Peritoneum and Retroperitoneum

Question 1

What structure separates the peritoneum from the retroperitoneum?

Answer 1

Peritoneal membrane

Question 2

Describe the peritoneum

Answer 2

Thin layer of loose connective tissue which lines the abdominal cavity

Question 3

What does the peritoneum produce?

Answer 3

Serous fluid

Question 4

What does the peritoneum contain?

Answer 4

Fat (provides padding and support), blood vessels, lymphatics and nerves

Question 5

Why does the peritoneum create ligaments and folds?

Answer 5

To anchor the organs

Question 6

How does the peritoneum allow for free movement b/w the organs?

Answer 6

Serous fluid

Question 7

What are the 2 layers of the peritoneum?

Answer 7

Parietal and Visceral

Question 8

What does the parietal and visceral cavity create?

Answer 8

Potential space/cavity

Question 9

What happens to the peritoneal membrane as structures move into the abdominal cavity from the posterior abdominal wall?

Answer 9

Moves anterior

Question 10

What are the organs that become enclosed with double folds of peritoneum called?

Answer 10

Intraperitoneal organs

Question 11

What are the organs that only have their anterior surfaces covered with peritoneal membrane called?

Answer 11

Retroperitoneum organs

Question 12

Define mesentery

Answer 12

Peritoneal folds connecting the small and large bowel to the posterior abdominal wall

Question 13

How is the mesentery shaped?

Answer 13

Large and fan shaped

Question 14

Define mesocolon

Answer 14

Peritoneum attached to the colon

Question 15

What does the mesocolon connect?

Answer 15

Connects the transverse colon and sigmoid to the posterior abdominal wall

Question 16

Define lesser omentum

Answer 16

Double layer of mesentery

Question 17

What does the lesser omentum connect?

Answer 17

Connects the lesser curve of the stomach and the 1st part of the duodenum to the visceral surface of the liver

Question 18

Define greater omentum

Answer 18

Apron like fold

Question 19

What does the greater omentum connect?

Answer 19

Connects the greater curvature of the stomach to the transverse colon

Question 20

What is a ligament?

Answer 20

Double fold of peritoneum that connects one organ to another

Question 21

How are ligaments named?

Answer 21

Names based on the organs they are attached to

Question 22

What runs within a ligament?

Answer 22

Blood, lymphatic vessels and nerves to organs

Question 23

Where is the falciform ligament located?

Answer 23

Passes over the anterior superior surface of the liver and splits

Question 24

Where does the falciform ligament travel?

Answer 24

From the umbilicus to the liver

Question 25

What structure runs through the falciform ligament?

Answer 25

Ligamentum teres

Question 26

What other ligaments are formed by the splitting of the falciform ligament?

Answer 26

1. Triangular ligament | 2. Coronary ligament

Question 27

What makes the coronary ligaments?

Answer 27

Made of parietal peritoneum

Question 28

Where are the coronary ligaments located?

Answer 28

On the posterior aspect of the liver

Question 29

What do the coronary ligaments define?

Answer 29

"Bare area" on the liver

Question 30

What makes up the ligamentum teres?

Answer 30

Remanent of the fetal umbilical cord

Question 31

Where does the ligamentum teres travel?

Answer 31

Runs in the falciform ligament and joins the LPV at the port hepatis

Question 32

What is the ligamentum venosum?

Answer 32

Remnant of the fetal ductus venosum

Question 33

What does the ligamentum venosum attach to?

Answer 33

Attaches to the LPV above the IVC

Question 34

What are the triangular ligaments?

Answer 34

"Corner" of the bare area

Question 35

What do the hepatoduodenal ligament conduct?

Answer 35

Conducts the MPV, CBD and HA

Question 36

What are other ligaments that run within the peritoneal cavity?

Answer 36

Hepatogastric Gastrocolic Gastrosplenic Splenorenal (lienorenal)

Question 37

Is the peritoneal sac a closed sac?

Answer 37

Not in females (due to fallopian tubes)

Question 38

What is another name for the right sub hepatic space?

Answer 38

Morison's pouch

Question 39

What structures is the morison's pouch posterior to?

Answer 39

Right lobe of the liver and GB

Question 40

What structures is the morison's pouch anterior to?

Answer 40

Upper pole of the right kidney

Question 41

What is the morison's pouch posteriorly bound by?

Answer 41

The upper pole of the right kidney and diaphragm

Question 42

What does the right boundary of the morison's pouch consist of?

Answer 42

Right lobe of the liver and diaphragm

Question 43

What lies interiorly to the morison's pouch?

Answer 43

2nd part of the duodenum

Question 44

What is to the left of the morison's pouch

Answer 44

Epiploic foramen of Windslow

Question 45

What is the most dependent portion of the subhepatic space?

Answer 45

Morison's pouch

Question 46

Is the lesser sac part of the right or left subhepatic space?

Answer 46

Left subhepatic space

Question 47

What is contained within the left subhepatic space?

