Download MBBS Anatomy PPT 69 Peritoneum Notes

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Peritoneum

Tough layer of elastic areolar tissue
Lined with simple squamous

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epithelium

Largest of the serous sacs of the body
Has 2 layers- the parietal and visceral
Layers separated from each other by a

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thin film of fluid

General features
The peritoneum is a thin

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serous membrane that line

the walls of the abdominal &

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pelvic cavities & cover the

organs within these cavities

Parietal peritoneum

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lines the walls of the

abdominal & pelvic cavities

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General features
Visceral peritoneum
covers the organs
Peritoneal cavity the

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potential space between the

parietal and visceral layer of

peritoneum, , is a closed

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sac, but in , there is a

communication with the

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exterior through the uterine

tubes, the uterus, and the

vagina

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Function
Secretes a lubricating

serous fluid that

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continuously moistens

the associated organs

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Absorb
Support viscera

Hepatorenal Pouch &

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Rectouterine Pouch

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? Superficial

view of

? the

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abdominal

? organs

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The peritoneum

vIs a thin serous membrane,
?Lining the wall of the

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abdominal and pelvic cavities,

(the parietal peritoneum).
?Covering the existing organs,

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(the visceral peritoneum).
?The potential space between

the two layers is the peritoneal

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cavity.

Parietal

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Visceral

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The peritoneum

vThe peritoneal cavity is the

largest one in the body.

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vDivisions of the peritoneal

cavity :
?Greater sac; extends from

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Lesser Sac

diaphragm down to the pelvis.
?Lesser sac; lies behind the

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stomach.
?Both cavities are interconnected

through the epiploic foramen.
?In male : the peritoneum is a

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closed sac .
?In female : the sac is not

completely closed because it

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Greater Sac

communicates with the exterior

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through the uterine tubes, uterus

and vagina.

The peritoneum

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qIntraperitonial and

Intraperitoneal viscera

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retroperitonial; describe the

relationship between various

organs and their peritoneal

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covering;
?Intraperitonial structure; which is

nearly totally covered by visceral

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peritoneum.
?Retroperitonial structure; lies

behind the peritoneum, and

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partially covered by visceral

peritoneum.

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Retroperitoneal viscera

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Intraperitoneal organ :
Is surrounded by the peritoneum and has a

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supporting mesentery : stomach & 1st part of

duodenum, liver, gall bladder, spleen,

jejunum, ileum, transverse colon, sigmoid

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colon, uterus, and ovaries.
Extraperitoneal or

retroperitoneal organ :

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Structure that lies behind the peritoneum or
An organ, which is only partially covered by

the peritoneum and has no supporting

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mesentery.
Primarily retroperitoneal organs

develop and remain outside the peritoneal

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cavity: kidneys, suprarenal glands, aorta,

inferior vena cava, urinary bladder,

prostate, vagina, and rectum.

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Secondarily retroperitoneal organs

develop in mesenteries, but get pushed

against the body wall (parietal peritoneum)

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during growth so that only half of their

surface or less is covered by peritoneum :

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pancreas, duodenum, ascending and

descending colon.

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Folds of the peritoneum

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qTypes of peritoneal folds

:

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Omenta.
Mesenteries.
Ligaments.

Omenta

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Lesser omentum

vTwo layered fold of peritoneum

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connecting the stomach to another

viscus.

? The lesser omentum attaches the

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lesser curvature of the stomach to

the liver.

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? The greater omentum connects

the greater curvature of the

stomach to the transverse colon.

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Greater omentum

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Lesser

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q Extends between the liver and the lesser

omentum

curvature of the stomach.

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It is continuous with the two layers of

peritoneum which cover the anterior &

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posterior surfaces of stomach and 1st part of

the duodenum.

Ascend as a double fold to the porta hepatis of

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liver, and fissure for ligamentum venosum.

To the left of porta hepatis it is carried to the

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diaphragm.

Its right border is a free margin; constitutes the

anterior boundary of the epiploic foramen.

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qContents between the two layers of

the lesser omentum :

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Close to the right free margin, are the hepatic

artery, the common bile duct, the portal vein,

lymphatics, and the hepatic plexus of nerves.

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At the attachement to the stomach, run the

right and left gastric vessels.

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Greater omentum

Greater omentum

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The largest peritoneal fold, with cribriform

Greater omentum appearance, contains some adipose tissue.

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It consists of a double sheet of peritoneum,

folded on itself so that it is made up of four

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layers (anterior 2 layers + posterior 2 layers).

The two layers which descend from the

greater curve of the stomach and

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commencement of the duodenum, pass

downward in front of the small intestines,

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then turn upon themselves, and ascend to the

transverse colon, where they separate and

enclose it.

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The left border of the greater omentum is

continuous with the gastrosplenic ligament.

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Its right border extends as far as the

commencement of the duodenum.

Contents : the anastomosis between the

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right and left gastroepiploic vessels.

Omental bursa,

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(Lesser Sac)

qIt is a part of the peritonial cavity

behind the stomach.

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qBoundaries of the omental bursa ;
?Anterior wall, from above downward,

by the caudate lobe of the liver, the lesser

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Lesser Sac

omentum, back of the stomach, and the

anterior two layers of the greater

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omentum.
?Posterior wall, from below upward, by

the posterior two layers of the greater

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omentum, the transverse colon, and the

ascending layer of the transverse

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mesocolon, the upper surface of the

pancreas, the left suprarenal gland, and

the upper end of the left kidney.

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Epiploic foramen It is the communication between

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the greater and lesser sacs .

