Peritoneum

Abdominal Paracentesis Draining fluid from the peritoneal cavity called ?

Aspiration or drainage paracentesis

Clinical Correlates: Peritonitis •? contamination of the peritoneum. Causes: Trauma, infection, ?citis, perforation an ?. -> Generalized peritonitis is dangerous.

Bacterial appendi- ulcer

Lesser Sac (aka Omental ?) •Irregular space that lies ? to the liver, lesser omentum, stomach, and upper anterior part of the greater omentum. •Is a ? sac, except for its communication with the greater sac through the ? ***Point where infection can spread from ? -> ?

Bursa posterior closed epiploic (omental) foramen **greater to lesser sac

Ascites ? fluid in the peritoneal cavity. •Causes: portal hypertension, metastasis of cancer cells, starvation •The excessive fluid interferes with ? of the viscera.

Excessive movement

Best way to drain fluid or puss from the peritoneum is to enter through the epiploic foramen ***if you go too far posteriorly here when draining -> you will cause a MAJOR BLEED OF THE ?

IVC

Hepatorenal recess ?, most ? dependent part of the peritoneal cavity when pt is ? If you inject fluids in -> they go to ? recess! Build up of fluid/ puss from ulcers -> will migrate to ? Also fluid can go to: RECTOVESICAL POUCH IN MEN RECTOUTERINE POUCH IN WOMEN

Lowest gravity supine Hepatorenal recess Hepatorenal recess

Mesoappendix: connects ? to the ?

Mesoappendix -> post abdominal wall

2. Hepatorenal recess (? pouch) Deep peritoneal pocket between: ? anteriorly and the ? posteriorly Where can infections travel from here? - CAN OPEN THROUGH the ? into the lesser sac to the stomach - CAN CONNECT to the ? to the paracolic organs

Morrisons RT liver RT kidney and suprarenal gland epicloic foramen paracolic gutter

CQ: Which of the following structures lie in the free edge of the lesser omentum and must be dissected out in order to be preserved? A: ?

Portal triad contents hepatic artery bile duct portal vein (most POST. Structure)

Mesentery proper: connects ? to the ?

SI (duodenum, jejunum, ileum) -> post abdominal wall

Sigmoid mesocolon: connects ? to the ?

Sigmoid colon -> post abdominal wall

Greater sac •Extends across the entire breadth of the ? From the ? -> to the ? floor •Presents numerous ? where puss-filled abscess may be ?

abdomen diaphragm pelvic recesses drained

Peritoneum: •Thin serous membrane that lines the ? and ? •Lies deep to the ?peritoneal fascia of the abdominal cavity -> subdivided into: 1. ? peritoneum is that portion that lines the abdominal and pelvic cavities. Those cavities are also known as the peritoneal cavity 2. ? peritoneum covers the external surfaces of most abdominal organs, including the intestinal tract.

abdomen and pelvis. extraperitoneal fascia parietal visceral

Secondary retroperitoneal organs Examples: ?, ?, ? •Organs that were ? initially but then become ? organs later on •Only covered on on ? surface

ascending and descending colon 1st part of duodenum pancreas intraperitoneal retroperitoneal anterior

3. Paracolic recess •Lie lateral to the ? -> (R paracolic gutter) and lateral to the ? -> (L paracolic gutter)

ascending colon descending colon

Portal triad: made of ? duct common ? artery ? vein

bile hepatic portal

Subperitoneal organ Example: ? Parietal peritoneum only on its ? surface

bladder superior

Parietal Peritoneum •Is served by the same ?, as is the region of the ? it ? Example: •Ant abdominal wall nerves will supply the parietal peritoneum lining it •Pelvis nerves will supply supply the parietal peritoneum lining it Note: LYMPHATICS: ? LYMPH NODES IN PERITONEUM LYMPH NODES -> located within the ?

blood, lymphatic vasculature, somatic nerve supply wall it lines NO arteries

Greater Sac Recesses 1. Subphrenic (Suprahepatic) Recess -Peritoneal pocket between the ? and the anterior and superior part of the ? -Separated into L and R recesses by the ? ligament

diaphragm liver falciform

1. Peritoneal ligament •consists of a ? layer of peritoneum that connects an organ with ? or to the ? -> Ex: ? ligament

double another organ abdominal wall Falciform

3. Mesenteries What is Mesentery? a ? layer of ? that occurs as a result of the ? is invaginated by an ? Function: A mesentery connects an ? to the ?

double peritoneum peritoneum invaginated by an organ intraperitoneal organ to the post abdominal body wall

2. Omentum •is a ?-layered extension or fold of peritoneum Passes from the ? + proximal ? -> to adjacent organs in the abdominal cavity 1. greater omenta 2. lesser omenta

double stomach + duodenum

Root of the mesentery Directed obliquely, inferiorly, and to the right Extends from: ? junction -> ? junction

duodenojejunal ileocolic

Greater omentum •Runs from the: ? curvature of stomach + ? part of the duodenum -> to the anterior aspect of ? How does it attach? •It's a double fold so it folds ? before attaching to transverse colon

greater first part of duodenum transverse colon back on itself

Root of the transverse mesocolon: Lies along the ? border of the pancreas Continuous with the parietal peritoneum ?

