1. Abdominal organs and peritoneumBy
Dr N Satyanarayana

2. Abdomen Lower part of trunk situated below the diaphragm
It is divided in to 3 parts:
Abdomen proper
Pelvis
Perineum
Abdominal cavity:
Cavity situated in the abdomen
It extends up in to the lower part of thoracic cage and extends down into the bony pelvis as pelvic cavity
Divided into 2 parts
Pelvic cavity

3. Abdomen proper Is the upper part of abdominal cavity Major contents:
Peritoneum
Parts of gastrointestinal tract – Stomach, small intestine (duodenum, jejunum and ileum), most of the large intestine (caecum, ascending colon, transverse colon, descending colon, sigmoid colon, appendix), liver, pancreas

4. Spleen, suprarenal (adrenal) glands,
Parts of urinary system - kidneys, parts of ureters,
Large vessels such as abdominal aorta, common iliac artery, external iliac and internal iliac arteries, inferior vena cava and portal vein

5. sigmoid colon

6. Urinary system
Kidney
Ureter
Urinary
bladder
Urethra

7. Pelvic cavity Situated in the pelvis
Is the lower part of abdominal cavity
Major contents:
Peritoneum
Parts of large intestine (sigmoid colon, rectum)
Parts of urinary system - urinary bladder, ureters, urethra
Male reproductive organs – vas deferens, prostate, seminal vesicle
Female reproductive organs – ovary, uterine tube, uterus, vagina
Nerves – sacral plexus of nerves
Blood vessels – internal iliac artery and vein

8. Male reproductive organs
Bulbourethral glands

9. Female reproductive organs

10. The peritoneum

11. lines the walls of the abdominal and pelvic cavities
General features
The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities
Parietal peritoneum
lines the walls of the abdominal and pelvic cavities
Visceral peritoneum
－covers the organs

12. The relationship between viscera and peritoneum
Intraperitoneal viscera
Interperitoneal viscera
Retroperitoneal viscera

13. Folds of peritoneum.
Organs in the abdomen suspended by folds of peritoneum.so such organs are mobile.
The peritoneal folds provide pathways for passage of vessels and nerves and lymphatics.
Peritoneal folds are given various names:
A)Name of the fold is made up of: prefix –meso followed by name of the organ.
Example: small intestine called enteron so peritoneal fold suspending part of colon called meso-colon or mesentry.

14. B) large peritoneal fold attached to stomach is called omenta
B) large peritoneal fold attached to stomach is called omenta.(means cover).
C) Double layered fold of peritoneum connect organs to abdominal wall is called ligaments.
These named after the structure they connect.
Example: Gastrosplenic lig. Connect stomach to spleen.
D) Some fold named according to shape:
Example: Triangular ligaments of liver.

15. RECESS OR SMALL POCKETS.
Small pockets or recess of the peritoneal cavity may be separated from the main cavity by small folds of peritoneum.
These peritoneal recess or fossae are of clinical importance.
Exp: internal hernia may take place in to these recess.

16. Peritoneal cavity －the potential space between the parietal and visceral layer of peritoneum.
Between these layers there is a thin filim of serous fluid secreted by mesothelial cells.these fluid lubricating function.
Peritoneal cavity divided in to two parts:
Grater sac:the main larger part.
Lesser sac:behind the stomach,lesser omentum, liver.
To sacs communicate with each other with epiploic foramen(foramen winslow)

17. Sex differences. In the male, is a closed sac, lined by mesothelium.
But in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina.
Peritoneum covering Ovaries by-cuboidal epithelium.
Peritoneum covering fimbria- columnar epithelium.

18. Peritoneal cavity
Lesser sac
Greater sac

19. Functions
1.Secretes a lubricating serous fluid that 2.continuously moistens the associated organs
3.Absorbtion and dialysis.
4.Support viscera.
5.Protection of viscera.
6.Healing power and adhesions.
7.storage of fat.

20. 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

21. Interperitoneal viscera

22. liver
spleen

23. DORSAL AND VENTRAL MESOGASTRIUM
AORTA
VENTRAL MESOGASTRIUM
COELIC TRUNK
LIVER
DORSAL MESOGASTRIUM
SPLEEN
SUPERIOR
MESENTRIC ARTERY
INFERIOR
MESENTRIC ARTERY

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

25. Lessor omentum
－two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum
Hepatogastric ligament －extends from porta hepatis to lesser curvature of stomach .
Hepatoduodenal ligament
Extends from porta hepatis to superior part of duodenum
Contains common bile duct, proper hepatic a. and hepatic portal v.
Contents:
right and left gastric vessels.
Hepatic artery, portal vein,bile duct.

26. Omental foramen or Epiploic foramen or foramen winslow.
Behind the right border of hepatoduodenal ligament(lesser omentum).
Superior－caudate lobe of liver
Inferior－superior part of duodenum
Anterior－hepatodudenal ligament
Posterior－peritoneum covering the inferior vena cava

27. Greater omentum
－four-layered fold of peritoneum, the anterior two layers descend from the greater curvature of stomach and superior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon.
If an infection occurs in the intestine, plasma cells formed in the lymph nodes combat the infection and help prevent it from spreading to the peritoneum. So it is called police men of the abdomen,

28. Lessor omentum
Greater omentum

29. 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

30. Right－formed by omental foramen
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.
Left side
Right side
Spleen,gastro,splenorenal lig.

31. Mesenteries or mesocolons－
two-layered fold of peritoneum that attach part of the intestines to the posterior abdominal wall

32. Mesentery
－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

33. Mesentery

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

35. 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

36. Ligaments Ligaments of liver
－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 live
Free border of ligament site of ligamentum teres

37. Coronary ligament －the area between upper and lower parts of the coronary ligament is the bare area of live, this area is devoid of peritoneum and lies in contract with the diaphragm
Left and right triangular ligaments:
formed by right extremity of coronary ligament and left leaf of falciform ligament, respectively

38. Hepatogastric ligament
Hepatoduodenal ligament
Ligamentum teres hepatis

39. 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
spleen

40. Ligaments of stomach Hepatogastric ligament Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament
Gastropancrestic ligament

41. 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

42. Retrocecal recess －in which the appendix frequenty lies
Hepatorenal recess (Morison”s pouch) －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. It is most dependent part of abdominal cavity.Fluid tend to collect here.

43. Hepatorenal (Morison’s) pouch:
Most dependent part of peritoneal cavity in supine position
Boundaries:
Anterior:
Right lobe of liver, gall bladder
Posterior:
Right kidney, second part of duodenum, right flexure of colon, transverse mesocolon, head of pancreas
Superior:
Inferior layer of coronary ligament
Inferior:
Opens to the general peritoneal cavity
Hepatorenal (Morison’s) pouch:

44. Hepatorenal pouch Stomach Gastrosplenic ligament Gall bladder Spleen
Liver
(right lobe)
Pancreas
Hepatorenal
pouch
Greater
omentum
Right flexure
of colon
Right kidney
Duodenum (2nd part)

45. Folds and fossas of anterior abdominal wall
Medial 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

46. Pouches In male－rectovesical pouch In female
Rectouterine pouch －between rectum and uterus
Vesicouterine pouch －between bladder and uterus

47. 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

48. 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)

49. Right infrahepatic recesses (hepatorenal recess)
lies between the live 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

50. 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.

51. 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