It is bounded by;
In front by the free border of the

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lesser omentum, with its contents :

hepatic artery, common bile duct,

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and portal vein between its two

layers.

Behind by the peritoneum

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covering the inferior vena cava.

Above (roof) by the peritoneum on

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the caudate process of the liver.

Below (floor) by the peritoneum

covering the commencement of the

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duodenum and the hepatic artery,

before ascending between the two

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layers of the lesser omentum.

Mesenteries or mesocolons

two-layered fold of

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peritoneum that attach part

of the intestines to the

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posterior abdominal wall

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Mesentery

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suspends the small

intestine from the

posterior abdominal wall

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Broad and a fan-shaped
Consists of two peritoneal

layers

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Intestinal borderfolded,

7 m long

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Radix of mesentery

15 cm long
Directed obliquely from

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left side of L2 to in front

of right sacroiliac joint

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Structure crossed by the root of mesentry

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Mesoappendix

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Triangular mesentery

extends from terminal

part of ileum to appendix

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Appendicular artery runs

in free margin of the

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mesoappendix

Transverse mesocolon

a double fold of

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peritoneum which connects

the transverse colon to the

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posterior abdominal wall

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Sigmoid mesocolon a trianguar

fold of peritoneum.

inverted V-shaped, with apex located in

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front of left ureter and division of common

iliac artery

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Ligaments

two-layered folds of

peritoneum that attached the

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lesser mobile solid visera to

the abdominal wall

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Ligaments of liver
Falciform ligament of liver

Consists of double peritoneal

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layer

Extends from anterior

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abdominal wall (umbilicus)

to liver

Free border of ligament site

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of ligamentum teres

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Coronary ligament

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the area between upper

& lower parts of the

coronary ligament is the

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bare area of liver, this area

is devoid of peritoneum

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and lies in contact with the

diaphragm

Left and right triangular

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ligament

formed by right extremity

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of coronary ligament and

left leaf of falciform

ligament, respectively

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Hepatogastric ligament
Hepatoduodenal

ligament

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Ligamentum teres

hepatis

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Ligaments of spleen

Gastrosplenic ligament a double layer of peritoneum that

connects the fundus of stomach to hilum of spleen. In this

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double layer of peritoneum are the short gastric and left

gastroepiploic vessels

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Splenorenal ligament extends between the hilum of spleen

and anterior aspect of left kidney. The splenic vessels lies within

this ligament, as well as the tail of pancreas

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Phrenicosplenic ligament
Splenocolic ligament

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Ligaments of stomach

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Hepatogastric ligament
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament

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Folds and recesses of posterior abdominal

wal

Superior duodenal

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fold and recess

Inferior duodenal

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fold and recess

Intersigmoid recess

formed by the

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inverted V attachment

of sigmoid mesocolon

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Retrocecal recess

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in which the

appendix frequenty lies

Hepatorenal recess

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lies between the

right lobe of liver, right

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kidney, and right colic

flexure, and is the

lowest parts of the

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peritoneal cavity when

the subject is supine

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Folds and fossas of anterior abdominal wal

Median umbilical fold
contain the remnant of

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urachus (median umbilical

ligaments)

Medial umbilical fold

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contains remnants of the

umbilical arteries (medial

umbilical ligaments)

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Lateral umbilical fold
contains the inferior

epigastric vessels

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Pouches
In malerectovesical

pouch

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In female

Rectouterine pouch

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between rectum and

uterus

Vesicouterine pouch

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between bladder and

uterus

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Peritoneal subdivisions

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The transverse colon and transverse

mesocolon divides the greater sac

into supracolic and infracolic

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compartments.

Supracolic

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compartments

(subphrenic space)lies between

diaphragm and transverse colon

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and transverse mesocolon

Suprahepatic recess lies

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between the diaphragm and liver

the falciform ligament divides it

into right and left suprahepatic

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recesses

Left suprahepatic

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recesses

left anterior

suprahepatic spaces

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left posterior

suprahepatic spaces

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Right suprahepatic

recesses

right anterior

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suprahepatic spaces

right posterior

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suprahepatic spaces

bare area of live

(extraperitoneal space)

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Infrahepatic recess

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lies between the liver and

transverse colon &

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transverse mesocolonthe

ligamentum teres hepatic

divides it into right and left

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infrahepatic recesses

Right infrahepatic

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recesses

(hepatorenal recess)
Left infrahepatic recesses

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left anterior infrahepatic

space

left posterior infrahepatic

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space

Infracolic

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compartments

lies below the transverse

colon and transverse

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mesocolon

Right paracolic sulcus

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(gutter) lies lateral to the

ascending colon. It

communicates with the

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hepatorenal recess and the

pelvic cavity. It provides a

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route for the spread of

infection between the pelvic

& the upper abdominal

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region.

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Infracolic

compartments

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Left paracolic sulcus
(gutter)
lies lateral to the

descending colon. It is

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separated from the area

around the spleen by the

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phrenicocolic ligament, a

fold of peritoneum that

passes from the colic

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flexure to the diaphragm.

Right mesenteric sinus

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triangular space, lies between

root of mesentery, ascending

colon, right 2/3 of transverse colon

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and transverse mesocolon

Left mesenteric sinus

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lies between root of mesentery,

descending colon, right 1/3 of

transverse colon and transverse

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mesocolon, its widens below where

it is continuous with the cavity of

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the pelvis


Applied Anatomy

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Peritoneum & surgical procedures
Peritonitis & Ascites
Abdominal paracentesis
Intraperitoneal injection
peritoneal dialysis

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