Peritoneum/Peritoneal Cavity
What is the Peritoneal Cavity?
-A VIRTUAL space in between parietal and visceral peritoneums. -It has a small amount of capillary fluid produced by mesothelial cells to lubricate the surfaces. -If this space is infected, then the virtual space becomes a real state.
What are the boundaries of the Epiploic/Omental Foramen?
-Anterior: Portal Hepaticus (portal triad). Contained within the Hepatoduodenal ligament...Portal vein is posterior, proper hepatic artery is on left, and common bile duct is on right -Posterior: IVC and rt crus of diaphragm -Superior: Caudate lobe of liver -Inferior: Superior part of duodenum
What is the Lesser Omentum?
-Connects lesser curvature of stomach and proximal part of duodenum to liver. -Hepatogastric Ligament -Hepatoduodenal Ligament (very thick)
What is the Infracolic Compartment?
-Divided into rt/lt infracolic spaces -Rt/Lt Paracolic Gutters (medial/lateral): Separated by ascending/descending colons respectively...these gutters slope superiorly and posteriorly so if fluid accumulates, it will follow gutters to superior part of abdomen when pt is supine
What is the Omentum?
-Double layer of peritoneum that attaches stomach to abdominal wall/other abdominal organs. -Divided into Greater and Lesser Omentums
What is the Peritoneal ligament?
-Double layer of peritoneum that connects an organ to another organ or abdominal wall. -Contain vessels/remnants of vessels: Falciform Ligament - obliterated umbilical vein
What is the mesentry?
-Double layer of peritoneum that encloses an organ and connects it to the abdominal wall -Changes name depending on organ involved (megogastrium, transverse mesocolon, etc) -Blood vessels that serve organs are transverse in mesentry
What is the Greater Omentum?
-Fat-laden fold of peritoneum that hangs down from greater curvature of stomach and connects stomach with diaphragm, spleen, and transverse colon. -Gastrocolic Ligament -Gastrosplenic Ligament -Gastrophrenic Ligament
What is the Supracolic Compartment?
-Located above transverse mesocolon -Divided by FALCIFORM ligament into: 1) Rt/Lt subphrenic recesses 2) Rt/Lt subhepatic recesses
Where is the Lesser Sac of Peritoneum/Omental Bursa?
-Located between stomach and posterior abdominal wall, posterior to lesser omentum and the stomach
What is the difference between male and female peritoneal cavity?
-Males: closed cavity -Females: Communication with exterior through uterine tubes, uterus, and vagina
What is the nerve supply of the Peritoneum?
-Parietal Layer: 1) Phrenic nerve (subdiaphragmatic branches) 2) Thoracolumbar nerves 3) Subcostal nerve 4) Lumbosacral plexus (L4-S4) -Visceral Layer: insensitive to pain
What are Peritoneal Recesses?
-Peritoneal folds that form blind pouches that are closed on one end and open into abdominal cavity -Retrocecal recess (SI/LI) -Uterovesical recess (bladder/uterus) -Pouch of Douglas/Rectouterine recess (rectum/uterus)
What are peritoneal folds?
-Peritoneal reflections as peritoneum covers abdominal structures (medial/lateral umbilical folds)
How to do a Paracentesis?
-RLQ/LLQ approach -Sub-umbilical approach (2 cm below) -When quadrant approach, perform lat to rectus sheath to avoid inferior epigastric vessels -Empty the bladder, especially with sub-umbilical approach
What is Paracentesis?
-Removal of fluid/gas from peritoneal cavity using a needle -Indications: Sudden ascites (accumulation of blood), rule out bacterial infection in ascites, decrease discomfort -Contraindications: Bleeding, avoid areas of skin where there is an infection, surgical scars, dilated veins, hematomas, use caution in pregnant pts
What are the two sacs the Peritoneal Cavity is divided into?
1) Greater peritoneal sac: from diaphragm to pelvic floor 2) Lesser peritoneal sac/Omental Bursa: posterior to stomach and liver (limited by lesser omentum)
What are the 2 compartments of Peritoneal Cavity?
1) Supracolic Compartment 2) Infracolic Compartment *Divided by the Transverse Colon*
Describe the Omental Foramen
It is a curtain that attaches from duodenum to liver...it's not a real hole; it's a makeshift opening
What is the peritoneum?
Thin, transparent membrane that has 2 layers: 1) Parietal peritoneum: lines abdominal wall 2) Visceral peritoneum: covers abdominal viscera and forms serosa of organs
Is the Omental Bursa in communication with the greater peritoneal sac?
Yes, through the Omental Foramen/epipolic foramen/foramen of Winslow...it is located posterior to free edge of lesser omentum (hepatoduodenal ligament)