Answer 47

Anterior and posterior recesses

Question 48

Describe the subphrenic space

Answer 48

Anterior and posterior portions

Question 49

What does the posterior right subphrenic space communicate with?

Answer 49

Right subhepatic space

Question 50

What structure defines the subphrenic space?

Answer 50

Liver and diaphragm

Question 51

What ligament divides the subphrenic space into right and left?

Answer 51

Falciform ligament

Question 52

Does the lesser sac communicate with the greater sac?

Answer 52

Yes

Question 53

What is the alternate name for the lesser sac?

Answer 53

Omental bursa

Question 54

What are the 3 terms for the opening of the lesser sac?

Answer 54

1. Epiploic foramen 2. Foramen of Winslow 3. Omental foramen/neck

Question 55

What structure lies posterior to the opening of the lesser sac?

Answer 55

IVC

Question 56

What structure lies superior to the opening of the lesser sac?

Answer 56

Caudate lobe

Question 57

What structure lies directly anterior to the lesser sac?

Answer 57

Stomach

Question 58

What retroperitoneal structure lies directly posterior to the lesser sac?

Answer 58

Pancreas

Question 59

Which sac accounts for the most space in the peritoneal cavity?

Answer 59

Greater sac

Question 60

What is the relation of the greater sac to the lesser sac?

Answer 60

Anterior to the lesser sac superiorly | Posterior to the lesser sac inferiorly

Question 61

What structure divides the greater sac to into supramesocolic and inframesocolic compartments?

Answer 61

Transverse mesocolon

Question 62

What structure are included in the Supramesocolon space?

Answer 62

Subphrenic and subhepatic spaces

Question 63

What structures are included in the Inframesocolic space?

Answer 63

Paracolic gutters and pelvic reflections

Question 64

What structure divides the inframesocolic into right and left compartments?

Answer 64

Root of mesentery

Question 65

The right and left inframesocolic compartments are further divided into medial and lateral compartments by what structures?

Answer 65

The ascending colon (right) | The descending colon (left)

Question 66

What is the right paracolic gutter?

Answer 66

Space b/w the ascending colon and the right lateral abdomen wall

Question 67

What is the left paracolic gutter?

Answer 67

Space b/w the descending colon and the left lateral abdomen wall

Question 68

Which portion of the inframesocolic compartment does not communicate with the pelvic cavity directly?

Answer 68

Right medial compartment because the root of the mesentery blocks any fluid

Question 69

Which ligament prevents the left lateral gutter from communicating with the left supramesocolic area?

Answer 69

Phrenocolic ligament

Question 70

What is the appearance of the parietal peritoneum?

Answer 70

Thin smooth echogenic line deep to the abdominal wall muscles- peritoneal line

Question 71

What is the scanning technique used for the peritoneum and retroperitoneum?

Answer 71

- Should fast overnight to reduce bowel gas - 3.5 to 5 MHz probe - Pt scanned in supine - Apply graded compression

Question 72

When is the mesentery viewed on US?

Answer 72

When there is ascitis in the abdomen- appears as a free floating smooth leaves directed towards the centre of the abdomen

Question 73

The retroperitoneum is posterior to what structure?

Answer 73

Peritoneum

Question 74

The retroperitoneum is anterior to what structure?

Answer 74

Transversalis fascia

Question 75

What forms the inferior boundary of the retroperitoneum?

Answer 75

Pelvic brim (pelvic diaphragm)

Question 76

How many compartments/spaces make up the retroperitoneum?

Answer 76

3

Question 77

How many layers of fascia is the retroperitoneum made of?

Answer 77

2

Question 78

What structures define the boundary of the anterior pararenal space?

Answer 78

Anterior- gerotas fascia | Posterior- peritoneum

Question 79

What are the major structures within the anterior pararenal space?

Answer 79

Ascending and descending colon, duodenum (besides the first part) and the pancreas

Question 80

Does the anterior pararenal space potentially communicate with the posterior pararenal space and pelvis?

Answer 80

Yes - potential midline communication

Question 81

What structures enclose the perirenal space?

Answer 81

Renal fascia or gerotas fascia

Question 82

What are the major structures within the perirenal space?

Answer 82

Kidneys, adrenals, ureters and great vessels

Question 83

Does the perirenal space communicate with the pelvic area?

Answer 83

No- no communication across midline due to the great vessels blocking flow

Question 84

Describe the posterior pararenal space

Answer 84

- Extends from the posterior renal fascia anteriorly to the transversalis fascia - No solid organs - Contains fat

Question 85

What are the 3 spaces that communicate with the posterior pararenal space?

Answer 85

1. Anterior pararenal space 2. Pelvis 3. Peritoneal space- potential space b/w peritoneum and transversalis fascia

Question 86

What is the role of US when examining the peritoneum and retroperitoneum?

Answer 86

- Characterize lesions - Assess aortic aneurysms - Provide guidance for interventional procedures