Peritoneal Relations

Question 1

what are the layers of the anterior abdominal wall?

Answer 1

1. Skin
2. Superficial Fascia
   2a. Fatty Layer (Camper’s Fascia)
   2b. Membranous Layer (Scarpa’s Fascia)
3. Deep (investing) fascia covering muscles
   External Oblique
   Internal Oblique
   Transversus Abdominis
4. Transversus Fascia
5. Extraperitoneal Fascia
6. Parietal Peritoneum

Question 2

what is the peritoneum?

Answer 2

innermost serous membrane that lines the abdominopelvic cavity
encloses the viscera
consists of two continuous layers: visceral and parietal

Question 3

what layer of peritoneum lines the internal surface of abdominal wall

Answer 3

parietal peritoneum

Question 4

what layer of peritoneum encloses the organs

Answer 4

visceral peritoneum

Question 5

what is the peritoneal cavity? (what is it filled with)

Answer 5

potential space b/w parietal and visceral layers

filled only with fluid

Question 6

difference b/w peritoneal cavity in males and females

Answer 6

in males: it is completely closed

in females: opening of uterine tubes creates communication with the outside

Question 7

what are the subdivisions of the peritoneal cavity

Answer 7

greater sac
lesser sac (omental bursa)

Question 8

greater sac (what is it, boundaries)

Answer 8

main and larger part of peritoneal cavity
begins at diaphragm and continues inferiorly to pelvic cavity
supracolic compartment and infracolic compartment

Question 9

what is entered when the parietal peritoneum is penetrated (what part of the cavity)

Answer 9

greater sac

Question 10

lesser sac (omental bursa)
(where is it, boundaries)

Answer 10

lies posterior to stomach and adjoining structures

has superior and inferior boundaries called recesses

Question 11

Superior Recess of Lesser Sac (limits)

Answer 11

limited superiorly by the diaphragm and coronary ligament of the liver

Question 12

Inferior Recess of Lesser Sac (where is it)

Answer 12

b/w superior part of the layers of the greater omentum

Question 13

the greater and lesser sac communicate through what? (aka the site of continuity b/w the compartment)

Answer 13

epiploic foramen (omental foramen, foramen of Winslow)

Question 14

intraperitoneal organs
(what does this mean)

Answer 14

structures that are completely encased in peritoneum
suspended from abdominal wall by the mesenteries
invaginate into the peritoneal cavity

Question 15

retroperitoneal organs
(what does this mean)

Answer 15

structures that lie outside the peritoneal cavity
only covered by peritoneum on one surface
not suspended in the abdominal cavity
found b/w abdominal wall and parietal peritoneum
two different types: primarily and secondarily

Question 16

primarily retroperitoneal organs

what does this mean

Answer 16

develop and remain between peritoneum and body wall

Question 17

secondarily retroperitoneal organs (what does this mean)

Answer 17

develop within peritoneum but later fuse to body wall

Question 18

intraperitoneal organs (name them)

Answer 18

stomach
dodenum (1st and 4th parts)
jejunum and ileum
cecum
appendix
transverse colon
sigmoid colon
spleen
liver (except bare area)
gall bladder

Question 19

primarily retroperitoneal organs (name them)

Answer 19

kidneys
adrenal glands
aorta
inferior vena cava
testes
bladder and ureters
uterus
rectum

Question 20

secondarily retroperitoneal organs (name them)

Answer 20

duodenum (middle)
pancreas
ascending colon
descending colon

Question 21

what structure forms the median umbilical fold

Answer 21

obliterated urachus

Question 22

what structure forms the medial umbilical folds (both of them)

Answer 22

obliterated umbilical arteries

Question 23

what structure forms the lateral umbilical folds (both of them)

Answer 23

inferior epigastric vessels

Question 24

mesentery (what is it)

Answer 24

double layer of peritoneum that suspends viscera from the posterior and part of the anterior body wall
constitute a continuity of visceral and parietal peritoneum
provide mobility for associated viscera

Question 25

nerves and blood vessels traveling in the mesenteries allows for what?

Answer 25

communication between the organ and body wall

Question 26

Dorsal Mesentery (where does it attach, where is it)

Answer 26

attaches viscera to posterior abdominal wall | found in foregut, midgut, and most of hindgut

Question 27

what are the named parts of the dorsal mesentery

Answer 27

greater omentum "the mesentery" proper mesocolons

Question 28

"the mesentery" proper | what is it

Answer 28

term used to describe the mystery of jejunum and ileum large fan-shaped mesentery that attaches the ~20ft of small intestine to a root that spans 15-20cm on posterior abdominal wall

Question 29

mesocolons (what are they, name them)

Answer 29

``` named mesenteries of different parts of the large intestine they are: mesoappendix transverse mesocolon sigmoid mesocolon ```

Question 30

ventral mesentery (what is it, what does it develop in association with, what structures is it limited to)

Answer 30

``` attaches viscera to anterior abdominal wall develops in association with the liver limited to: terminal esophagus stomach and proximal duodenum ```

Question 31

what forms the peritoneal covering of the liver?

Answer 31

ventral mesentery

Question 32

ventral mesentery (named parts)

Answer 32

Lesser omentum Falciform ligament Coronary ligament Left and right triangular ligament

Question 33

ligamentum teres is formed from what?

