Peritoneum and peritoneal cavity

محاضرة دكتورة نورا الطحاوى للفرقة الاولى كلية الطب البشرى
يوم الاحد 17 ابريل 2011س

Lectures of Anatomy by Dr. Noura El Tahawy for first year Faculty of Medicine, El Minia University. 17-4-211
م

1. The abdominal cavity,
the peritoneum
& the peritoneal cavity

By
Dr. Noura El Tahawy
Faculty of Medicine
E] Minia University

2. —Falciform ligament

— Liver

Superficial Gallbladder:

view of Lesser omentum ZT -

the abdominal —Spieon

organs —Stomach = 2. _

Duodenum —— a

—Ligamentum teres
Transverse colon

— Greater omentum

Small intestine

Cecum:

Urinary bladder

3. Peritoneum

4. + Sagittal section
through the
abdominopelvic

cavity

Liver
7 Lesser omentum

a Pencreas

= - Falciform ligament
— Stomach

SA Duodenum
ALA Transverse
dal mesocolon

T—— Transverse colon

Mesente:
AST. sl

> Greater omentum

Jejunum
A

——

DIA — Meum
— Visceral peritoneum
+—— Parictal peritoneum

Urinary bladder

Rectum

5. Abdominal cavity
proper

The larger part of the
abdominopelvic cavity

BOUNDARIES
Superiorly: diaphragm
Inferiorly: Pelvic inlet

A large part is under the
cover of the
osteocartilaginous thoracic
cage

Walls are lined by the
parietal peritoneum

6. » Thin transparent
serous membrane
that consists of 2
layers:

1. PARIETAL
PERITONEUM —
lines the
abdominal cavity

2. VISCERAL
PERITONEUM —
invests the
abdominal viscera

7. Composed of a single
layer of squamous
epithelial cells
(mesothelium)

The 2 layers are

separated by a capillary
film of peritoneal fluid.

8. PERITONEAL DERIVATIVES: Definition

Ligaments Solid viscera Abdominal wall

Omentum Stomach Another viscus

Mesentery Parts of the intestine Posterior abdominal wall

9. PERITONEAL DERIVATIVES: Examples

Peritoneal D tive From

Ligaments Solid viscera Abdominal wall

Falciform ligament liver —____________} | Diaphragm and anterior
abdominal wall

10. Left angular ligament

Fibrous appendix of liver

Coronary ligament

Diaphragm (pulled up)

Right
iangula
ligament

Right lobe
etes _

e Leftlobe of iver
Border

Inferior border er liver

Round ligament ligamentum totes) ot
liver oblltstatad umbilical veln) forming
aa bordar of faloitom ligament

11. Peritoneal cavity

12. DEFINITION

The potential space between the parietal and
visceral layers of the peritoneum

MALES: closed cavity

FEMALES: (+) communication with the
exterior through the reproductive tract
(fallopian tubes, uterus, vagina)

13. Divisions of the peritoneal cavity

+ As the fetal
organs assume
their adult
positions, the
parietal cavity
is divided into
the 2 peritoneal
sacs:

1. the greater sac

2. the lesser sac
(omental bursa

Liver
Lesser omentum

—— Pancreas
T— Falciform ligament

T— Stomach

-— Duodenum

Transverse
mesocolon

—— Transverse colon

Mesentery
Greater omentum

Visceral peritoneum
Parictal peritoncum
Urinary bladder

Rectum

14. Peritoneal cavity

GREATER SAC + LESSER SAC

Main compartment of « Smaller
the peritoneal cavity

Extends from the + Lies behind the
diaphragm into the stomach

pelvis |
The communication between
the greater sac and the lesser sac is the
EPIPLOIC FORAMEN

15. PERITONEAL DERIVATIVES: Examples

Omentum Stomach Another viscus

Greater omentum Greater curvature ———> | Transverse colon

Lesser curvature Undersurface of the liver

Gastrosplenic Stomach ————————> Hilum of the spleen
omentum

(ligament)

16. Greater Omentum

17. Left lobe of liver

Right lobe of liver

— stomach

Gallbladder

Greater omentum overlying
transverse colon and small
intestine Gejunum and ileum)

18. A. Superficial dissection

Diaphragmatic surface of ver Cellac nodes
reas peer PRÉC mac: | Paracardia! nodes Left gastric nodes
| /

\ x \
Hepatic nodes a Pyloric nodes \ Right gastric nodes Superior pancreatic nodes:
Pancreaticoduodenal nodes Right gastro-omental nodes

19. B. Deep dissection
Hepatic nodes Celacnodes Leftgasticnodes Splenicnodes

Superior pancreatic nodes

Pyloric nodes

Pancreaticoduodenal nodes Superior mesenteric nodes

20. A. Greater omentum

Liver:
Lefi lobe
Right lobe

Gallbladder

Layers of abdominal wall:
‘Skin
Superficial fascia
External abdominal
oblique muscle -——
internal abdominal
oblique muscle =
Transvereue abdominis
muscle a
Transversalls fascia -
Extraperitoneal fat
and connective tissue
Parietal peritoneum —

