen in order (right to left)
A
Right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right inguinal, hypogastric, and left inguinal
10
Q
What’s found in the right hypochondriac region?
A
Liver
11
Q
What is found in the epigastric region?
A
Stomach
12
Q
What is found in the left hypochondriac region?
A
Spleen
13
Q
What is found in the right lumbar region
A
Right kidney
14
Q
What is found in the umbilical region
A
Transverse colon
15
Q
What is found in the Left lumbar region
A
Left kidney
16
Q
What is found in the right inguinal region
A
appendix
17
Q
What is found in the hypogastric region
A
Small intestine
18
Q
What is found in the left inguinal region
A
Sigmoid colon
19
Q
What are the 2 planes that divide the abdomen into four quadrants used by physicians
A
Median plane and transumbilical
20
Q
What are the names of the 4 quadrants of the abdomen when divided by the median and transumbilical planes?
A
Upper left/right and Lower left/right quadrants
21
Q
What was the embryonic precursor of the peritoneal cavity?
A
The intraembryonic coelomic cavity
22
Q
What organs are contained within the peritoneal cavity
A
none
23
Q
Are abdominal and peritoneal cavity synonymous?
A
No
24
Q
Peritoneum
A
Serous membrane (thin layer of CT) covered by simple squamous epithelium (also called mesothelium)
25
What are the 2 peritoneum that delineated the peritoneal cavity
Parietal and visceral peritoneum
26
Which peritoneum is under extraperitoneal fat and transversals fascia that lies the abdominal wall?
Parietal peritoneum
27
Which peritoneum forms a shiny external covering over the abdominal organs
Visceral peritoneum
28
Mesentery definition
Double layer of peritoneum that encloses an organ and connects it to the body wall.
29
How do organs that are held within mesenteries receive blood?
Blood vessels travel through the mesentery to reach the organ
30
Peritoneal ligament definition
Double layer of peritoneum connecting an organ to the body wall or to another organ
31
Retroperitoneal definition
Organ that only slightly protrudes the peritoneal cavity
32
What doe retroperitoneal organs lack?
Mesenteries
33
Unique characteristics of retroperitoneal organs?
immobile and tough to access surgically
34
Primarily retroperitoneal
Never had a mesentery and never will (not gut organs)
35
Example of primarily retroperitoneal organ
Kidney
36
Secondarily retroperitoneal
They developed a mesentery but it was reabsorbed
37
Examples of secondary retroperitoneal organs
pancreas, duodenum, ascending and descending colon
38
How did the pancreas and duodenum loose their mesentery
Growth of the liver forces these two organs against the posterior back wall
39
How did the ascending and descending colons loose their mesentary
gut rotation cement rated the two structures against the posterior back wall
40
Location of subphrenic recess
Between the liver and thoracic wall
41
What boundaries from the hepatorenal recess
Bounded by the right kidney, liver, colon, and duodenum
42
What is the lowest point of the peritoneal cavity when the patient is laying down
The hepatorenal recess
43
In what recess does the vermiform appendix lie?
the retrocecal recess
44
What are the 2 divisions of the peritoneal cavity
The greater and lesser sac (or peritoneal cavity proper and omental bursa)
45
Location of the lesser sac
between the stomach and posterior body wall
46
What does the lesser sac allow for?
Dissension of the stomach
47
How does the lesser sac communicate with the greater sac?
Through the epiploic foramen of Winslow
48
What is another name for the epiploic foramen of Winslow?
Omental foramen
49
What are the lateral boundaries of the mental bursa
Glastrosplenic ligament and lienorenal ligament
50
What are the structures that are anterior and posterior to the omental bursa
Anterior: Stomach
Posterior: Pancreas
51
What are the 3 parts of the omental bursa
- Superior recess- between the liver and diaphragm
- Main portion behind the stomach
- Inferior recess- Between the double layers of the gastrocolic ligament
52
What recess is obliterated in the omental bursa during adulthood
the inferior recess
53
What forms the median umbilical fold
Formed by urachus
54
What is the urachus an embryonic remanent of
allantois
55
Function of the allantois
Connect the urinary bladder to anterior body wall
56
What is the medial umbilical fold a remanent of?
