Understanding the Peritoneal Cavity

Question 1

What is the peritoneum?

Answer 1

• layer of serous membrane
• comprising connective tissue and squamous epithelium which lines the abdominal cavity
• has 2 parts parietal and visceral peritoneum

Question 2

What does the peritoneum adhere to and is it the parietal of visceral peritoneum?

Answer 2

• anterior and posterior abdominal walls
• undersurface of the diaphragm
• cavity of the pelvis
• this is the parietal peritoneum (red in image)

Question 3

What type of tissue lines the outside of the parietal peritoneum?

Answer 3

• loose areola tissue
• dense fibrous tissue
• fat
• all closely related to deep layer of abdominal muscles

Question 4

What is the name of the cells, and the cell type of the peritoneum?

Answer 4

• mesothelial cells
• composed of simple squamous epithelial

Question 5

Where does the visceral peritoneum line, and what type of cells is this composed of?

Answer 5

• surrounds organs of the GIT
• it is an extension of the parietal pleura
• simple sqaumous epithelial cells called mesothelium

Question 6

Where does the visceral peritoneum line, and does it surround all organs in the GIT?

Answer 6

• no, does not surround more mobile organs
• moves around the SI and LI, fusing at back of them
• fusing begind the SI and LI forms the mesentary

Question 7

What nervse innervate the parietal peritoneum and what are they able to sense?

Answer 7

• L2-L4
• somatic so are sensitive to everything
• pain is well localised

Question 8

What nervse innervate the visceral peritoneum and what are they able to sense?

Answer 8

• visceral nerves
• stretch receptors only

Question 9

Do the parietal and visceral peritoneum originate from the ecoderm, mesoderm or the endoderm in embryological development?

Answer 9

• formed of connective tissue
• all connective tissue comes from the mesoderm
• derive from the somatic mesoderm in the embryo

Question 10

Does the GIT originate from the ecoderm, mesoderm or the endoderm in embryological development?

Answer 10

• endoderm

Question 11

What does mesentrary mean?

Answer 11

• a double fold of the peritoneum
• attaches the stomach, small intestine, pancreas, spleen, and other organs to the posterior wall of the abdomen

Question 12

In addition to providing support and attaching organs to the posterior wall of the abdomen, what else does the mesentary create?

Answer 12

• support ligaments for the stomach (gastrosplenic ligament)
• support ligaments for the spleen (lienorenal ligament)

Question 13

Ventrally what else does the mesentary create?

Answer 13

• ligaments around the liver
• falciform ligament
• lesser omentum

Question 14

What is Intraperitoneal?

Answer 14

• intra = inside the peritoneum
• completely wrapped in peritoneum
• peritoneal folds form mesenterys

Question 15

What is retroperitoneal?

Answer 15

• retro means outside of peritoneum
• the anterior aspect of retroperitoneal organs attach to peritoneum

Question 16

Are retroperitoneal or intraperitoneal organs more mobile?

Answer 16

• intraperitoneal are generally more mobile
• like the small intestines they can be moved easily in surgery

Question 17

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the S stand for?

Answer 17

• Suprarenal (adrenal) glands

Question 18

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the A stand for?

Answer 18

• Aorta and Inferior Vena Cava

Question 19

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the D stand for?

Answer 19

• duodenum (except for the first part)

Question 20

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the P stand for?

Answer 20

• pancreas
• except for the tail

Question 21

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the U stand for?

Answer 21

• ureters
• tube carrying urine from kidneys

Question 22

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the C stand for?

Answer 22

Colon

• ascending and descending parts

Question 23

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the K stand for?

Answer 23

• kidneys

Question 24

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the E stand for?

Answer 24

• Esophagus

Question 25

SAD PUCKER can be used to remeber organs that are classed as retroperitoneal. What does the R stand for?

Answer 25

- rectum

Question 26

The peritoneal cavity has two areas called sacs, what are their names?

Answer 26

- lesser sac (behind stomach) - greater sac

Question 27

What is the omenta in the GIT?

Answer 27

- fused peritoneal folds - they attach the abdominal organs with one another

Question 28

How many omentum are present in the GIT, and what are their names?

Answer 28

- lesser omentum - greater omentum

Question 29

What do the lesser and greater omentum both attach to in the GIT?

Answer 29

- stomach - lesser is superior - greater is inferior

Question 30

What does the lesser omentum attach together in the GIT?

Answer 30

- stomach - liver - can be divided into hepatogastric and hepatoduodenal ligaments

Question 31

What does the greater omentum attach together in the GIT?

