2General featuresThe peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavitiesParietal peritoneum －lines the walls of the abdominal and pelvic cavitiesVisceral peritoneum －covers the organsPeritoneal cavity －the potential space between the parietal and visceral layer of peritoneum, in the male, is a closed sac, but in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina
3FunctionSecretes a lubricating serous fluid that continuously moistens the associated organsAbsorbSupport viscera
4The 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 ovaryInterperitoneal viscera －most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colon, upper part of rectum, urinary bladder and uterusRetroperitoneal 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 ureterIntraperitoneal visceraInterperitoneal visceraRetroperitoneal viscera
6Structures which are formed by peritoneum Omentum －two-layered fold of peritoneum that extends from stomach to adjacent organs
7Lessor omentum－two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenumHepatogastric ligament －extends from porta hepatis to lesser curvature of stomachHepatoduodenal ligament Extends from porta hepatis to superior part of duodenumContains common bile duct, proper hepatic a. and hepatic portal v.
8Omental foramen Behind the right border of hepatoduodenal ligament Superior－caudate lobe of liverInferior－superior part of duodenumAnterior－hepatodudenal ligamentPosterior－peritoneum covering the inferior vena cava
9Greater 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.
11Omental bursa Position－situated behind the lesser omentum and stomach WallsSuperior－peritoneum which covers the caudate lobe of liver and diaphragmAnterior－formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentumInferior－conjunctive area of anterior and posterior two layers of greater omentumPosterior－formed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland
12Left－formed by the spleen, gastrosplenic ligament and splenorenal ligament Right－formed by omental foramenThe Omental bursa (lesser sac) communicates with the greater sac through the omental foramen.
13Mesenteries or mesocolons－two-layered fold of peritoneum that attach part of the intestines to the posterior abdominal wall
14Mesentery－suspends the small intestine from the posterior abdominal wallBroad and a fan-shapedConsists of two peritoneal layersIntestinal border－folded, 7 m longRadix of mesentery15 cm longDirected obliquely from left side of L2 to in front of right sacroiliac joint
16MesoappendixTriangular mesentery－extends from terminal part of ileum to appendixAppendicular artery runs in free margin of the mesoappendix
17Transverse mesocolon －a double fold of peritoneum which connects the transverse colon to the posterior abdominal wallSigmoid mesocolon －inverted V-shaped, with apex located in front of left ureter and division of common iliac artery
18Ligaments Ligaments of liver －two-layered folds of peritoneum that attached the lesser mobile solid visera to the abdominal wallLigaments of liverFalciform ligament of liverConsists of double peritoneal layerExtends from anterior abdominal wall (umbilicus) to liveFree border of ligament site of ligamentum teres
19Coronary 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 diaphragmLeft and right triangular ligaments－formed by right extremity of coronary ligament and left leaf of falciform ligament, respectively
21Ligaments of spleenGastrosplenic 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 vesselsSplenorenal 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 pancreasPhrenicosplenic ligamentSplenocolic ligament
23Folds and recesses of posterior abdominal wall Superior duodenal fold and recessInferior duodenal fold and recessIntersigmoid recess －formed by the inverted V attachment of sigmoid mesocolon
24Retrocecal 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
25Folds 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 vesselsSupravesical fossaMedial inguinal fossaLateral inguinal fossa
26Pouches In male－rectovesical pouch In female Rectouterine pouch －between rectum and uterusVesicouterine pouch －between bladder and uterus
27Peritoneal 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 mesocolonSuprahepatic recess lies between the diaphragm and live－the falciform ligament divides it into right and left suprahepatic recesses
28Left suprahepatic recesses left anterior suprahepatic spacesleft posterior suprahepatic spacesRight suprahepatic recessesright anterior suprahepatic spacesright posterior suprahepatic spacesbare area of live (extraperitoneal space)
29Infrahepatic recesslies between the live and transverse colon and transverse mesocolon－the ligamentum teres hepatic divides it into right and left infrahepatic recessesRight infrahepatic recesses (hepatorenal recess)Left infrahepatic recessesleft anterior infrahepatic spaceleft posterior infrahepatic space
30Infracolic 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.
31Right mesenteric sinus －triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolonLeft 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
37Unpaired branches Celiac trunk －a short thick vessel that arises from the front of aorta, at the level of T12Superior mesenteric a. －arises from the front of aorta, at the level of L2Inferior mesenteric a. －arises from the front of aorta, at level of L3
38Celiac trunk Left gastric a. Left branch Right branch Short gastric a. Commonhepatic a.Cystic a.Splenic a.Right gastric a.Splemic branchesProper hepatic a.Gastroduodenal a.Left gastrioeploic a.Superior pancreaticoduodenal a.Right gastroepiploic a.