Umbilical arteries
57
What artery travels through the lateral umbilical fold?
The inferior epigastric artery
58
Where does the falciform ligament extend
From the umbilicus to liver
59
What does the falciform ligament contain
The ligamentum teres hepatic
60
What is the ligamentum teres hepatis a remanent of?
Umbilical v.
61
Which mesentery is the derivative of the falciform ligament
Ventral mesentery
62
What are the functions of the mesenteries that attach structures to the posterior body wall?
transport vessels, nerves, and lymphatics, and allow for mobility of intestines
63
What are the 3 mesenteries that suspend the intestines to the back wall
- Mesentery proper (suspends the jejunum and ileum)
- Transverse mesocolon (transverse colon)
- Sigmoid mesocolon (sigmoid colon)
64
Function of Greater Omentum
Attach the stomach and proximal duodenum to body wall
65
What did omentum derive from
primitive mesentery
66
Greater omentum location and description
Fat-filled apron suspended from the greater curvature of the stomach over intestines
67
Structural derivative of the greater omentum
Dorsal mesentery
68
How many layers was the greater omentum in the embryo
4 layers
69
How many layers is the greater omentum in the adult
2 layers
70
Why is the greater omentum the "policeman of the GI tract"
Localizes infection
71
What ligaments make up the major and minor portions of the greater omentum
Major- Gastrocolic ligament
| Minor- Gastrosplenic and gastrophrenic ligaments
72
Role of the lesser omentum
Suspends the stomach (from lesser curvature) from the liver
73
What is the structural derivative of the lesser omentum
The ventral mesentery
74
What ligament from the liver attaches to the stomach in the lesser momentum
Hepatogastric ligament
75
What are the two ligaments that make up the lesser omentum
hepatogastric and hepatoduodenum ligaments
76
What are the four depressions (or pathways) for the conduction of fluid and infections formed by the attachments of mesenteries of the small intestine, ascending and descending colon
- Right paracolic gutter
- Gutter to the right of the mesentery
- Gutter to the left of the mesentery
- Left paracolic gutter
77
How is the right paracolic gutter formed
Formed from the fact that ascending colon is secondary retroparitoneal pushed against back wall and there is parietal paritoneum on the outside making an unimpeded path for fluid to travel when you are upright.
78
What is the role of the right paracolic gutter
Communication between hepatorenal recess and pelvis
79
What is the direction of fluid movement from the hepatorenal recess when you sit up
Fluid from the hepatorenal recess drains into the peritoneal gutter via the right parabolic gutter down to the retrocecal recess.
80
What gutter is the pathway for infection from the hepatorenal pouch into the pelvis?
The right paracolic gutter
81
Gastrosplenic ligament
Stomach to spleen
82
Gastrophrenic ligament
Stomach to diaphragm
83
At what vertebral level does the esophagus pierce the diaphragm
T10
84
What is the name of the hole the esophagus enters through the diaphragm
Esophageal hiatus
85
What does the abdominal portion of the esophagus "groove" before
The left lobe of the liver
86
What region of the stomach does the esophagus enter?
Cardiac oriface
87
Where along the esophagus is the structure covered in peritoneum
Lateral and anterior borders
88
What nerve plexus surrounds the esophagus
Esophageal plexus
89
What arteries supply the esophagus
Esophageal artery from left gastric artery of celiac trunk and inferior phrenic a.