Falciform ligament
- Round ligament of liver

¿ Wl Stomach

‘Omental apron portion
of greater omentum
(covering small intestine)

Large intestino

7 Small intestine

21. A. Greater omentum

Lor
Tet obo
Fight be

Gaitiaséor

Lag mnt
E
E
er
EE
ee
mn
er
es
Pen
En
omnes

B. Large and small intestines

Feat ot go incio: |
mental appondagos
Hausa (accua)

Fight cole (patie) flexure —
‘Asconding con

Falcon Igarent
Round garent Ier

Somach

“Omnia! spros porton
‘ot grate’ amertam
fever eral ino)

Largo inostro

‘omental aaron portion
A grater omentum (turned up)
Tranerse on (umes up)

Lot cle (spl) euro

Duodenceja junction

Dosoonding coin

22. Falciform ligament

Left lobe of liver

Right lobe of liver ———

~~ stomach

Gallbladder

— Greater omentum overlying
ttaneverse colon and small
intestine Gejunum and ileum)

23. Lesser Omentum & Lesser sac

24. —Falciform ligament

— Liver

Superficial Gallbladder:

view of Lesser omentum ZT -

the abdominal —Spieon

organs —Stomach = 2. _

Duodenum —— a

—Ligamentum teres
Transverse colon

— Greater omentum

Small intestine

Cecum:

Urinary bladder

25. + Sagittal section
through the
abdominopelvic

cavity

DR Liver

y =a) Lesser omentum

————A__ Pancreas
)~ Falciform ligament
— Stomach
3011 Duodenum
fe Transverse
AI mesocolon
7 —— Transverse colon

Mesente:
ESA éd

Der Greater omentum

Jojunum

Dr lleum
— Visceral peritoneum
+—— Parictal peritoneum

Urinary bladder

Rectum

26. Lesser omentum

Visceral peritoneum
Transverse mesocol
Transverse colon

Parietal peritoneum.

Inferior recess of
omental bursa

Greater omentum

Greater sac -M |
r

‘Small intestine

Uterus

Urinary bladder
Symphysis pubis

Vagina
Urethra ————H

__— Diaphragm

Bare area of liver

Superior recess of
omental bursa

Aorta

Omental bursa

Celiac trunk

Pancreas

Duodenum

Mesentry of small
intestine

Rectouterine pouch

Rectum

27. Hepatogastric Ligament

Fil
Feito ligament
Round ligament
Hepatogastric fi
ligament

Hepato a
Prigent © (HAN

Epiploic
foramen
Henao
ment 1
oflasser emonum
Epiplole foramen
Right one cf ver

Duodenum

— Gastroepiplole
vessels

Greater omentum

28. Hepatoduodenal Ligament

Factor igament

Round ligament
Iver

Hepatoduccional =!
ligamont
of lesser omentum

ight kidney

D:
Pylorus ~

A
Taunia li

Greater omentum

ater omentum! ja se mesocolon
Contents: The Portal Triad

+ Proper hepatic a , Portal v, Common bile duct

29. Boundaries of
Epiploic foramen

Proper
hepatic
artery

Portal vein

Common
bile duct

EN dal MN i A j
Contents: The Portal Triad

« Proper hepatic a
» Portal v

+ Common bile duct

30. À: Superficial dissection Boundaries of Epiploic foramen

Diaphragmatic surface of ver Cellac nodes
reas peer PRÉC mac: | Paracardia! nodes Left gastric nodes
| /

\ x \
Hepatic nodes a Pyloric nodes \ Right gastric nodes Superior pancreatic nodes:
Pancreaticoduodenal nodes Right gastro-omental nodes

31. E
o
E
2

2

a

2

2
a

u

33. Epiploic foramen

35. Mesentery

36. PERITONEAL DERIVATIVES: Examples

Mesentery

Mesogastrium

Mesentery of the small
intestine

Transverse mesocolon

Sigmoid mesocolon

Parts of the intestine

Stomach

Small intestine ————>

Transverse colon ———

Sigmoid colon >

Posterior abdominal
wall

———— Posterior abdominal wall

Posterior abdominal wall

Posterior abdominal wall

Posterior abdominal wall

37. Transverse
> mesocolon

Mesentery

of the small intestine i —
I

38. BR

Aun (out
Free ten ena sen) E

Omentalfepiploe) appendices 1 id

— Let cate capenie) cure
Right coie(rapation tere |

Right paracsle quer _

Lan paracolo gutter

—

amoid colon

39. Omertai apron portion
of greater omentum (tumed up)

Transverse colon (turned up)

Middle colic artery

‘Superior mesenteric:
ven and artery

Horizontal (9) part
perra

Right coll artery:
ing branch
Descending branch
llegcolc artery:
‘Colic branch ——
lal branch
Anterior cecal branch.
Posterior cecal branch