inferior posteriorly

Peritoneal organs Intraperitoneal in this case does NOT mean ? the peritoneal cavity (although the term is used clinically for substances injected into this cavity). Intraperitoneal organs have ? into the closed sac, like pressing your fist into an inflated balloon.

inside invaginated

Peritoneal organs: Stomach ?peritoneal Covered ? by peritoneum on ? sides Aorta •?peritoneal •Only covered on with peritoneum on ? surface Pancreas •?, ?peritoneal (Organ that were ? initially but then become ? organs later on) •Only covered on ? surface Uterus •?peritoneal •Parietal peritoneum only on its ? surface.

intra completely, all retro anterior secondary retro intraperitoneal retroperitoneal anterior sub superior

Retroperitoneal organs Example: ? ? to the parietal peritoneum Only covered with peritoneum on ? surface

kidneys External (located between the parietal peritoneum and the post abdominal wall) anterior surface

Lesser omentum • Extend from the ? curvature of the stomach + ? part of the duodenum -> to the ? of the liver -> (where structures ?/? the liver)

less first portaheptis (enter and leave)

Epiploic Foramen Winslow's Foramen Omental Foramen A natural opening between the ? and ? Boundaries: Superiorly by ? Inferiorly by ? Anteriorly by the ? Posteriorly by peritoneum covering the ?

lesser and greater sacs caudate lobe of the liver first part of the duodenum free edge of the lesser omentum aka lesser sac aka (hepatoduodonal ligament) IVC

Fluid in Omental Bursa Perforation of the post. wall of the stomach -> passage of its fluid contents into the ? CQ: Inflamed/injured ? can also result in the passage of pancreatic fluid into the bursa -> forming a pancreatic pseudo-cyst

omental bursa pancreas

Peritoneal cavity •Between ? and ? peritoneum •Contains ? fluid CQ: PC is ? space (*) between the parietal and visceral peritoneum •If need be these 2 layers will ? •In F: ? •In M: ?

parietal and visceral peritoneal potential separate open closed

Spread of Pathological Fluids Peritoneal recesses are of clinical importance in connection with the spread of ? -> Infection can spread to the: ? gutters ? recess ? recesses ? pouch

pathological fluids paracolic hepatorenal subphrenic rectouterine

Parts of lesser omentum 1. Gastrohepatic ligament -From lesser curvature to the ? of liver 2. Heptoduodenal ligament -From the ? part of duodenum to the ? of liver ? EDGE of the lesser omentum **Contains ?

portahepatsis first portahepatsis FREE portal triad (made of bile duct, common hepatic artery, and portal vein)

5. Peritoneal recess aka peritoneal fossa -> is a ? of peritoneum that is formed by a peritoneal fold ? pouches Like a "?"

pouch Blind end caul-de-sac

Abscess formation •Subphrenic abscess is a medical condition where there is accumulation of ? in space between the diaphragm, the spleen and the liver. -> Develops after ? operations on abdomen such as splenectomy or bowel perforation

pus or infected fluid in the space surgical

Note: lines the walls of the abdominal cavity and, at various points, ? onto the abdominal viscera, providing either a ? or ? covering.

reflects complete or a partial

Intraperitoneal Injection •Peritoneum is a ? membrane. •It overlies blood and lymphatic capillary beds. •Fluid injected into the peritoneal cavity is absorbed ? -Widely used to administer ? to treat some cancers - ovarian cancer

semipermeable rapidly chemotherapy drugs

Intestine in Omental Bursa (Uncommon) SI loop may pass through the omental foramen into the omental bursa and be ? by the edges of the foramen ? of the boundaries of the foramen can be incised because each contains ? The swollen intestine must be decompressed using a ? -> so it can be returned to the greater sac of the peritoneal cavity through the omental foramen

strangulated None blood vessels needle

Lesser Sac (aka Omental Bursa) Recesses Presents 3 recesses: (1) ? recess, which lies behind the stomach, lesser omentum, and L lobe of the liver; (2) ? recess, which lies behind the stomach, extending into the layers of the greater omentum (3) ? recess, which extends to the ? at the hilus of the ?.

superior inferior splenic L @ spleen

Transverse mesocolon: connects ? to the ?

transverse colon-> post abdominal wall

1 Median umbilical fold - formed by the ? 2 Medial umbilical fold - formed by the obliterated ? artery 2 Lateral umbilical fold - formed by the ? artery

uracus umbilical inf epigastric a.

Visceral Peritoneum: •Covers the ? •Lacks ? innervation, so it does NOT feel ? -> thus, pain is ? localized Does feel ? Note: It is served by the ? blood, lymphatic vasculature, and nerve supply as the organ it is ?

viscera sensory stretch pain poorly same covering.

Peritoneal Adhesions •When the peritoneal surfaces become inflamed: -> healing causes abnormal attachments between ? •These adhesions cause chronic ? *Adhesiotomy refers to the surgical ? of ?

visceral and parietal peritoneum pain separation adhesions

Parietal Peritoneum •lines the surface of the abdominal and pelvic ? •Is sensitive to: ? •Parietal peritoneal pain is ?

wall pain, heat, cold and laceration well localized