90
What partially covers the stomach
ribs
91
Greater curvature of the stomach
Left boarder of the stomach notched where the esophagus enters (cardiac notch). Greater momentum attaches here
92
Lesser curvature of the stomach
Right border at the pyloric end contains the angular notch
93
What are the 4 different regions of the stomach
Cardiac antrum, fundus, body, and pylorus
94
Cardiac antrum
region joining esophagus
95
Fundus
Region superior and left of cardiac antrum demarcated by a horizontal plane through the cardiac oriface
96
Body
Major portion of the stomach
97
Pylorus
separate from the body by the angular notch of the stomach Divided into the pyloric antrum (wider) and pyloric canal which ends with a very thick band of smooth muscle the pyloric sphincter
98
Duodenum shape
C shaped loop
99
4 parts of duodenum
- Superior
- Descending
- Horizontal
- Ascending
100
What parts of the duodenum are secondarily retroperitoneal?
The superior and descending
101
What are the vertebral levels for each region of the duodenum
- Superior L1
- Descending L3
- Horizontal L3
- Ascending L2
102
What regions of the duodenum are forgut derivatives? What are the remaining regions a part of?
-Superior and descending are forget derivatives the remainder are midgut
103
What is the blood supply to the superior and descending portion of the duodenum?
Celiac trunk
104
What are the horizontal and ascending regions of the duodenum supplied by?
Superior mesenteric artery
105
What is another name for the superior region of the duodenum?
The duodenal bulb
106
Ampulla of Vater location
Descending suodenum
107
Ampula of Vater: What is it?
Region where the common bile duct and main pancreatic duct enter the descending duodenum
108
Major duodenual papilla
Marks the opening of the common bile and main pancreatic duct inside the duodenum
109
Where do duodenal ulcers typically occur
Superior and descending region above the major duodenal papilla
110
What mesentery suspends the jejunum and ileum
Mesentery proper
111
Location of the mesentery proper
Obliquely, inferior, and to the right of the duodenaljejunal fleecer to the left side of L2 vertebrae and to the right sacroiliac joint (next to midbody of L5)
112
What covers the jejunum and ilium anteriorly?
Greater omentum
113
What region of the abdomen contains the jejunum
Unbilical region
114
What region of the abdomen contains the ileum
Hypogastric and inguinal regions
115
Which is more muscular the jejunum or ileum?
Jejunum
116
What do the intestinal arteries from the superior mesenteric artery form
Arterial arcades and vasa recta
117
Differences in arterial arcades and vasa recta between the jejunum and ileum
The ileum has more complicated arterial arcades and shorter vasa recta
118
Pilcae circulares
Spiral folds of mucous membrane
119
Which has more pronounced plicate circulates the jejunum or ileum?
Jejunum
120
What are the different regions of the large intestine
Cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
121
What parts of the large intestine have a mesentery
The transverse and sigmoid colon
122
Where does the large intestine begin
At the ileoceccal junction
123
At what point does the descending colon become the sigmoid colon
When it crosses the pelvic brim
124
Taenia Coli
Longitudinal muscle layer forms 3 stripes on surface of large intestine
125
Haustra
Sacculations of large intestine (can see well in radiographs)
126
Appendicies epiploicae
Fat-filled peritoneal sacs become filled with waste in dicerticulosis
127
What are the 2 fluxures present in the large intestine
Hepatic fluxure and splenic fluxure
128
Hepatic fluxure
Ascending to transverse colon
129
Splenic fluxure
Transverse to descending colon
130
Arterial supply to the large intestine
Branches off the inferior and superior mesenteric a.a
131
Where does the rectum start and end?
Starts: S3 and ends at anal canal
132
Gastric ulcer
Lesions of the wall of the stomach that may disrupt the splenic a. causing sever hemorrhage. Gastric juices can also be released into the omental bursa and cause periontitis
133
Appendicitis
Acute inflammation of the appendix
134
Ascites
Effusion of peritoneal cavity with fluid
135
Peritonitis
Inflammation of pariteoneal cavity
136
Adhesions
Scar tissue connecting parietal and visceral paritoneum