Appondicular artery

‘Straight artorlos

{arteriae rectae)
Cecum—

‘Appendix

“Fight colo artery is absent In about 19% of
‘ates and angel Ium einer Ve leosste

artery or middie colic artery in 50% of cases

40. A, Dissection Omental apron portion of greater omentum (turned up)

‘Transverse colon
(turned up) Transverse mesocolon

Middle colle artery —
(rom superior _1__-Duodenojejunal junction

mesenteric artery)
Paraduodenal fold

‘Superior mesenteric i ] (containing inferior

age mar
ae (ag

Lott coll (splenic) flexure

inferior mesenteric artery:
Left colle artery-— i Retroduodenal fossa

Sigmold arteries —
Superior rectal artery

Descending colon

Sigmoid mesocolon

Sigmoid colon

41. A. Diaseetion
pra cot

Hauotra (acculations) Superior mesontario atar

Fight paracol guter

lsocsca fo

Li wann

Aopanax ” N Externa inc vessels

©. Location of appendix

B. lleococal valve

ERAS
e er
ie umelicus)

42. 8. Jojunum

43. PERITONEAL ORGANS

[

RETROPERITONEAL ORGANS

When an organ is
partially covered

by visceral peritoneum.

The organ lies

behind the peritoneum.

Kidneys
Suprarenal glands
Pancreas
Part of the duodenum,
Ascending colon
Descending colon

INTRAPERITONEAL ORGANS

When an organ is
almost entirely covered

by visceral peritoneum

44. Secondary peritoneal
organs 1 Primary peritoneal
PERITONEAL ORGANS organs

| ]

RETROPERITONEAL ORGANS INTRAPERITONEAL ORGANS

When an organ is When an organ is
partially covered almost entirely covered
by visceral peritoneum. by visceral peritoneum

The organ lies

behind the peritoneum.
Kidneys
Suprarenal glands
Pancreas
Part of the duodenum
Ascending colon
Descending colon

45. A. Small intestine, cecum,
ascending colon,
and transverse colon

Middle colle nodes

‘Superior mesenteric nodes
Right colic nodes

lleocolic nodes

Appendicular node

46. B. Descending colon,
sigmoid colon, and rectum

Left colic nodes:

Sigmoid nodes

47. Greater omentum

Pancreas with uncinate process
Transverse colon

Junction of 2nd and 314
parts of duodenum,

Ascending colon

Liver

ht renal vein (entering
inferior vena cava)

Inferior vena cava

Right orus of diaphragm

Psoas major muscle

L1—2 intervertebral disc

Conus medullaris and cauda equina

Superior mesenteric vein

Superior mesenteric artery

Transverse colon
leum

Jejunum

Perirenal fat

Ureteropelvie

Pararenal fat

Left renal artery

Left renal vein Centering
inferior vena cava)

Left crus of diaphragm

48. EXTRAPERITONEAL ORGANS

* Organs devoid of
peritoneal lining

+ Rectum

49. PERITONEAL RECESSES

+ Subphrenic recess

Description and significance
+ Hepatorenal recess e 8

« Paracolic gutter

50. SUBPHRENIC RECESS

The existence is due to
the complicated
arrangement of the
peritoneum in the region
of the liver

Right and left anterior
subphrenic spaces

Right posterior
subphrenic space

Right extraperitoneal
space

51. SUBPHRENIC RECESS

+ between the diaphragm and the
liver on each side of the falciform
ligament

52. SUBPHRENIC RECESS

+ between the right lobe of the
liver, the right kidney and the
right colic flexure

53. Anterior and Posterior
Subphrenic Abscess

Anterior

Posterior

54. SUBPHRENIC RECESS

+ between the layers of the
coronary ligament

55. HEPATORENAL RECESS

* Located between the
inferior surface of the
right lobe of the liver
and the right kidney

56. PARACOLIC GUTTER

+ Results form the
arrangement of the
ascending and
descending colons,
attachment of the
transverse mesocolon,
and the mesentery of
the small intestine to
the abdominal wall

57. PARACOLIC GUTTER

+ 4 gutters

* Lie in the lateral and
medial side of the
ascending and
descending colons
respectively

58. PARACOLIC GUTTER

+ Right medial paracolic gutter
— Closed off from the peritoneal
cavity by the mesentery of the
small intestines
+ Left lateral paracolic gutter
— Separated from the area
around the spleen by the
phrenicocolic ligament

+» Left medial paracolic gutter

59. PARACOLIC GUTTER

Right lateral par

— Incommunica |
right posterior
subphrencicsp *

Left lateral para

— Separated fro!
around the sp j
phrenicocolic “mern TT

Left medial par

60. PARACOLIC GUTTER

+ Right lateral paracolic gutter
— In communication with the
right posterior subphrenic
space

Right medial paracolic gutter

— Closed off from the peritoneal
cavity by the mesentery of the
small intestines

— Separated from the area
around the spleen by the
phrenicocolic ligament

Left medial paracolic gutter

61. The Subphrenic Spaces
and the Paracolic Gutters

* Clinically important !

« Sites for the collection and movement of

infected peritoneal fluid