Download MBBS Anatomy PPT 69 Peritoneum Notes

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Peritoneum

Tough layer of elastic areolar tissue
Lined with simple squamous

epithelium

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

thin film of fluid

General features
The peritoneum is a thin

serous membrane that line

the walls of the abdominal &

pelvic cavities & cover the

organs within these cavities

Parietal peritoneum

lines the walls of the

abdominal & pelvic cavities






General features
Visceral peritoneum
covers the organs
Peritoneal cavity the

potential space between the

parietal and visceral layer of

peritoneum, , is a closed

sac, but in , there is a

communication with the

exterior through the uterine

tubes, the uterus, and the

vagina

Function
Secretes a lubricating

serous fluid that

continuously moistens

the associated organs

Absorb
Support viscera

Hepatorenal Pouch &

Rectouterine Pouch




? Superficial

view of

? the

abdominal

? organs

















The peritoneum

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

abdominal and pelvic cavities,

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

(the visceral peritoneum).
?The potential space between

the two layers is the peritoneal

cavity.

Parietal

Visceral




The peritoneum

vThe peritoneal cavity is the

largest one in the body.
vDivisions of the peritoneal

cavity :
?Greater sac; extends from

Lesser Sac

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

stomach.
?Both cavities are interconnected

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

closed sac .
?In female : the sac is not

completely closed because it

Greater Sac

communicates with the exterior

through the uterine tubes, uterus

and vagina.

The peritoneum

qIntraperitonial and

Intraperitoneal viscera

retroperitonial; describe the

relationship between various

organs and their peritoneal

covering;
?Intraperitonial structure; which is

nearly totally covered by visceral

peritoneum.
?Retroperitonial structure; lies

behind the peritoneum, and

partially covered by visceral

peritoneum.

Retroperitoneal viscera






Intraperitoneal organ :
Is surrounded by the peritoneum and has a

supporting mesentery : stomach & 1st part of

duodenum, liver, gall bladder, spleen,

jejunum, ileum, transverse colon, sigmoid

colon, uterus, and ovaries.
Extraperitoneal or

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

the peritoneum and has no supporting

mesentery.
Primarily retroperitoneal organs

develop and remain outside the peritoneal

cavity: kidneys, suprarenal glands, aorta,

inferior vena cava, urinary bladder,

prostate, vagina, and rectum.
Secondarily retroperitoneal organs

develop in mesenteries, but get pushed

against the body wall (parietal peritoneum)

during growth so that only half of their

surface or less is covered by peritoneum :

pancreas, duodenum, ascending and

descending colon.






Folds of the peritoneum

qTypes of peritoneal folds

:

Omenta.
Mesenteries.
Ligaments.

Omenta

Lesser omentum

vTwo layered fold of peritoneum

connecting the stomach to another

viscus.

? The lesser omentum attaches the

lesser curvature of the stomach to

the liver.

? The greater omentum connects

the greater curvature of the

stomach to the transverse colon.

Greater omentum






Lesser

q Extends between the liver and the lesser

omentum

curvature of the stomach.

It is continuous with the two layers of

peritoneum which cover the anterior &

posterior surfaces of stomach and 1st part of

the duodenum.

Ascend as a double fold to the porta hepatis of

liver, and fissure for ligamentum venosum.

To the left of porta hepatis it is carried to the

diaphragm.

Its right border is a free margin; constitutes the

anterior boundary of the epiploic foramen.

qContents between the two layers of

the lesser omentum :

Close to the right free margin, are the hepatic

artery, the common bile duct, the portal vein,

lymphatics, and the hepatic plexus of nerves.

At the attachement to the stomach, run the

right and left gastric vessels.

Greater omentum

Greater omentum




The largest peritoneal fold, with cribriform

Greater omentum appearance, contains some adipose tissue.

It consists of a double sheet of peritoneum,

folded on itself so that it is made up of four

layers (anterior 2 layers + posterior 2 layers).

The two layers which descend from the

greater curve of the stomach and

commencement of the duodenum, pass

downward in front of the small intestines,

then turn upon themselves, and ascend to the

transverse colon, where they separate and

enclose it.

The left border of the greater omentum is

continuous with the gastrosplenic ligament.

Its right border extends as far as the

commencement of the duodenum.

Contents : the anastomosis between the

right and left gastroepiploic vessels.

Omental bursa,

(Lesser Sac)

qIt is a part of the peritonial cavity

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

by the caudate lobe of the liver, the lesser

Lesser Sac

omentum, back of the stomach, and the

anterior two layers of the greater

omentum.
?Posterior wall, from below upward, by

the posterior two layers of the greater

omentum, the transverse colon, and the

ascending layer of the transverse

mesocolon, the upper surface of the

pancreas, the left suprarenal gland, and

the upper end of the left kidney.




Epiploic foramen It is the communication between

the greater and lesser sacs .

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

lesser omentum, with its contents :

hepatic artery, common bile duct,

and portal vein between its two

layers.

