Name six peritoneal folds of the anterior abdominal wall
Falciform ligament, median umbilical fold, two medial umbilical folds, two lateral umbilical folds.
Where does the falciform ligament run?
From the umbilicus to the xiphisternum, entering the fissure of ligamentum trees on the visceral surface of the liver. After delivering the ligament to the liver it sweeps right.
What does the falciform ligament contain?
The posterior and crescentic free margin of the ligamentum teres
What is the origin of the ligamentum trees?
The obliterated remnant of the left umbilical vein
What does the median umbilical fold contain and from what did it originate?
The median umbilical ligament which is the obliterated remains of the urachus
What do the medial umbilical folds contain?
The obliterated remains of the umbilical artery
What do the lateral umbilical folds contain?
The inferior epigastric vessels (these do not reach the umbilicus)
What is the main abdominal cavity? How much free fluid does it contain?
The greater sac, a few mLs of fluid.
What is the lesser sac?
An invagination of the greater sac behind the stomach through the epiploic foramen
Other than being a smaller area, how is the capacity of the lesser sac further reduced?
The posterior layers of the momentum fuse
What constitutes the roof of the lesser sac?
The sloping roof is the peritoneum covering the caudate lobe of the liver.
What constitutes the lowest part of the posterior wall of the lesser sac?
The transverse mesocolon attached to the lowest part of the pancreas.
What constitutes the greater omentum?
Two closely attached layers of peritoneum enclosing blood vessels and lymphatics
What are the boundaries of the greater omentum?
The greater omentum is a vascular apron along the greater curvature of the stomach. It reaches from the oesophagus to the duodenum.
What is the lesser omentum?
Two layers of peritoneum that extend between the liber and upper border of the stomach
Why is the hepatic attachment of the letter omentum L-shaped?
It is L-shaped in the fissure for the ligamentum venous and the portahepatis
What happens to the peritoneum of the lesser omentum inferiorly?
Traced downwards it becomes the greater omentum
What happens to the peritoneum of the lesser omentum superiorly?
Traced upwards it encloses the liver and spreads over the diaphragm
What is the upper boundary of the epiploic foramen?
The caudate process of the liver
What is the lower boundary of the epiploic foramen?
The ascending first part of the duodenum
What is the anterior boundary of the epiploic foramen?
The right free margin of the lesser omentum and contains the portal vain, hepatic artery (medial) and the CBD
What is the posterior boundary of the epiploic foramen?
The IVC covered by the parietal peritoneum
What shape and size is the epiploic foramen?
The epiploic foramen is a 2.5cm vertical slit
What are the four divisions of the sypracolic compartment and their boundaries?
- Right upper (right sub diaphragmatic) - Rt of falciform and upper coronary
- Right lower (right) - between liver and kidney, posteriorly bounded by the lower layer of the coronary ligament = the lowest point when supine
- Left upper (left sub diaphragmatic) - left of falciform, posterior ???? left triangular ligament
- Left lower (left sub hepatic compartment) - lesser sac
What four things does the transverse mesocolon attach to?
Rt kidney, duodenum, lower border of pancreas, lower part of left kidney
How is the infracolic compartment divided?
Into two, by the root of the mesentery which contains the pancinian corpuscles
What is a pancinian corpuscle?
What is the course of the root of the mesentery, and over what four items does it pass? How long is it?
15cm long. Passes from left upper to right lower. Passes the DJ junction, aorta, IVC, Rt psoas, Rt ureter
What are the boundaries of the upper, right section of the infracolic compartment?
Apex is found at the ileocolic junction, on the right the ascending colon, on the left the attachment of the mesentery, at the base the transverse mesocolon
What is found on the floor of the upper right section of the infracolic compartment?
The lower pole of the right kidney crossed by the right colic vessels, the second part of the duodenum, turning to the third part. The DJ flexure lies to the left of the midline on the left psoas L2. The right paracolic gutter lies laterally and is an easy pathway for fluid spread.
What are the boundaries of the lower left division of the infracolic compartment?
Quadrilateral shape Upper: transverse mesocolon, Right: mesentery Left: descending colon Lower: attachment of sigmoid colon
What is found on the floor of the lower left division of the infracolic compartment?
The fourth part of the duodenum, and DJ flexure, paraduodenal fossae, inferior pole of the left kidney, shallowest in the midline (2’vertebrae), sigmoidcolon attachment, left ureter running near apex of sigmoid mesentery
What limits the upper margin of the left paracolic gutter?
The phrenicocolic ligament
The peritoneum is a ……….. ………….. composted of ………… (well ……………) and ………. (poorly …………….) parts. It is a ……… layer of flattened …………….. cells with overlying areolar tissue. Over expansile parts it is loose and ……….., and over non-expansile parts it is thick. Retroperitoneal organs have ….. attachments to …………. tissue.
serous membrane, parietal, innervated, visceral, innervated, single, mesothelial, cellular, firm, muscular