Answer 33

obliterated umbilical veins

Question 34

gutters (what are they0

Answer 34

channels created by fusion of GI tract to the posterior abdominal wall

Question 35

what provides a pathway for the flow of ascitic fluid and the spread of intraperitoneal infection

Answer 35

paracolic gutters

Question 36

Peritoneal Gutters (name them)

Answer 36

right lateral (paracolic) left lateral (paracolic) right of the mesentery (infracolic) left of the mesentery (infracolic)

Question 37

Pouches or Recesses (what are they)

Answer 37

fossae of peritoneum formed by peritoneal reflections (folds)

Question 38

what determine the extent and direction of the spread of pathological fluids that enter the peritoneal cavity

Answer 38

peritoneal recesses

Question 39

Subphrenic Recess | what is it

Answer 39

space in the greater sac b.w the diaphragm and liver on either side of the falciform ligament

Question 40

``` Hepatorenal Recess (of Morison) (what is it) ```

Answer 40

part of the greater sac b/w liver (anteriorly) and right kidney and diaphragm (posteriorly)

Question 41

what is the lowest part of the adominopelvic cavity when the patient is laying down

Answer 41

hepatorenal recess (of Morison)

Question 42

infection of the pleural cavity is a common associated complication of what and why?

Answer 42

Infection of Hepatorenal Recess (of Morison) infection can be absorbed by diaphragmatic lymphatics in this recess and then the infection can spread via systemic circulation

Question 43

Peritoneal Ligament (what are they)

Answer 43

double layer of peritoneum that connects and organ with another organ or the abdominal wall

Question 44

Omenta (what are they)

Answer 44

specific peritoneal ligaments of the stomach | pass from stomach and proximal duodenum to adjacent viscera in abdominal cavity or abdominal wall

Question 45

Omenta (name them and what they are derived from)

Answer 45

Greater Omentum- dorsal mesentery | Lesser Omentum- ventral mesentery

Question 46

Lesser Omentum (what does it connect)

Answer 46

lesser curvature of the stomach and proximal duodenum to the liver

Question 47

Lesser Omentum (named parts and contents)

Answer 47

Hepatogastric ligament Hepatoduodenal Ligament Contains- portal triad

Question 48

falciform ligament (what does it connect, what does it contain, what is it derived from)

Answer 48

connection b/w liver and anterior abdominal wall from ventral mesentery free interior margin contains legamentum teres (obliterated umbilical vein)

Question 49

Coronary ligament (what is it derived from, what does it connect)

Answer 49

liver to diaphragm

Question 50

Left and right triangular ligaments (what are they derived from, what do they connect)

Answer 50

ventral mesentery | liver to diaphragm

Question 51

Greater Omentum (what is it path and connections)

Answer 51

dorsal mesentery fused 4 layer sheet hangs down like an apron from the greater curvature of the stomach and proximal duodenum descends and then folds back to attach to the anterior part of the transverse colon and its mesentery

Question 52

Grater Omentum (named parts)

Answer 52

Gastrophrenic ligament Gastrosplenic Ligament Gastrocolic Ligament

Question 53

Splenorenal ligament (derived from what, what does it connect)

Answer 53

dorsal mesentery | spleen to left kidney

Question 54

Phrenicocolic ligament (derived from what and connects what

Answer 54

dorsal mesentery | extends from left colic flexure to diaphragm

Question 55

what is the portal triad

Answer 55

hepatic artery, bile duct, portal vein

Question 56

Peritonitis (what is it, what causes it)

Answer 56

inflammation of peritoneum that occurs form injury or infection peritoneum secretes fluid and cells in response to trauma, leading to excess fluid accumulation in the peritoneal cavity (ascites)

Question 57

ascites

Answer 57

when excess fluid accumulates in peritoneal cavity

Question 58

Peritoneal Adhesions (what are they, what causes them)

Answer 58

fibrous bands of scar tissue that form between abdominal organs and walls, joining them together abnormally caused by inflammation, injury, infection, and most commonly surgery most do not cause clinical problems, can be associated w/ intestinal obstruction

Question 59

Intra-abdominal infections usually stay where?

Answer 59

stay below the diaphragm and do not enter other body cavities

Question 60

the large surface area of the abdomen allows for what (in terms of infection and malignant cells)

Answer 60

they can spread easily and rapidly throughout the abdomen

Question 61

anterior boundary of epiploic foramen

Answer 61

portal triade in heptoduodenal ligament

Question 62

posterior boundary of epiploic foramen

Answer 62

inferior vena cava and right crus of diaphragm

Question 63

superior boundary of epiploic foramen

Answer 63

caudate lobe of liver

Question 64

inferior boundary of epiploic foramen

Answer 64

first part of duodenum

Question 65

depression lateral to the lateral umbilical fold?

Answer 65

lateral inguinal fossa

Question 66

lateral inguinal fossa is the site of?

Answer 66

deep lingual ring | indirect hernia

Question 67

why are women at particular risk of infection of the hepatorenal recess?

Answer 67

because of open communication b/w fallopian tubes and peritoneal cavity

Question 68

where is the opening of the epiploic foramen

Answer 68

lateral edge of hepatoduodenal ligament of the lesser momentum

Question 69

what must be cut for surgical access to lesser sac

Answer 69

gastrocolic ligament