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COM: GI (Midterm) COPY > Lecture 5: Peritoneal Cavity & Mesenteries > Flashcards

Lecture 5: Peritoneal Cavity & Mesenteries Flashcards

1
Q

Explain the neurovascular supply of the parietal peritoneum

A
  • Somatic innervation -> sensitive to pressure, pain, & temperature -> able to localize pain
  • Supplied by the same blood, nerve, and lymphatic structures as the region of the wall it lines
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2
Q

Explain the neurovascular supply of the visceral peritoneum

A
  • Innervated by autonomics -> sensitive to stretch and chemical irritation -> hard to localize pain
  • Suppplied by the same blood, nerve aand lymphatic structures as the organ
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3
Q

The foregut is attached to the dorsal and ventral mesogastrium. The foregut rotates swinging the ventral mesogastrium to the ______ and dorsal mesogastrium to the ______

A

Right; left

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4
Q

What does the ventral mesogastrium run along?

A

The lesser curvature of the stomach and on top of the proximal duodenum

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5
Q

What does the ventral mesogastrium give rise to?

A

Liver -> the liver grows rapidly pushing against the body wall and obliterating the peritoneum producing the lesser sac behind the stomach

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6
Q

What does the dorsal mesogastrium run along?

A

The greater curvature of the stomach and under the proximal duodenum

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7
Q

What does the dorsal mesogastrium give rise to?

A

Spleen

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8
Q

What ligaments make up the lesser omentum?

A

Hepatogastric ligament

Hepatoduodenal ligament

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9
Q

What ligament conducts the portal triad (portal vein, hepatic artery, bile duct)?

A

Hepatoduodenal ligament

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10
Q

What does the falciform ligament connect to?

A

Connects the liver to the anterior abdominal wall

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11
Q

What 3 structures make up the portal triad?

A

Portal vein
Hepatic artery
Bile duct

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12
Q

What does the gastrophrenic ligament connect to?

A

Connects stomach to inferior diaphragm

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13
Q

What does the gastrosplenic ligament connect to?

A

Connects the spleen to the stomach

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14
Q

What does the gastrocolic ligament connect to?

A

Connects the transverse colon to the stomach

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15
Q

What structures make up the greater omentum?

A

Gastrophrenic ligament
Gastrosplenic ligament
Gastrocolic ligament

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16
Q

What does the phrenicocolic ligament connect to?

A

Connects the diaphragm to the colon

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17
Q

What does the splenorenal ligament connect to?

A

Connects the spleen to the kidneys

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18
Q

What 2 structures make up the anterior boundary of the epiploic foramen?

A

Hepatoduodenal ligament

Portal triad

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19
Q

What 2 structures make up the posterior border of the epiploic foramen?

A

IVC

Right crus of diaphragm

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20
Q

What structure makes up the superior border of the epiploic foramen?

A

Caudate lobe of liver

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21
Q

What structure makes up the inferior border of the epiploic foramen?

A

1st part of duodenum

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22
Q

What is the Pringle maneuver?

A

Stick fingers in epiploic foramen and ligate/cut off blood supply coming into th elver via the portal triad

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23
Q

What structures are found anterior to the lesser sac?

A

Lesser omentum
Stomach
Gastrocolic ligament

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24
Q

What structures are found posterior to the lesser sac?

A 
Pancreas
Left suprarenal gland
Left kidney 
Aorta
IVC
Splenic artery and vein
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25
Q

What structures are foudn superior to the lesser sac?

A

Liver

Diaphragm

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26
Q

What structures are found inferior to the lesser sac?

A

Transverse mesocolon

1st part of duodenum

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27
Q

What structures are found to the left of the lesser sac?

A

Hilum of the spleen

Gastrosplenic ligament

28
Q

What structures are found to the right of the lesser sac?

A

Epiploic foramen opens into greater sac

29
Q

If the stomach ruptures anteriorly, where will the contents go?

A

They will go into the greater sac

30
Q

If the stomach ruptures posteriorly, where will the contents go?

A

They will go into the lesser sac

31
Q

Is an anterior or posterior rupture of the stomach bettter and why?

A

Posterior rupture because the contents are contained in the lesser sac. There is still the epiploic foramen through which the contents can leave but it takes time so you have more time to get it fixed

32
Q

If the pancreas ruptures anteriorly, where will the contents go and what forms because of this?

A

Into the lesser sac forming a pancreatic pseudo-cyst

33
Q

Can the anterior or posterior boundaries of the epiploic foramen be cut? Why or why not?

A

Anterior cant because of the portal triad

Posterior cant because of the IVC

34
Q

What happens if a loop of the intestine gets into the omental bursa and how is this treated?

A

Loops of small intestine can pass through the epiploic foramen and become strangulated. Can’t cut any of the boundaries of the epiploic foramen so have to decompress with a needle and pull the. Intestine out instead

35
Q

What structure divides the peritoneal cavity into the supracolic and infracolic compartments?

A

Transverse mesocolon

36
Q

What 3 organs are found in the supracolic compartment?

A

Stomach
Liver
Spleen

37
Q

What 3 organs are found in the infracolic compartment?

A

Small intestine
Ascending colon
Descending colon

38
Q

How do the supracolic and infracolic compartments communicate?

A

Paracolic gutters

39
Q

What paracolic gutter is limited due to compression from the phrenicocolic. Ligament and why is this clinically significant?

