The peritoneum and peritoneal cavity.pptx

Your peritoneum is a membrane that lines the inside of your abdomen and pelvis (parietal layer). It also covers many of your organs inside (visceral layer). The space in between these layers is called your peritoneal cavity.

1. The peritoneum and peritoneal cavity Dr. NDAYISABA CORNEILLE CEO of CHG MBChB,DCM,BCSIT,CCNA Supported BY

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8. Relationship between the organs and peritoneum Due to intraembryonal processes the organs have different relationship with the peritoneum . 1. Intraperitoneal organs are entirely covered with peritoneum . They are connected to the abdominal wall with ligaments or meso , which ensures greater mobility . 2. Extraperitoneal organs are partially or entirely devoid of peritoneum . They are slightly movable or immovable . According to their position these are : а) retroperitoneal – on the posterior abdominal wall b ) subperitoneal – in the lesser pelvis c ) preperitoneal – at the anterior abdominal wall . Dr Ndayisaba Corneille

9. The relationship between viscera and peritoneum Intraperitoneal viscera － viscera completely surrounded by peritoneum, example, stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovary Interperitoneal viscera － most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colon, upper part of rectum, urinary bladder and uterus Retroperitoneal viscera － some organs lie on the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only, example, kidney, suprarenal gland, pancreas, descending and horizontal parts of duodenum, middle and lower parts of rectum, and ureter Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera Dr Ndayisaba Corneille

10. PERITONEAL LIGAMENTSS = 2 folds of peritoneum connecting viscera to abdominal wall OMENTUM = 2 folds of peritoneum connecting stomach to another viscus e.g. greater & lesser omenta MESENTERY = 2 folds of peritoneum connecting intestines to post abdominal wall in adults. For children it is post and anterior Definitions - ligs , omenta & mes Dr Ndayisaba Corneille

11. Lesser sac A peritoneal pouch lies behind stomach & lesser omentum It projects upwards as far as the diaphragm. Inferiorly it lies within the folding of the greater omentum . Its lower part is usually obliterated due to fusion of the anterior & post layers of the greater omentum . Dr Ndayisaba Corneille

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13. Greater sac It is the part of peritoneal cavity which lies behind the anterior abdominal wall . Peritoneum lines the anterior abdominal wall then the under surface of diaphragm, from where it is reflected on to superior surface of liver forming the upper layer of coronary ligament Dr Ndayisaba Corneille

14. Structures which are formed by peritoneum Omentum － two-layered fold of peritoneum that extends from stomach to adjacent organs Dr Ndayisaba Corneille

15. Epiploic Foramen: Boundaries Anterior: free margin of lesser omentum , containing (hepatic artery, bile duct and portal vein) Posterior: peritoneum covering Inferior Venacava . Superior: Caudate process of the caudate lobe of the liver. Inferior: 1 st inch of the1 st part of duodenum. Dr Ndayisaba Corneille

16. Omental bursa Position － situated behind the lesser omentum and stomach Walls Superior － peritoneum which covers the caudate lobe of liver and diaphragm Anterior － formed by lesser omentum , peritoneum of posterior wall of stomach, and anterior two layers of greater omentum Inferior － conjunctive area of anterior and posterior two layers of greater omentum Posterior － formed by posterior two layers of greater omentum , transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland Dr Ndayisaba Corneille

17. Left － formed by the spleen, gastrosplenic ligament and splenorenal ligament Right － formed by omental foramen The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen. Dr Ndayisaba Corneille

18. Mesenteries or mesocolons This are two-layered fold of peritoneum that attach part of the intestines to the posterior abdominal wall Dr Ndayisaba Corneille

19. － suspends the small intestine from the posterior abdominal wall Broad and a fan-shaped Consists of two peritoneal layers Intestinal border － folded, 7 m long Radix of mesentery 15 cm long Directed obliquely from left side of L2 to in front of right sacroiliac joint Mesentery Dr Ndayisaba Corneille

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21. Mesoappendix Triangular mesentery － extends from terminal part of ileum to appendix Appendicular artery runs in free margin of the mesoappendix Dr Ndayisaba Corneille

22. Transverse mesocolon － a double fold of peritoneum which connects the transverse colon to the posterior abdominal wall Sigmoid mesocolon － inverted V-shaped, with apex located in front of left ureter and division of common iliac artery Dr Ndayisaba Corneille

23. Ligaments Two-layered folds of peritoneum that attached the lesser mobile solid visera to the abdominal wall. Dr Ndayisaba Corneille

