SDL - Peritoneum

Question 1

What is the parietal peritoneum?

Answer 1

Parietal peritoneum lines the walls of the abdominal cavity. It clothes the anterior and posterior abdominal walls, the under surface of the diaphragm and the cavity of the pelvis.

Question 2

What is the nerve supply of the parietal peritoneum?

Answer 2

Thoracoabdominal nerves

Intercostal, subcostal, iliohypogastric, ilioinguinal nerves

Question 3

What are the upper parts of the pelvic organs covered by?

Answer 3

The upper parts of the pelvic organs (rectum, uterus, bladder) project into the abdominal cavity and are covered by visceral peritoneum which hangs down in pouches between them

Question 4

When in situ, are the following organs are retro/intraperitoneal?:

1. Stomach
2. Liver
3. Gall bladder
4. Spleen
5. Duodenum
6. Pancreas
7. Kidneys
8. Jejunum and ileum
9. Caecum
10. Appendix
11. Ascending, transverse, descending, sigmoid colon
12. Rectum

Answer 4

Intra: Stomach, liver, gallbladder, spleen, tail of pancreas, 1st part of duodenum, jejunum, ileum, appendix, transverse colon, sigmoid colon

Retro: Rest of duodenum, pancreas, kidneys, caecum, ascending colon, descending colon, rectum

Question 5

What is found at the free edge of the falciform ligament?

Answer 5

Ligamentum teres

Question 6

What is the ligamentum teres a remnant of?

Answer 6

Umbilical vein

Question 7

What is an adhesion?

Answer 7

Pathological connection between the GI tract and the parietal peritoneum or another viscus

Question 8

What is attached to the posterior surface of the greater omentum?

Answer 8

Transverse colon

Question 9

What does the transverse mesocolon divide?

Answer 9

The greater sac into the supracolic and infracolic compartment

Question 10

What is found between the liver and the diaphragm?

Answer 10

The subphrenic space (in supracolic compartment)

Question 11

What is the subphrenic space divided into?

Answer 11

Right and left by the falciform ligament

Question 12

What space is found under the liver?

Answer 12

Subhepatic channel

Question 13

What is the inferior limit of the subhepatic channel?

Answer 13

The transverse mesocolon

Question 14

What space is found to the right of the subhepatic channel? What is this pouch continuous with?

Answer 14

Hepatorenal pouch

With the right paracolic gutter

Question 15

Why is the hepatorenal pouch of surgical importance?

Answer 15

Fluid can collect here when the individual is supine

Question 16

Which 3 structures are enclosed within the free border of the lesser omentum?

Answer 16

Portal triad:

Anterior left - hepatic artery
Anterior right - bile duct
Posterior - hepatic portal vein

Question 17

What is the embryological origin of the lesser omentum?

Answer 17

Ventral mesogastrium

Question 18

What is the ventral mesogastrium?

Answer 18

A ventral mesentery of the embryonic stomach that persists as the falciform ligament and the lesser omentum

Question 19

What forms the anterior, inferior, superior and posterior boundary of the epiploic foramen?

Answer 19

Anterior margin: Portal triad

Posterior margin: IVC

Superior margin: Caudate lobe

Inferior margin: First portion of duodenum

Question 20

Where is the gastrocolic ligament found?

Answer 20

The part of the greater omentum between the greater curvature of the stomach and the transverse colon

Question 21

How many layers of peritoneum make up the greater omentum as it runs between the greater curvature of the stomach and the transverse colon?

Answer 21

6

Question 22

How many layers of peritoneum make up the greater omentum inferior to the transverse colon?

Answer 22

4

Question 23

What is the space enclosed between the anterior and posterior layers of the greater omentum part of?

Answer 23

Lesser sac

Question 24

Where is the gastrosplenic ligament?

Answer 24

Part of greater omentum, runs from greater curvature to spleen

Question 25

How is the lienorenal ligament formed?

Answer 25

From the spleen, this same fold continues to the posterior abdominal wall where it attaches in the region of the left kidney

Question 26

What runs in the lienorenal ligament?

Answer 26

The terminal part of the splenic artery

Question 27

What does the infracolic compartment contain?

Answer 27

The main mass of intestinal coils.

Question 28

Where is the beginning of the large intestine?

Answer 28

In the right iliac fossa

Question 29

Is the splenic or the hepatic flexure higher?

Answer 29

The splenic flexure (due to the great bulk of liver on the right)

Question 30

What is located between the splenic flexure and the diaphragm?

Answer 30

A small transverse fold of peritoneum --> the phrenico-colic ligamen N.B. there is NO phrenico-colic ligament on the right

Question 31

Where are the right and left paracolic gutters located?

Answer 31

On the lateral aspects of the ascending and descending colons

Question 32

Why are the paracolic gutters clinically important?

Answer 32

Movement of free fluid from compartments within the abdomen

Question 33

Describe the mesentery of the small intestine

Answer 33

First part of duodenum is intraperitoneal. Rest of duodenum is retroperitoneal. Mesentery begins at the duodenojejunal flexure so the jejunum and ileum are intraperitoneal.

Question 34

What is the root of the mesentery?

Answer 34

The line of attachment of the mesentery to the posterior wall

Question 35

What is the infracolic compartment divided into? By what?

Answer 35

Left and right parts by the mesentery of the small intestine

Question 36

What side of the infracolic compartment communicates with the pelvis?

Answer 36

Left

Question 37

Where does the small intestine terminate? What is also found here?

Answer 37

Right iliac fossa The caecum and the appendix and its associated meso-appendix

Question 38

What does the mesoappendix contain?

Answer 38

Appendicular artery (branch of the iliocolic)

Question 39

How is 'normal' sensory info from an organ generally transmitted?

Answer 39

Through visceral sensory fibres that accompany the parasympathetic motor fibres supplying that organ

Question 40

What is the parasympathetic motor supply to the foregut and midgut?

Answer 40

Vagus nerve

Question 41

What is the parasympathetic motor supply to the hindgut?

Answer 41

Pelvic splanchnic

Question 42

What is the parasympathetic motor supply to the bladder?

Answer 42

Pelvic splanchnic

Question 43

How is 'painful' sensory info from an organ generally transmitter?

Answer 43

Through visceral sensory fibres that accompany the sympathetic motor fibres accompanying the organ

Question 44

What is the sympathetic motor supply to the abdominal and pelvic viscera?

Answer 44

Greater, lesser, least and lumbar splanchnic nerves

Question 45

Where are painful sensations from the viscera vaguely localised to?

Answer 45

The median plane

Question 46

What are the parietal layers innervated by?

Answer 46

Sensory branches of somatic nerves

Question 47

Why does pain from parietal layers localise well?

Answer 47

As it signals through the somatic systems

Question 48

Early in acute appendicitis, what is inflamed? Where is pain felt?

Answer 48

Only the vermiform appendix and visceral peritoneum Pain felt in the central abdomen

Question 49

As soon as the parietal peritoneum becomes inflamed in appendicitis, where is the pain?

Answer 49

Pain localises to right iliac fossa (pain associated with somatic structures of the abdominal wall as you cannot feel pain 'in the appendix') This is referred pain

Question 50

Where is cardiac pain felt?

Answer 50

Left arm

Question 51

Where is gall bladder pain felt?

Answer 51

Right shoulder

Question 52

Where is ureteric pain felt?

Answer 52

External genitalia