Copy of PERITONEUM AND PERITONEAL CAVITY.pptx

ANATOMY OF THE PELVIS, SUMMARIZED

1. PERITONEUM AND PERITONEAL CAVITY DR. OKONTA E M

2. INTRODUCTION This is the serous lining of the abdominal cavity, composed of mesothelial cells and derived from the mesoderm Consists of the parietal peritoneum and the visceral peritoneum. Both types are made up of simple squamous epithelia l cells aka mesothelium. It provides support for the viscera, blood vessels and lymph

3. The Peritoneum

4. The Peritoneum seen through the sagittal section of the abdomen

5. INTRODUCTION A. Parietal Peritoneum Lines the abdominal, pelvic walls and the inferior surface of the diaphragm. Is innervated by somatic nerves such as the phrenic, lower intercostal, subcostal, iliohypogastric, and ilioinguinal nerves{PLISII} B. Visceral Peritoneum Covers the viscera Is innervated by visceral nerves, and is insensitive to pain.

6. INTRODUCTION Abdominal viscera can be divided anatomically based on their relationship to the peritoneum, namely: intraperitoneal and retroperitoneal organs. Intraperitoneal organs are enclosed by visceral peritoneum, both anteriorly and posterior, eg . the stomach, liver and spleen. Retroperitoneal organs are covered by the parietal peritoneum, on the anterior surface. Also the retroperitoneal organs are further divided into two groups based on their embryological development: Primary retroperitoneal organs developed and remain outside of the parietal peritoneum, eg oesophagus, rectum and kidneys. Secondary retroperitoneal organs eg the ascending and descending colon.

7. Intraperitoneal and retroperitoneal organs

8. PERITONEAL REFLECTIONS This is te adaptations of the peritoneal folds in various aspects of the abdominal cavity it is usually raised from the body wall by underlying blood vessels, ducts, and sometimes ligaments formed by obliterated fetal vessels (e.g., the umbilical folds on the internal surface of the anterolateral abdominal wall). Some peritoneal folds contain blood vessels and bleed if cut, such as the lateral umbilical folds, which contain the inferior epigastric arteries. other examples of the peritoneal reflections includes mesentery, omentum and peritoneal ligament

9. PERITONEAL REFLECTIONS: Omentum Is a fold of peritoneum extending from the stomach to nearby abdominal organs. 1. Lesser Omentum: Is a double layer of peritoneum extending from the porta hepatis of the liver to the lesser curvature of the stomach and the beginning of the duodenum. Consists of the hepatogastric and hepatoduodenal ligaments which forms the anterior wall of the lesser sac of the peritoneal cavity. Transmits the left and right gastric vessels, which run between its two layers along the lesser curvature. Has a right free margin that contains the proper hepatic artery, bile duct, and portal vein.

10. Curvatures of the stomach

11. PERITONEAL REFLECTION: Omentum 2. Greater Omentum: Is derived from the embryonic dorsal mesentery. Bears down like an apron from the greater curvature of the stomach, thereby covering the transverse colon and other abdominal viscera. Transmits the right and left gastroepiploic vessels along the greater curvature. Can cover the neck of a hernial sac, thereby preventing the entrance of coils of the small intestine. It adheres to areas of inflammation and wraps itself around the inflamed organs, thus preventing serious diffuse peritonitis { Peritonitis is an inflammation of the peritoneum, characterized by an accumulation of peritoneal fluid that contains fibrin and leukocytes (puss)}

12. PERITONEAL REFLECTIONS: Ligaments associated with the greater omentum Gastrolienal (Gastrosplenic) Ligament It stretches from the left portion of the greater curvature of the stomach to the hilus of the spleen and contains the short gastric and left gastroepiploic vessels. Lienorenal (Splenorenal) Ligament Courses from the hilus of the spleen to the left kidney and contains the splenic vessels and the tail of the pancreas. Gastrophrenic Ligament Courses from the upper part of the greater curvature of the stomach to the diaphragm. Gastrocolic Ligament Courses from the greater curvature of the stomach to the transverse colon.

13. PERITONEAL REFLECTIONS: Mesentery 1. Mesentery of the Small Intestine (Mesentery Proper) Is a double fold of peritoneum suspending the jejunum and the ileum from the posterior abdominal wall and transmits nerves and blood vessels to and from the small intestine. It forms the root that extends from the duodenojejunal flexure to the right iliac fossa and measures approx 15 cm (6 in.) long. It has a free border that encloses the small intestine, which is approximately 6 m (20 ft) long. Contains the superior mesenteric and intestinal (jejunal and ileal) vessels, nerves, and lymphatics

14. PERITONEAL REFLECTIONS: Mesentery 2. Transverse Mesocolon Attaches the posterior surface of the transverse colon to the posterior abdominal wall. Also fuses with the greater omentum to form the gastrocolic ligament. Contains the middle colic vessels, nerves, and lymphatics. 3. Sigmoid Mesocolon Attaches the sigmoid colon to the pelvic wall It contains the sigmoid vessels. Its line of 4. Mesoappendix Atthaches the appendix to the mesentery of the ileum contains the appendicular vessels.

