Peritoneum

Preperitoneal organ - Which organ? - how is it situated? Subperitoneal organs -Where is situated? - Name the organs in male and female

- *Preperitoneal organ* > Only- filled urinary bladder > When it is situated behind the anterior abdominal walls and in front of the parietal peritoneum > this position allows suprapubic aspiration to obtain uncontaminated bladder urine Subperitoneal organs > These organs are situated in lesser pelvis below the parietal peritoneum - *Male*: > Empty urinary bladder > Seminal vesicles > Prostata > Urethra - *Female* > Empty urinary bladder > Vagina > Urethra

Peritoneum - histological structure - Consist of what? (layer)

- A single layer of flat mesothelial cells(simple squamous epithelium) supported by submesothelial connective tissue - *Parietal peritoneum* is loosely connected to the abdominal and pelvic walls by subserous tissue - it allows considerable alteration on the size of the bladder and recutm - is only fused firmly with diaphragm - *Visceral peritoneum* is firmly attached to the surface of organs - it cannot be easily detached - it forms serous coat (tunica serosa) of the organs

Peritoneum What is it? What does it do? What does it cover?

- A thin serous membrane which lines the walls of the abdominal and pelvic cavity and covers much of the viscera

Transverse mesocolon - Structures (layers) - Connects what to what? - Root (crosses what) - Structures between its layers

- Double-layered fold of peritoneum -Connects the transverse colon tot the posterior abdominal wal - *The root of transverse mesocolon* crosses *descending part of duodenum and pancreas* - Between its layers are the middle colic arteries and veins, nerves, and lymphatics supplying the transverse colon

Sigmoid mesocolon - Shape - Attaches what to what? - Root (crosses what)? - Contains what?

- In shape : inverted V-shaped peritoneal fold - It attaches the sigmoid colon to the abdominal wall - *The root of sigmoid mesocolon - crosses left iliac vessels, left gonadal vessels, left ureter* - Contains sigmoid and superior rectal vessels, along with the nerves and lymphatics associated with the sigmoid colon.

Greater omentum - policeman if the abdomen - Its ability when inflammation

- It has ability to migrate to any inflamed area and wrap itself around the organ to enclose the inflammation

Mesentery - Shape - Connects what to what - Root ( from -> to?) and crosses with structures - Contains what structures and which structures do they supply?

- It is fan shaped, double layered fold of peritoneum - Connects the jejunum and ileum to the posterior abdominal wall - *The root of mesentry* > From duodenojejunal junction to the ileocecal junction - crosses *abdominal aorta, inferior vena cava and right ureter* - Contains arteries, veins, nerves, and lymphatics that supply the jejunum and ileum

Peritoneal cavity What is it? What does it contain?

- Narrow space between parietal and visceral peritoneum - Contains a peritoneal fluid - small amount of serous fluid that lubricates the peritoneum and allows the mobile visceral to glide freely on the abdominal wall and upon each other. - Contains no gas in normal circumstance

Peritoneal folds -Name all of them - Their function - What do they contain - Developed from where

- Omenta - Mesenteries - Ligaments > Peritoneal folds connect organs to the abdominal wall or to each other > They contain vessels and nerves supplying the viscera or help maintain the proper position of the viscera > These folds develop from the original dorsal and ventral mesenteries, which suspend the developing gastrointestinal tract in the embryonic coelomic cavity

Nerve supply of peritoneum - Nerves

- Parietal peritoneum - somatic nerves - segmental ares (also for he muscles and the skin) - when the parietal peritoneum is irritated - muscles tend to contract reflexly - rigidity of abdominal wall - abdominal guarding - to guard inflamed organs within the abdomen from the pain of pressure upon them - defense muscular - it is a characteristic finding in the physical exemption for an abruptly painful abdomen (an acute abodmen) with inflammation of the inner abdominal (peritoneal) surface due to appendicitis, diverticulitis... - Visceral peritoneum - visceral afferents.

Supramesocolic and inframesocolic part of the peritoneal cavity - What happens to the root of transverse mesocolon? - Name the parts. And their supplying arteries for associated organs.

