Peritoneum And Peritoneal Cavity

Peritoneum and Peritoneal Cavity Dr. Aldwin A. Yaneza Dept of Anatomy

Terminology Greek     

Liver – hepar ex. hepatitis Stomach – gaster ex gastric ulcer Spleen - splen ex splenic artery Diaphragm – phren ex phrenic nerve Kidney – renes ex renal vein

Terminology       

1. Peritoneum 2. Mesentery 3. Omentum 4. Peritoneal ligament 5. Peritoneal folds 6. Peritoneal recess 7. Omental bursa

  1. 2. 

1. PERITONEUM

Thin transparent serous membrane 2 layers Parietal - lining of abd. wall Visceral – covers the viscera Peritoneal fluid – separates parietal & visceral periton. 

Lubricates peritoneal surfaces, enables viscera to move on each other without friction

Parietal

Visceral

2. MESENTERY

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Double layer of peritoneum w/c encloses an organ and connects it to abdominal wall Contains fat, lymph nodes, BV, nerves going to viscus Named after viscus it attaches    

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Most mobile parts of intestine 

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Stomach – mesogastrium Transverse colon – transverse mesocolon Sigmoid colon – mesosigmoid Appendix – mesoappendix Transverse colon, small intestine

None in retroperitoneal viscus 

Ascending colon , kidney, parts of duodenum

Transverse mesocolon

mesosigmoid

3. OMENTUM 

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Double layered sheet or fold of peritoneum Attach the stomach to the body wall or to other abdominal organs 2 forms  Greater omentum  Lesser omentum

3a. Greater Omentum   

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Fatty fold of peritoneum Hangs fr stomach Connects stomach w/ diaphragm, spleen and transverse colon Thin as paper in thin persons Thick and fat laden in obese persons Long enough to cover whole abdomen [apron]

252]

[ plt

3b. Lesser Omentum 

Plate 258

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Connects lesser curve of stomach and proximal duodenum to liver 2 portions

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1.Hepatogastric ligament - Connects liver to stomach 2. Hepatoduodenal - Connects liver to duodenum

4. Peritoneal Ligament 

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255]

Double layer of peritoneum that connects an organ with another organ or with abdominal wall May contain BV or remnants of BV 

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Examples:

Splenocolic ligamentatt spleen to colon Gastrosplenic ligamentatt stomach to spleen

[plt

5. Peritoneal folds 

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Reflection of peritoneum w/ sharp borders Often formed by peritoneum that covers blood vessels, ducts, and obliterated BV Ex. Umbilical folds

6. Peritoneal Recesses [plt Peritoneum folds to form a blind pouches [cul de sacs] or tubular cavities that are closed at one end with an opening into the peritoneal cavity Ex.  Retrocecal recess – posterior to cecum  Ileocecal recess – anterior to cecum 

264]

Subdivisions Upon lifting the greater omentum  Divides peritoneal cavity into 2 compartments 1. Supracolic 2. Infracolic 

Supracolic compartment Divided into smaller spaces by falciform lig 1. Subphrenic recess 

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R and L Bet diaphragm and liver

2. Hepatorenal recess 

Bet R liver lobe and R kidney

Infracolic Compartment, plt 264

Divided into R and L by mesentery of small intestine 1. Paracolic gutters 

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R – assoc w/ ascending colon L – assoc w/ descending colon

2. Paravetebral gutter  

On each side of vertebra Cont kidney,ureter,part of colon

7. Omental Bursa,    

Large compartment Bet stomach and posterior abd wall Posterior to lesser omentum and stomach Extension of the main PC into the invaginated R side of the dorsal mesentery of the stomach

plt 255

Omental Bursa 

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Extension of omental bursa 1. Superior recess 

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Limited superiorly by diaphragm

2. Inferior recess 

Potential space

Omental Bursa, 

Foramen of Winslow   

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Communic of OB w/ main peritoneal cavity Posterior to lesser omentum Admits 2 digits

Boundaries 

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Anterior – portal v, hepatic artery and bile duct or portal triad Posterior – IVC and R crus diaphragm Superior – caudate lobe,liver Inferior – superior part of duodenum and portal triad

plt 258

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Peritoneal [abdominal] cavity Larger part of abdominopelvic cavity Contains viscera Located superior to the pelvic inlet Lined by parietal peritoneum Boundaries  

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Superior – diaphragm Inferior – contin. w/ pelvic cavity Posterior – vertebral column Anterior – abdominal wall

IDENTIFY? Greater omentum

Peritonitis  

Inflammation of peritoneum Underlying causes:    

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Inflammed viscus Abscess in peritoneal cavity Spillage of intestinal contents into peritoneal cavity Trauma of abdomen[SW,GSW]

Pain in overlying area Rebound tenderness Reflex increase in tone of ant abd wall [ AAW ]muscles Spasm of AAW muscles Muscle guarding