52 terms

Peritoneum

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6 Parts of the Ailimentary Canal (
1)Mouth
2)Pharynx
3)Esophagus
4)Stomach
5)Small Intestine
6)Large Intestine
Digestive Glands
**SALIVARY GLANDS**
1)Contain ducts that open into the mouth
**LIVER AND PANCREAS**
1)Discharge exocrine secretions through ducts opening into the duodenum (1st part of SI)
2)Liver: LARGEST gland of GI system (Bile)
3)Pancreas is the 2nd LARGEST gland of the GI system (produces pancreatic juice; considered a mixed gland)
Peritoneum
-->Closes serous membrane consisting of parietal & visceral peritoneum, filled with serous fluid
-->IN MALES: A closed cavity
-->IN FEMALES: An open cavity in most places with communication with the exterior (via uterine tubes, uterus, & vagina)
1)**ASCENDING INFECTIONS IN FEMALES INFECT THE PERITONEAL SPACE**
Peritoneal Fluid
-->Secreted by peritoneum; allows mobile viscera to glide easily on surface of one another
Retroperitoneal Space
The space betwn. the PARIETAL PERITONEUM & POSTERIOR ABDOMINAL WALL
Adult Derivatives of Germ Layers
1) Endoderm --> Gut Tube
2) Mesoderm --> Peritoneum (Visceral & Parietal)
3) Ectoderm --> Body Wall
**Celom: Responsible for the development of all cavities (serous, peritoneal, & abdominal cavity)
Intraperitoneal Organs
-->Organ that is mostly covered with visceral peritoneum
Examples of Intraperitoneal Organs
1)Stomach
2)1st Part of Duodenum
3)Jejunum
4)Ileum
5)Cecum w/appendix
6)Transverse Colon
7)Sigmoid Rectum
8)Spleen
9)Liver & Gallbladder
10)Uterus (females)
Retroperitoneal Organs
-->Organ that is BEHIND the peritoneum and is only PARTIALLY covered with peritoneum
Examples of Retroperitoneal Organs
1)Pancrease
2)Duodenum EXCEPT for 1st part
3)Ascending Colon
4)Descending Colon
5)Lower part of the Rectum
6)Kidneys
7)Ureters
8)Rectum (Lower Part)
Falciform Ligament
-->Works with CORONARY LIGAMENT to suspend liver to diaphram ABOVE IT
-->Terminates as the round ligament of the liver (ligamentum teres)
-->Contains Paraumbillical Veins to connect the veins of ant. abdom. wall with LEFT branch of the portal vein
Lesser Omentum
-->Double layered fold of peritoneum that connect the lesser curvature and proximal duodenum to the liver
-->2 Ligaments
1)Hepatoduodenal L.
***Contains the portal triad (Bile duct, portal vein, & proper hepatic artery)
2)Hepatogastric L.(Contains gastric vessels & CT)
Greater Omentum
-->A four-layered fold of peritoneum that hangs down from the greater curvature of the stomach & proximal duodenum
1)Folds back on itself to attach to the transverse colon
***Contents
1)Greater & Lesser gastroepiploic vessels
2)Liagemtnts (Gastrophrenic, Gastrosplenic, & Gastrocolic)
-->Major Fxn: Moves within peritoneal cavity & wrap itself around an inflammed organ
1)***Localize inflammation & prevent the adhesion betwn. visceral & parietal peritoneum of abdominal wall
Gastrophrenic Ligament
-->Peritoneal fold connecting the diaphragm to the upper part of back of stomach
-->Continues as Gastrosplenic & Gastrocolic Ligaments
Mesentaries
-->Double layer of peritoneum that is created by invagination of peritoneum by an organ
-->***Transmits vessels, nerves, lymph nodes, fat, & blood toward INTRAPERITONEAL ORGANS
Contents of Mesentary
1)Superior Mesenteric Artery & Vein
2)Jejunal & ileal branches of SMA & tributaries
3)Arterial Arcades
Mesentary of the Large Intestine
1)Transverse Mesocolon
***Major content: MIDDLE COLIC VESSELS
2)Sigmoid Mesocolon
***Major content: SIGMOID ARTERIES & ACCOMPANYING VEINS
Mesoappendix
-->Triangular fold of peritoneum around appendix; Free border encloses the **appendicular artery & vein**
2 Parts of the Peritoneal Cavity
1)Greater Peritoneal Sac
2)Lesser Peritoneal Sac ("Omental Bursa")
Greater Sac
-->Main compartment of the peritoneal cavity
-->Extends from the diaphram DOWN to the pelvis
Lesser Sac
-->Smaller of the 2; Located behind the stomach
Epiploic Foramen ("Winslow's Foramen")
-->Opening of the lesser sac that serves as the means of communication betwn. greater & lesser sac's
-->Borders:
1)Anteriorly: Hepatoduodenal Ligament containg portal triad
2)Posteriorly: IVC
3)Superiorly: Caudate Lobe of the liver
4)Inferiorly: The 1st part of the duodenum
Sharp Pain in the Epigastrium Region
***A clinical sign of a ruptured ulcer (ex. gastric ulcer) in the posterior wall of the stomach (Will find stomach contents FIRST in OMENTAL BURSA)
1) A **Secondary consequence** is pancreatitis (b/c it is retroperitoneal located behind the stomach)
2 Walls of the Lesser Sac
1)Anterior Wall
-->Lesser Omentum
-->***Posterior Border of the Stomach
-->Ant. 2 Layers of the Greater Omentum
2)Posterior Wall
-->***Body of the pancreas
-->***Part of the left kidney
-->***Left suprarenal gland