Behind by the peritoneum

covering the inferior vena cava.

Above (roof) by the peritoneum on

the caudate process of the liver.

Below (floor) by the peritoneum

covering the commencement of the

duodenum and the hepatic artery,

before ascending between the two

layers of the lesser omentum.

Mesenteries or mesocolons

two-layered fold of

peritoneum that attach part

of the intestines to the

posterior abdominal wall








Mesentery
suspends the small

intestine from the

posterior abdominal wall

Broad and a fan-shaped
Consists of two peritoneal

layers

Intestinal borderfolded,

7 m long

Radix of mesentery

15 cm long
Directed obliquely from

left side of L2 to in front

of right sacroiliac joint




Structure crossed by the root of mesentry






Mesoappendix
Triangular mesentery

extends from terminal

part of ileum to appendix

Appendicular artery runs

in free margin of the

mesoappendix

Transverse mesocolon

a double fold of

peritoneum which connects

the transverse colon to the

posterior abdominal wall




Sigmoid mesocolon a trianguar

fold of peritoneum.

inverted V-shaped, with apex located in

front of left ureter and division of common

iliac artery

Ligaments

two-layered folds of

peritoneum that attached the

lesser mobile solid visera to

the abdominal wall


Ligaments of liver
Falciform ligament of liver

Consists of double peritoneal

layer

Extends from anterior

abdominal wall (umbilicus)

to liver

Free border of ligament site

of ligamentum teres






Coronary ligament

the area between upper

& lower parts of the

coronary ligament is the

bare area of liver, this area

is devoid of peritoneum

and lies in contact with the

diaphragm

Left and right triangular

ligament

formed by right extremity

of coronary ligament and

left leaf of falciform

ligament, respectively






Hepatogastric ligament
Hepatoduodenal

ligament

Ligamentum teres

hepatis

Ligaments of spleen

Gastrosplenic ligament a double layer of peritoneum that

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

double layer of peritoneum are the short gastric and left

gastroepiploic vessels

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

Phrenicosplenic ligament
Splenocolic ligament






Ligaments of stomach
Hepatogastric ligament
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament

Folds and recesses of posterior abdominal

wal

Superior duodenal

fold and recess

Inferior duodenal

fold and recess

Intersigmoid recess

formed by the

inverted V attachment

of sigmoid mesocolon




Retrocecal recess

in which the

appendix frequenty lies

Hepatorenal recess

lies between the

right lobe of liver, right

kidney, and right colic

flexure, and is the

lowest parts of the

peritoneal cavity when

the subject is supine

Folds and fossas of anterior abdominal wal

Median umbilical fold
contain the remnant of

urachus (median umbilical

ligaments)

Medial umbilical fold
contains remnants of the

umbilical arteries (medial

umbilical ligaments)

Lateral umbilical fold
contains the inferior

epigastric vessels






Pouches
In malerectovesical

pouch

In female

Rectouterine pouch

between rectum and

uterus

Vesicouterine pouch

between bladder and

uterus




Peritoneal subdivisions

The transverse colon and transverse

mesocolon divides the greater sac

into supracolic and infracolic

compartments.

Supracolic

compartments

(subphrenic space)lies between

diaphragm and transverse colon

and transverse mesocolon

Suprahepatic recess lies

between the diaphragm and liver

the falciform ligament divides it

into right and left suprahepatic

recesses

Left suprahepatic

recesses

left anterior

suprahepatic spaces

left posterior

suprahepatic spaces

Right suprahepatic

recesses

right anterior

suprahepatic spaces

right posterior

suprahepatic spaces

bare area of live

(extraperitoneal space)




Infrahepatic recess

lies between the liver and

transverse colon &

transverse mesocolonthe

ligamentum teres hepatic

divides it into right and left

infrahepatic recesses

Right infrahepatic

recesses

(hepatorenal recess)
Left infrahepatic recesses

left anterior infrahepatic

space

left posterior infrahepatic

space

Infracolic

compartments

lies below the transverse

colon and transverse

mesocolon

Right paracolic sulcus

(gutter) lies lateral to the

ascending colon. It

communicates with the

hepatorenal recess and the

pelvic cavity. It provides a

route for the spread of

infection between the pelvic

& the upper abdominal

region.




Infracolic

compartments

Left paracolic sulcus
(gutter)
lies lateral to the

descending colon. It is

separated from the area

around the spleen by the

phrenicocolic ligament, a

fold of peritoneum that

passes from the colic

flexure to the diaphragm.

Right mesenteric sinus

triangular space, lies between

root of mesentery, ascending

colon, right 2/3 of transverse colon

and transverse mesocolon

Left mesenteric sinus

lies between root of mesentery,

descending colon, right 1/3 of

transverse colon and transverse

mesocolon, its widens below where

it is continuous with the cavity of

the pelvis


Applied Anatomy

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

This post was last modified on 05 April 2022