Answer 31

- greater curvature of the stomach and the transverse colon - lies over the infracolic compartment - descrinbed as the policeman or an apron of the abdomen - freely moveable and protect other organs from inflamed or diseased organs

Question 32

The peritoneal cavity includes the greater lesser sacs. The greater sac can be subdivided into the Supra and Inferior colic compartments. What is the dividing line for these compartments?

Answer 32

- mesentary attaching transverse colon to posterior abdominal wall - this mesentary is called the **mesocolon**

Question 33

What is contained within the Supra colic compartment of the greater sac of the peritoneal cavity?

Answer 33

- most of the foregut - stomach - liver and biliary tree - pancreas - spleen

Question 34

What is superior border of the Supra colic compartment of the greater sac of the peritoneal cavity?

Answer 34

- diaphragm - costal margin

Question 35

The greater momentum contains a number of things to supply and insulate the organs in that area. What are these contents?

Answer 35

- blood vessels - fat - lymphatics

Question 36

Where is the lesser sac within the Supra colic compartment of the peritoneal cavity?

Answer 36

- posterior to the stomach and lesser omentum - functions by allowing the stomach to move freely against the structures posterior and inferior to it

Question 37

The greater and lesser sacs of the supra colic compartment are able to communicate via what?

Answer 37

- epiploic foramen - ep-ee-plow-ic

Question 38

The epiploic foramen is the communication between the greater and lesser sacs of the supra colic compartment. Why can this be surgically important?

Answer 38

- if liver bleeds a clamp can be placed here - stops blood leaking into both sacs

Question 39

Is the supracolic and infracolic compartments larger?

Answer 39

- infracolic

Question 40

The infra-colic compartment has 2 gutters running either side of it, what are these called?

Answer 40

- left and right para colic gutters - either side of the ascending (right) and descending (left) colon

Question 41

Where does the right para colic gutter run?

Answer 41

- crosses betwee the supra and Infra-colic compartment - up to right kidney - undersurface right lobe of liver – (recess called the hepato-renal pouch) - lateral to ascending colon and caecum to pelvic cavity

Question 42

Where does the left para colic gutter run?

Answer 42

- left side of transverse mesocolon - lateral to descending colon and base of sigmoid mesocolon - runs to pelvic cavity

Question 43

The infra-colic compartment of the greater sac can be further subdivided into the left and right intracolic compartments. What divides left from right intracolic compartments?

Answer 43

- root of small intestines mesentery attached to posterior abdominal wall

Question 44

The infra-colic compartment of the greater sac can be further subdivided into the left and right intracolic compartments. What is included within the right intracolic compartment?

Answer 44

- small intestines - ascending colon

Question 45

The infra-colic compartment of the greater sac can be further subdivided into the left and right intracolic compartments. What is included within the left intracolic compartment?

Answer 45

- larger than the right - descedning colon - transverse colon

Question 46

What is the vesico-uterine pouch that is formed by reflections of the peritoneum?

Answer 46

- bladder and uterus in females - fluid can collect here causing abscess formartoon - abscess (pus formation) can form bulges that can be palpated

Question 47

What is the recto-uterine pouch that is formed by reflections of the peritoneum?

Answer 47

- pouch between uterus and rectum - abscess (pus formation) can form bulges that can be palpated

Question 48

What is the recto-vesical pouch that is formed by reflections of the peritoneum?

Answer 48

- pounch between bladder and rectum - abscess (pus formation) can form bulges that can be palpated

Question 49

How does the peritoneum contribute to immune function?

Answer 49

- contains phagocytes to protect viscera - mesothelial cells transform to fibroblasts for healing - greater omentum physically protects (like an apron)

Question 50

What is peritonitis?

Answer 50

- inflammation of the peritoneum - common

Question 51

How does appendicites cause peritonitis?

Answer 51

- appendix bursts - contents infect peritoneum - greater omentum tries to encompass this

Question 52

What is Peritoneal Malignancy?

Answer 52

- cancer that has spread to the peritoneum

Question 53

There are some therapeutic approaches that can be used to treat the peritoneum. What is intraperitoneal chemotherapy?

Answer 53

- chemotherapy delivered directly into the peritoneum

Question 54

There are some therapeutic approaches that can be used to treat the peritoneum. What is peritoneal dialysis?

Answer 54

- dialysis uses peritoneum as a membrane - fluid and substances can dissolve through peritoneum into blood - can remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure

Question 55

There are some therapeutic approaches that can be used to treat the peritoneum. What is peritoneal-venous shunts?

Answer 55

- peritoneal fluid is drained into veins using a 1 way valve - can be used in patients with refractory ascites