A

The left paracolic gutter; this is clinically significant for pts who have their appendix rupture, the contents go up from the paracolic gutter and even into the right subphrenic recess and form an abscess

40
Q

What structures provide pathways for the spread of cancer cells that have sloughed from the ulcerated surface of the tumor and entered the peritoneal cavity?

A

Paracolic gutters

41
Q

What structures provide pathways for the flow of ascetic fluid and the spread oof intraperitoneal infections?

A

Paracolic gutters

42
Q

Ascetic fluid can be transported along paracolic gutters into the pelvis when someone is in what position? Is this good or bad?

A

Seated; sometimes this is good because the absorption of toxins is slow in the pelvis so having a pt in a seated position can slow toxic absorption

**When a pt is supine infections in the pelvis may extend superiorly to a subphrenic recess under the diaphragm

43
Q

What structures are found posterior to the pancreas?

A

SMV and SMA
IVC and Aorta
Splenic a
L kidney and suprarenal gland

44
Q

What artery runs within the gastrosplenic ligament?

A

Left gastroepiploic a.

45
Q

What artery runs within the splenorenal ligament?

A

Splenic a.

Retroperitoneal!

46
Q

What artery runs within hepatoduodenal ligament?

A

Right gastric a.

47
Q

What artery runs within the hepatogastric ligament (lesser omentum)?

A

Left gastric a.

Retroperitoneal!

48
Q

What structures are found anterior to the pancreas?

A

Lesser sac

Stomach

49
Q

What structure is found to the right of the pancreas?

A

2nd part of the duodenum

50
Q

What structure is found to the left of the pancreas?

A

Spleen and tail is intraperitoneal

51
Q

What structure is found inferior to the pancreas?

A

3rrd part of the duodenum

52
Q

What is the primary mechanism in female reproductive organs to prevent peritonitis?

A

A Mucous plug that effectively blocks the opening of the uterus to most pathogens, but not sperm

  • The potency of the uterus can be tested by injecting air or dye into the uterine cavity and watching it travel
53
Q

Why are large invasive, open incisions of the peritoneum painful?

A

The peritoneum is well innervated and the pain is well localized

  • When you do surgery you want to try to go in the posterolateral aspect to avoid interruption the peritoneum -> surgery can result in adhesions so try to stay out of peritoneum when possible
54
Q

How do adhesions form when the peritoneum is damaged?

A

If the peritoneum is damaged the surfaces of it become inflamed, making them sticky with fibrin. As healing occurs the fibrin may be replaced with fibrous tissue forming abdnormal attachments between the visceral peritoneum or parietal peritoneum

55
Q

Define peritonitis

A

Infection of the peritoneal cavity

  • It can occur from rupture of infected organ or from external wound; localization of infections can lead to abscesses
56
Q

What is an ascite?

A

Excess fluid in peritoneal cavity

Can be caused by portal hypertension

57
Q

What position is most comfortable for pts with peritonitis?

A

Pain worsens with movement so they commonly lie with their knees flexed to relax their anteroabdominal muscles.

  • They also breathe shallowly reducing the intra-abdominal Pressure & pain
58
Q

What is the treatment for generalized peritonitis?

A

Removal os ascetic fluid via paracentesis

59
Q

What is paracentesis?

A

Drainage of large volumes of blood or serous fluid that accumulates in the cavity.

60
Q

How do you perform a paracentesis?

A

Needle is inserted superior to the empty urinary bladder -> most inferior point = rectouterine pouch (females) or rectovesicular pouch (males)

  • *Need to avoid inferior epigastric artery**
  • *Drainage of abscesses is possible without causing generalized peritonitis**
61
Q

Why can anesthetic agents be injected into the peritoneal cavity by intraperitoneal injection?

A

Because the peritoneum is semi-permeable with extensive surface area, therefore fluid injected into the peritoneal cavity is rapidly absorbed

62
Q

What is peritoneal dialysis?

A

Using dilute solution to remove soluble substances and excess water from the system by transfer across the peritoneum -> diffusible solutes & H2O are transferred between the blood & peritoneal cavity as a result of concentration gradients between the 2 fluid compartments

63
Q

What are the functions of the greater omentum?

A
  • Prevents visceral peritoneum from adhering to parietal peritoneum. Has considerable mobility and moves around the peritoneal cavity with peristaltic movemtns of the viscera
  • Often forms adhesions adjacent to an inflamed organ, sometimes walling off and protecting other viscera from it
  • Cushions abdominal organs from injury and forms insulation against heat loss
64
Q

What 3 conditions may lead to the formation of an abscess in the subphrenic recess?

A

Duodenal ulcer
Rupture of gallbladder
Perforation of appendix

The abscess may be walled inferiorly by adhesions

65
Q

What structures determine the extent and direction of the spread of fluids that may enter the peritoneal cavity when an organ is diseased or injured?

A

Peritoneal recess

66
Q

During what procedure must the cystic artery be lighted or claimed and then severed? What do you do if its severed before ligated?

A

Cholecystectomy (gallbladder removal); control hemorrhage by compressing the hepatic artery as it traverses the hepatoduodenal ligament. The index finger is placed in the omental foramen and thumb is on the anterior wall

COM: GI (Midterm) COPY (7 decks)

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