24. 1. The ligaments of the liver ① The falciform ligament of liver ② The ligamentum teres hepatis ③ The coronary ligament ④ The right triangular ligament ⑤ The left triangular ligament ⑥ The hepatogastric ligament ⑦ The hepatoduonedenal ligament Dr Ndayisaba Corneille

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26. Falciform ligament of liver Consists of double peritoneal layer Sickeleshape Extends from anterior abdominal wall (umbilicus) to liver Free border of the ligament contains Ligamentum teres (obliterated umbilical vein) Dr Ndayisaba Corneille

27. Coronary ligament the area between upper and lower layer of the coronary ligament is the bare area of liver which contract with the diaphragm; Left and right triangular ligaments formed by left and right extremity of coronary ligament Dr Ndayisaba Corneille

28. Hepatogastric ligament Hepatoduodenal ligament Dr Ndayisaba Corneille

29. 2- Ligaments of spleen Gastrosplenic ligament - Connects the fundus of stomach to hilum of spleen. - Contents the short gastric & left gastroepiploic vessels pass through it. Splenorenal ligament extends between the hilum of spleen and left kidney. Contents The splenic vessel Lymphatic vessels ,nodes & nerve the tail of pancreas Dr Ndayisaba Corneille

30. Ligaments of spleen Phrenicosplenic ligament Splenocolic ligament Dr Ndayisaba Corneille

31. 3- Ligaments of stomach Hepatogastric ligament Gastrosplenic ligament Gastrophrenic ligament Gastrocolic ligament Gastropancrestic ligament Dr Ndayisaba Corneille

32. 4. The suspensory ligament of duodenum Sometimes named Treitz ligament at the junction between duodenum & jejunum Dr Ndayisaba Corneille

33. 5. The phrenicocolic ligament It is a fold of peritoneum which is continued from the left colic flexure to the diaphragm opposite the 10 th and 12 th ribs. Dr Ndayisaba Corneille

34. Folds and recesses of posterior abdominal wall Superior duodenal fold and recess Inferior duodenal fold and recess Intersigmoid recess － formed by the inverted V attachment of sigmoid mesocolon Dr Ndayisaba Corneille

35. 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 Dr Ndayisaba Corneille

36. Folds and fossas of anterior abdominal wall 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 Supravesical fossa Medial inguinal fossa Lateral inguinal fossa Dr Ndayisaba Corneille

37. Pouches In male － rectovesical pouch In female Rectouterine pouch － between rectum and uterus Vesicouterine pouch － between bladder and uterus Dr Ndayisaba Corneille

38. 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 live － the falciform ligament divides it into right and left suprahepatic recesses Dr Ndayisaba Corneille

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41. 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) Dr Ndayisaba Corneille

42. Infrahepatic recess lies between the liver and transverse colon and transverse mesocolon － the 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 Dr Ndayisaba Corneille

43. 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 and the upper abdominal region. 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. Dr Ndayisaba Corneille

44. 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 Dr Ndayisaba Corneille

45. Ascites: Is the excessive accumulation of the peritoneal fluid within the peritoneal cavity . . The infection may spread into the peritoneal cavity and cause inflammation of the peritoneum which is called as peritonitis. The infected fluid may tend to collect in the most dependent area of the peritoneal cavity in supine position, these areas are pelvis and the right subphrenic space . In such condition the patient complains of pain in the shoulder. Peritoneal Pain: abdominal pain arising due to the parietal peritoneum can be localised as it is supplied by the somatic nerves T7-T12 and L1. An inflamed parietal peritoneum is extremely sensitive to stretching. This fact is made use of clinically in diagnosing peritonitis. Pressure is applied to the abdominal wall with a single finger over the site of the inflammation. The pressure is then removed by suddenly withdrawing the finger. The abdominal wall rebounds, resulting in extreme local pain, which is known as rebound tenderness Applied anatomy Dr Ndayisaba Corneille

46. Pain arising from the visceral peritoneum is dull and poorly localized as the visceral peritoneum is supplied by the autonomic nerves. Peritoneal Dialysis : Because the peritoneum is a semi permeable membrane, it allows rapid bidirectional transfer of substances across itself. Because the surface area of the peritoneum is enormous, this transfer property has been made use of in patients with acute renal insufficiency. Internal abdominal hernia : occasionally a loop of intestine may enter into the peritoneal pouch or recesses and gets strangulated , this is called as internal abdominal hernia. Dr Ndayisaba Corneille

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