-->Greater Omentum
Division of the Geater Sac of Peritoneum
-->Divided by the TRANSVERSE MESOCOLON INTO:
1)Suprcolic Compartement (Above transverse colon)
-->Btwn. Transverse mesocolon & parietal peritoneum
2)Infracolic Compartement (Below transverse colon)
-->Betwn. Transverse mesocolon & inlet of the true (lesser pelvis) (grooves)
4 Recesses in the Supracolic Compartment
1)Right Subphrenic Recess
-->Continous with the right subhepatic recess
2)Left Subphrenic Recess
3)Right Subhepatic Recess
-->***Can see it
4)Left Subhepatic Recess ("Lesser peritoneal sac")
***Can see it
Falciform Ligament
-->Separates to right & left subphrenic recess
Right subhepatic recess ("Morrison's Space/Pouch"; "Hepatorenal Space")
-->***The deepest point of the PERITONEAL SPACE when the patient is in the SUPINE POSITION
Left subhepatic space
-->Connected with the right subhepatic space through the EPIPLOIC FORAMEN
4 spaces & gutters of the infracolic compartment
1)Right paracolic space
-->Located on right side of mesentary
-->See Key Points for borders
2)Right infracolic space
***IS A CLOSED SPACE
3)Left infracolic space
-->On the left side of mesentary, betwn it & the descending colon
-->***Continuous INFERIOROLY with pelvic cavity (OPEN SPACE_
4)Left paracolic space
Right paracolic gutter
-->LATERALLY is continuous with MORISSIONS POUCH superiorly
Left paracolic gutter
-->Separated from the area around the spleen by the PHRENICOCOLIC LIGAMENT
1)A fold of peritoneum passing from the left colic flexure to the diaphram
Intersigmoid Recess
-->Located at the apex of the inverted, J shaped root of the SIGMOID COLON
-->***Lies in front of the LEFT URETER
Internal Hernia
-->Occurs when the loop of intestine is logdged in a peritoneal recess OR epiploic foramen
**HIGH PROBABILITY OF OBSTRUCTION & STRANGULATION OF THE INTESTINS**
--Treatment involves surgical removal of affected peritoneal
Female Pelvic Cavity
-->2 Major Types:
1)Rectouterine Pouch (Pouch of Douglas)
2)VesicoUterine Pouch
Rectouterine Pouch (of Douglas)
-->***The deepest point of peritoneal space when the patient is in the VERTICAL POSITION of the female body
-->LOCATED between the rectum & the uterus
***The space of PELVIC ABSCSS LOCATION
Vesicouterine Pouch
-->The depression betwn. the uterus & the urinary bladder
Culdocentesis
-->The aspiration of fluid from Pouch of Douglas by using a needle puncture of the POSTERIOR VAGINAL FORNIX near the midline betwn. the uterosacral ligaments
Maor structure in the male pelvic cavity
***Rectovesical Pouch: The depression betwn. the rectum & the urinary bladder
2 Deepest points of the peritoneal space
1)Right Suphepatic Recess (Morrisons space)
-->Patient in SUPINE position
2)Rectouterine Pouch
-->Patient is in VERTICAL position
***Important difference in position of urinary blader
-->USUALLY is a retroperitoneal organ, but can change position based on amount of urine it holds:
1)If Urinary Bladder is fully: MESOPERITONEAL
2)If Urinary Bladder is empty:RETROPERITONEAL
**Acutue Peritonitis**
-->A generalized inflammation of the peritoneum
-->Patient will demonstrate 4 MAJOR SIGNS of inflammation:
1)Pain
2)Incr. in temperature
3)Change in color
4)Swelling
-->Other important symptoms:
1)Spasm of the anteriolateral abdominal muscles
2)Leukocytosis (An. incr. in the amout of white blood cells)
Local Peritonitis
-->Regional inflammation in a separated/closed space of the peritoneum
Ex. Lesser Sac or Right infracolic Space
Pelvioperitonitis
***A local peritonitis of the rectouterine pouch (of Douglas (due to complication of inflammation of female internal genital organs)
Acities
Abnormal amounts of fluid in the peritoneal cavity (USUALLY due to periotinitis or metastases to abdominal viscera)
Paracentesis
-->Removal of excess peritoneal fluid from the abdominal cavity
-->Puncture must occur at the level of T7-L1
-->Point of insertion of needle & canuula is at the linea alba BELOW the umbillicus
2 Major Causes of metasasis of cancer into the abdominal cavity
1)Portal Hypertension
2)Cancer
Nerve supply of the parietal peritoneum
***SENSITIVE TO PAIN, TEMPERATURE, & TOUCH
-->Supplied by the SOMATIC NERVES (**GVA fibers**)supplying the anterior & superior abdominal walls
Nerve supply of the visceral peritoneum
***NOT SENSITIVE TO PAIN, TEMPERATURE & TOUCH
-->Affected by TENSION of the viscera or traction on the omentum/mesentaries, which leads to VISCERAL PAIN
Blood supply of the parietal peritoneum
***Supplied by the arteries of the ant. abdominal & pelvic wall
-->Ex. Intercostal arteries T7-L1
Blood supply of the visceral peritoneum
***Supplied by the arteries of the underlying visera ("Non-localized")
Venous drainage of the peritonium
-->Drained by the veins corresponding to the supplying arteries