Peritoneum, Peritoneal Cavity, Viscera and Vasculature  

A 36-year-old man with profound intellectual disability is brought to the physician by staff at his facility because of increasing abdominal girth during the past 2 weeks. He is unable to speak, and no medical history is currently available. Physical examination shows a protuberant abdomen with a fluid wave and shifting dullness. There are no signs of trauma to the area. Laboratory studies show no abnormalities. A CT scan of the abdomen is shown. Fluid is present in which of the following areas as indicated by the arrow?

(A) Epiploic foramen (B) Gastrosplenic ligament (C) Hepatorenal pouch (of Morison) (D) Omental bursa (lesser sac) (E) Sulcus pericolicus D : excess fluid in peritonial vacity make fluid wave and shifting dullness

The omental bursa (lesser sac)

, the smaller part of the peritoneal cavity, lies posterior to the stomach, lesser omentum, and adjacent structures.

Mesentery

A mesentery is a double layer of peritoneum that oc- curs as a result of the invagination of the peritoneum by an organ and constitutes a continuity of the visceral and parietal peritoneum recess -- go in , reflects come out

Omental / Epiploic Foramen

A. Tear in the stomach Anteriorly communicates with Peritoneal Cavity B. Tear in the stomach Posteriorly communicates with Omental Bursa

cross sections

Boundaries of Omental Foramen: Ant: Heptoduodenal Lig. Post: IVC Sup: Caudate lobe of liver Inf: Duodenum 1st part (sup.)

Epiploic Foramen:

Communication between greater and lesser sacs Peritoneal Cavity communicates with Omental Bursa

clicker

D , dull, constant pain in the right part of her abdomen but she couldn't tell me the exact site. After around 2 hours or so, she developed fever and suddenly localized her pain to McBurney's point (appendicitis causes pain in this particular region) That's a pretty classical picture of acute appendicitis. But wait, the appendix is an abdominal organ, why did its pain get localised? That's because once it got inflamed (the fever proved that the appendix was infected and thus acutely inflamed), it started irritating the PARIETAL peritoneum, which causes somatic or localized pain, thus helping us narrow down our diagnosis. So although this process is painful for the patient, it's a helpful diagnostic feature for the physician! rigidity of muscle

Peritoneum: Paracolic Gutter left and right

Free communication occurs between the supracolic and the infracolic compartments through the paracolic gutters, the grooves between the lateral aspect of the ascending or descending colon and the posterolateral ab-dominal wall, flow less obstructed on the right.

Peritoneum Cavity: Division

Greater sac Lesser sac or Omental bursa Compartments: Paracolic gutters Pouches Supracolic Infracolic

What two ligaments arise from the lesser omentum?

Hepatogastric and Hepatoduodenal ligament portal vein , artery and common bile duct is also comes down

lesser omentum superior border of stomach

Liver to stomach Liver to duodenum (heptogastric lig.) (hepatoduodenal Lig.) black arrow is Epiploic Foramen

Is Gallbladder Bed covered with Peritoneum

No Tip of Rt. 9th costal cartilage

nerves and vessels of parietal peritoneum

Parietal Peritoneum: lymphatics supplying vasculature, nerves & body wall & diaphragm it lines supplies parietal vasculature, nerves & also peritoneum Visceral Peritoneum: lymphatics supplying the organ it covers also supplies vesceral peritonium T7-T11 abdominal wall also supplies parietal peritoneum C3-C5 (since central tendon of diaphragm that lines with peritoneum wall ) phrenic nerve

what organs do we see in infracolic compartment

Small intestine • Ascending & descending colon, transverse colon , sigmoidal colon , appendix

Greater adjacent organs (Inferior border of Stomach)

Stomach to colon- (gastrocolic ligamanet) stomach to spleen ( gastrospleenic lig) stomach to diaphragm ( gastrophrenic)

Peritonitis (infection of peritoneum) Collection of Pus in the peritoneal cavity including recess, pouches ot gutters Pus can collect in Subphrenic and / or Hepatorenal RECESS Subphrenic abscess is drained by an incision inferior to the 12th rib

Subphrenic and Heptorenal Recess

Heptatopancreatic Ampulla

The ampulla of Vater, also known as the hepatopancreatic ampulla,or as hepatopancreatic duct, is formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla.

Ascites

accumulation of fluid in the peritoneal cavity

another question

answer D

what is the function of rectovesical pouch

contain excess fluid in peritonaeum , when Ascites , laying supine can cause fluid travel into other organs

peritoneum

is a glistening, transparent serous membrane that consists of two continuous layers • Parietal peritoneum, lining the internal surface of the abdominopelvic wall • Visceral peritoneum, investing viscera (organs) such as the spleen and stomach

a fold of peritoneum connecting the stomach with other abdominal organs.

omentum

Extending from the two curvatures of the stomach are two mesenteries called ___________

omentum Greater and lesser omentum

A tumor growing from the anterior body of the vertebrae destroys which of the following structure?

pancreas , because it is a retroparitoneal organ

Peritoneal Cavity Boundaries

paramedial sagital plane , since arcuate line is present

What is the name for the deep space created from the peritoneum located on the superior of the rectum and the posterior aspect of the bladder ?

rectovesical pouch

what organs do we find in supracolic compartment

stomach , liver , spleen , gallblader , duodenum

QUESTION

supraclsvicular nerves and the phrenic nerve arise from spinal cord segment C3-C4

Peritoneal Cavity: Compartments & Gutters

supracolic compartment and infracolic compartment point of reference is transverse colon

Cystic artery - Hepatic Artery - Omental Foramen

using the omental foramen, and hepatoduodenal ligament , surgent can ligate portal triad ( portal vein , hepatic artery and common hepatic duct). cystis artery is a branch oof hepatic artery that supplied galbladder

Visceral Peritoneum:

vasculature, nerves & lymphatics supplying the organ it covers also supplies visceral peritoneum. Sympathetic nerves innervates visceral Epigastric area: For foregut pain Periumblical area: For midgut pain Suprapubic area: For hindgut pain