lecture 5

Question 1

Abdominal cavity is lined with peritoneum

Answer 1

Parietal and visceral peritoneum

Question 2

Abdominal cavity is lined with peritoneum - Parietal and visceral

Answer 2

• connects the viscera to the posterior abdominal wall
• As a result, many compartments and recesses are formed

Question 3

• Parietal peritoneum

Answer 3

lines the abdominal wall

Question 4

Visceral peritoneum

Answer 4

lines the viscera such as stomach and intestines
invaginates to cover majority of abdominal viscera.

Question 5

Question 6

Question 7

Peritoneal adhesions

Answer 7

Fibrous bands that form abnormal connections:
- Visceral peritoneum = attaches to adjacent organ
- Visceral peritoneum attaches to parietal peritoneum

Question 8

Intraperitoneal:

Answer 8

Intraperitoneal organs are surrounded by visceral peritoneum – covered anteriorly and posteriorly
EG: Stomach, liver and spleen

Question 9

Retroperitoneal organs:

Answer 9

Only covered with parietal peritoneum – only covered anteriorly
- Can be further subdivided based on their embryological development
1. Primarily retrop. Organs developed and stayed outside of the parietal peritoneum
EG: esophagus, rectum and kidneys\
2. Secondary retrop. Organs were originally intraperitoneal and were suspended by mesentery
- Through embryogenesis they become retroperitoneal as their mesentery gets fused with post abdominal wall
EG: ascending and descending colon

Question 10

Retroperitoneal structures are SAD PUCKER:

Answer 10

S = suprarenal (adrenal) glands
A = Aorta/IVC
D = Duodenum (except proximal 2cm – the duodenal cap)

P = Pancreas (except tail)
U = Ureters
C = Colon (ascending and descending parts)
K = Kidneys
E = esophagus
R =rectum

Question 11

Mesentery:

Answer 11

• Double layer of peritoneum
• Attaches an organ to the posterior abdominal wall
• Provides pathway for blood vessels and nerves to the organ from body wall

Question 12

Question 13

Omentum:

Answer 13

= Double layer of peritoneum
* Attaches the stomach to another organ:
– Liver = lesser omentum
– Transverse colon = greater omentum

Question 14

greater omentum

Answer 14

Part of the omentum which attaches stomach to the transverse colon

Question 15

lesser omentum

Answer 15

Part of omentum that attaches the lesser curve of the stomach and duodenum to the liver

Question 16

Question 17

Lesser omentum ligaments

Answer 17

• On its free edge it is thickened – contains hepatoduodenal ligament
• Deeper into this area, find the membranous part of the lesser omentum – contains hepatogastrial ligament
• Hepatoduodenal ligament is NB as it allows passage to the portal triad in the area

Question 18

Question 19

Lesser omentum: Contains the Portal triad

Answer 19

• Lies within free edge of lesser omentum

Question 20

• Contents lesser omentum:

Answer 20

– Common bile duct – Proper hepatic artery – Hepatic portal vein
= portal triad

Question 21

Subdivisions of the peritoneal cavity

Answer 21

• Greater sac
  – makes up majority of peritoneal cavity
• Is sub-divided into Supracolic & infracolic compartments – by mesentery of transverse colon (aka transverse mesocolon)
  Infracolic further divided into left and right colic spaces
• Lesser sac (aka omental bursa)
• Peritoneal gutters
• Peritoneal recesses
  These are pathways and accumulation areas for fluids that spread infections and inflammation

Question 22

Question 23

Question 24

Lesser sac or Omental bursa

Answer 24

• Omental bursa (lesser sac)is small
• Located posterior to the stomach and lesser omentum.
• Superior recess extends behind liver
• Inferior recess between the layers of the greater omentum.
• Permits free movement of stomach as it ensures the stomach lies over the other structures
• Omental bursa communicates with greater sac via the omental foramen (epiploic foramen)
• Fluid in omental bursa can indicate perforation of the stomach or a collection of pancreatic fluid

Question 25

Question 26

Peritoneal recesses...1

Answer 26

As peritoneum wraps around the viscera, they form several fossa and spaces = recesses Potential sites for herniation of pelvic viscera Recesses serve to provide more room for viscera and therefore reduces congestion of structures within abdominal cavity - Pouches of peritoneum formed by peritoneal folds * – Duodenal recess * – Caecal recesses: * Superior ileocaecal * Inferior ileocaecal * Retrocaecal * – Intersigmoid recess

Question 27

Peritoneal recesses...2

Answer 27

- Right and left subphrenic recesses Located below the diaphragm and above the liver - Hepatorenal recess: Located between the liver and the right kidney

Question 28

Question 29

Drainage of fluid In supracolic compartment:

Answer 29

Fluid to the right of the falciform lig. Above the liver and fluid from the inferior part of the liver will drain into the R paracolic gutter Falciform lig blocks fluid from the left and forces it to go inf into the paracolic gutter * Right paracolic gutter: either superior or inferior depending on position

Question 30

Drainage of fluid: In infracolic compartment:

Answer 30

* Accumulation on the right, between mesentry of jejenum and ileum and ascending colon (no exit) * To the left of the root of the mesentery, between mesentery of jejenum and ileum and descending colon (exit inferior) * Left paracolic gutter: towards inferior since phrenocolic ligament block superior drainage in supine position