- The root of transverse mesocolon divides the peritoneal cavity into: > Supramesocolic part - the organs contained in this part are supplied by *coeliac a.* > Inframesocolic part - the organs in there are supplied by superior and inferior mesenteric arteries Duodenum and pancreas - are supplied by coeliac a. + superior mesenteric a. + inferior mesenteric a.

Retroperitoneal organs - Where do they lie? - How are they covered? Name the organs

- These organs lie behind the peritoneum and in front of the posterior abdominal or pelvic walls - They are only partially (anteriorly) covered by peritoneum Organs >Duodenum >Ascending and Descending colon and rectum >Pancreas >Abdominal aorta, inferior vena cava >Kidneys >Ureters > Suprarenal glands

Intraperitoneal organs - what are they covered with? - What connects them to abdominal or pelvic walls? - What does the connection contain? Name the intraperitoneal organs

- They are completely covered by visceral peritoneum - Connected to the abdominal or pelvic walls by the folds of peritoneum -> omenta, mesenteries which contain blood vessels, lymphatics and nerves Intraperitoneal organs: > abdominal part of the eosophagus >Stomach >Jejunum and Ileum >Caecum, transverse colon, sigmoid colon >Liver >Spleen > uterus, uterine tubes (ovaries)

Greater omentum - Structure (layers) - Where does it arise from? - What does it cover? - General features (ligament, vessels)

- Two-layered peritoneal apron - Arises from the greater curvature of the stomach - Drapes over the transverse colon, jejunum and ileum - freely suspended - Its thicker upper part forms *gastrocolic ligament* - Usually contains an accumulation of fat - Contains the *right* and *left gastroomental vessels* - is derived from the dorsal mesentery

Lesser omentum - Structure (layers) - Where does it extend from and to? - Medial part - Lateral part

- Two-layered peritoneal fold - It extends from the lesser curvature of the stomach and the first part of the duodenum to the inferior surface of the liver - Medial part: > *Hepatogastric ligament* which passes between the stomach and liver - Lateral part > *Hepatoduodenum ligament* which passes between the duodenum and liver

Visceral and parietal peritoneum What lines what?

- Visceral peritoneum - lines all the organs that are intraperitoneal - Parietal peritoneum - lines the anterior, lateral, and posterior walls of the peritoneal cavity - abdominal and pelvic cavity

Peritoneal connection of the liver - Name the ligament - What is it, extends from -> to? - Contains what? - Continues to what? Other structures that connects liver to peritoneal.

-*Falciform ligament of the liver* > Is a peritoneal fold which extends from the umbilicus to the liver > Contains fibrous cord - *round ligament of the liver - ligamentum teres* - runs on the inferior surface of the liver. > Falciform ligament continuous on the diaphragmatic surface of the liver into the *coronary ligaments* (right and left) - which attaches liver to the diaphragm. - Lesser omentum

Parietal peritoneum of the anterior abdominal wall - Folded by, and between? - There folds, name all

-Parietal peritoneum of the anterior abdominal wall is folded by some embryonic remnants between the umbilicus and pubic bone - *Middle umbilical fold* - is caused by middle umbilical ligament (remnant of urachus) - *Medial umbilical fold* - is elevated by umbilical ligament (remnant of umbilical artery) - *Lateral umbilical fold* - elevated by inferior epigastric vessels.

Hepatoduodenal ligament Structures and their relations to the ligament

> Portal vein - posteriorly > Proper hepatic artery - anteriorly on the left side > Bile duct - anteriorly on the right side

Parietal peritoneum of the posterior abdominal wall - Interrupted (avbrutt) by? - Name all 3 attachements and what they cross

Interrupted by: - Attachment of *the mesentery = the root of mesentery* > Crosses the abdominal aorta, inferior vena cava and right ureter - Attachment of *transverse mesocolon = the root of transverse mesocolon* > Crosses *descending part of duodenum* and *pancreas* - Attachment of *sigmoid mesocolon = the root of sigmoid mesocolon* > Crosses *left iliac vessels, left gonodal vessels, left ureter*