15. PERITONEAL REFLECTIONS:The ligaments 1. Phrenicocolic Ligament Courses from the left colic flexure to the diaphragm. 2. Falciform Ligament It connects the liver to the diaphragm and the anterior abdominal wall. It attaches onnects the branch of the portal vein with the subcutaneous veins in the region of the umbilicus Contains the ligamentum teres hepatis and the paraumbilical vein

16. PERITONEAL REFLECTIONS: The ligaments 3. Ligamentum Teres Hepatis (Round Ligament of the Liver) It is the remnant of the embryologic left umbilical vein, which carries oxygenated blood from the placenta to the left branch of the portal vein in the fetus. (The right umbilical vein is obliterated during the embryonic period.) It forms the free margin of the falciform ligament courses from the umbilicus to the inferior (visceral) surface of the liver, lying in the fissure that forms the left boundary of the quadrate lobe of the liver. 4. Coronary Ligament It is a reflection of the diaphragmatic surface of the liver onto the diaphragm

17. PERITONEAL REFLECTIONS:The ligaments Houses a triangular area of the right lobe, the bare area of the liver. Has right and left extensions that form the right and left triangular ligaments. 5. Ligamentum Venosum A remnant of the ductus venosus a narrow, trumpet-shaped vessel which is seen in the fetal liver connecting the umbilical vein directly to the caudal inferior vena cava or distal left hepatic vein Lies in the fissure on the inferior surface of the liver, forming the left boundary of the caudate lobe of the liver.

18. PERITONEAL REFLECTIONS: The folds 1. Umbilical Folds Are five folds of peritoneum below the umbilicus, including the median, medial, and lateral umbilical folds. 2. Rectouterine Fold Courses from the cervix of the uterus, along the side of the rectum, to the posterior pelvic wall, forming the rectouterine pouch (of Douglas). 3. Ileocecal Fold Courses from the terminal ileum to the cecum.

19. PERITONEAL CAVITY It is a potential space between the parietal and visceral peritoneum and contains serous fluid that lubricates the surface of the peritoneum and enhances free movements of the viscera. It Is a completely closed sac in the male but is open in the female through the uterine tubes, uterus, and vagina. It is divided into the lesser and greater sacs The greater sac is the main and larger part of the peritoneal cavity while the lesser sac aka omental bursa lies posterior to the stomach and lesser omentum

20. PERITONEAL CAVITY Lesser Sac (Omental Bursa) It Is the space that lies behind the liver, lesser omentum, stomach, and upper anterior part of the greater omentum. It Is a closed sac, except for its communication with the greater sac through the epiploic (omental) foramen. Has three known recesses: (a) superior recess, which is posterior to the stomach, lesser omentum, and left lobe of the liver; (b) inferior recess, which is posterior to the stomach, however extends into the layers of the greater omentum; and (c) splenic recess, which extends to the left at the hilus of the spleen

21. PERITONEAL CAVITY Epiploic or Omental (Winslow) Foramen It is an opening between the lesser and greater sacs. It is bounded superiorly by peritoneum on the caudate lobe of the liver, inferiorly by peritoneum on the first part of the duodenum, anteriorly by the free edge of the lesser omentum, and posteriorly by peritoneum covering the IVC

22. Epiploic or Omental (Winslow) Foramen

23. PERITONEAL CAVITY Greater Sac It extends across the entire breadth of the abdomen and from the diaphragm to the pelvic floor and has numerous recesses. 1. Subphrenic (Suprahepatic) Recess Is the peritoneal pocket between the diaphragm and the anterior and superior part of the liver and is separated into right and left recesses by the falciform ligament.

24. PERITONEAL CAVITY 2. Subhepatic Recess or Hepatorenal Recess (Morrison Pouch) Is a deep peritoneal pocket between the liver anteriorly and the kidney and suprarenal gland posteriorly and communicates with the lesser sac via the epiploic foramen and the right paracolic gutter, thus the pelvic cavity. 3. Paracolic Recesses (Gutters) Lie lateral to both the ascending colon (right paracolic gutter) and the descending colon (left paracolic gutter).

25. CLINICAL CORRELATIONS Peritonitis is inflammation and/or infection of the peritoneum. Some causes include infiltration of fecal material from a burst appendix, a penetrating wound to the abdomen, perforating ulcer that leaks stomach contents into the peritoneal cavity (lesser sac), or poor sterile technique during abdominal surgery. Peritonitis can be treated by rinsing the peritoneum with large amounts of sterile saline solution and giving antibiotics. Paracentesis (abdominal tap) is a procedure in which a needle is inserted 1 to 2 in. through the abdominal wall into the peritoneal cavity to obtain a sample or drain fluid while the patient is sitting upright. The entry site is usually the midline at approximately 2 cm below the umbilicus or lateral to McBurney’s point, so s to avoid the inferior epigastric vessels

26. REFERENCES Chung, K W (2015) Board review series Anatomy 8thed Wolters Kluwer: Philadelphia Harold, E (2019) Clinical Anatomy Applied Anatomy for Students and Junior Doctors 14 th ed Wiley Blackwell: Oxford Moore K L (2014) Clinically Oriented Anatomy 7ed Wolters Kluwer: Philadelphia

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