43Relations of abdominal aorta Anteriorly (from above downward) PancreasAscending part of duodenumRadix of mesenteryPosteriorlyUpper four lumber vertebraeOn its rightInferior vena cavaOn its leftLeft sympathetic trunk
44Veins of abdomen and pelvis Internal iliac veinParietal tributaries: accompany with arteriesVisceral tributaries→superior rectal vein→inferior mesenteric v.①Rectal venous plexus →inferior rectal vein→internal iliac v.→anal vein→internal pudendal v.②Vesical venous plexus →vesical v.③Uterine venous plexus →uterine v.
45External iliac vein– accompany the artery Common iliac vein– formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4~L5 by uniting each other to form inferior vena cava
46Inferior vena cavaFormed by union of two common iliac veins anterior to and just to the right of L4~L5Ascends on the right side of aorta, pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atriumConveys blood from the whole body below the diaphragm to the right atrium
47Chief tributaries Parietal Visceral Paired inferior phrenic v. paired lumbar v. (four)VisceralRight and left renal veinsRight suprarenal vein (left drain into left renal vein)Right testicular or ovarian v. (left drain into left renal vein)Hepatic veins : right, left and intermediate
48Relations of inferior vena cava Anteriorly (cranially to caudally)LiverHead of pancreasHorizontal part of duodenumRight testicular (or ovarian) a.Radix of mesenteryPosteriorlyRight crus of diaphragmUpper four lumber vertebraeLeft sympathetic trunkParietal branches of abdominal aortaOn its rightPsoas majorRight kidneyRight suprarenal glandOn its leftAbdominal aorta
49Hepatic portal vein General features Formed behind the neck of pancreas by the union of superior mesenteric vein and splenic veinAscends upwards and to the right, posterior to the first part of duodenum and then enters the lesser omentum to the porta hepatis, where it divides into right and left branchesThere are no functioning valves in hepatic portal systemDrains blood from gastrointestinal tract from the lower end of oesophagus to the upper end of anal canal, pancreas, gall bladder, bile ducts and spleen
51Tributaries of hepatic portal vein 1. Superior mesenteric v.2. Inferior mesenteric v.3. Splenic v.4. Left gastric v.5. Right gastric v.6. Cystic v.7. Paraumbilical v.
52Portal-systemic anastomoses 1. At the lower end of the oesophagusHepatic portal vein → left gastric vein → esophagealvenous plexus → esophageal vein → azygos vein→ superiorvena cava2. At rectal venous plexusHepatic portal vein → splenic vein → inferior mesentericvein → superior rectal vein → rectal venous plexus →inferior rectal and anal veins → internal iliac vein →inferior vena cava3. At periumbilical venous plexusHepatic portal vein→paraumbilical vein→periumbilicalvenous plexus→thoracoepigastric and superior epigastric vein → superiorvena cavasuperficial epigastric and inferior epigastric veins → inferior vena cava
534. Portal-retroperitoneal anastomosis Between the retroperitoneal branches of the colic veins and the lumbar veins, pancreaticoduodenal veins with the renal veins and the subcapsular veins of the liver with the phrenic veins twigs of colic veins (portal) anastomosing with systemic retroperitoneal veins
54The lymphatic drainage of abdomen Lymphatic drainage of abdominal wallTo axillary lymph node from region above umbilicusTo superficial inguinal lymph node from region below umbilicusTo lumbar lymph node from post wall of abdomen
55Lymphatic drainage of abdominal viscera Lumbar lymph nodes Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cavaReceive lymph from kidneys, suprarenal glands, testes, ovaris, fundus of uterus, ovary, and common iliac nodesRight and left lumbar trunks formed by efferent vesselPaired viscera－drain to the lumbar lymph nodes
56Celiac lymph nodes －situated around the celiac trunk Superior mesenteric lymph node －situated around superior mesenteric a.Inferior mesenteric lymph node －situated around inferior mesenteric a.Intestinal trunk －formed by efferent vessel of celiac, superior and inferior lymph nodes
57Thoracic ductBegins in front of L1 as a dilated sac, the cisterna chyli, which formed by joining of left and right lumbar trunks and intestinal trunkEnter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column, between thoracic aorta and azygos veinTravels upward, veering to the left at the level of T5At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angleJust before termination, it receives the left jugular, subclavian and bronchomediastinal trunksDrains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb
58SpleenLocation: lies in the left hypochondriac region (between stomach and diaphragm) deep to the 9th to 11th rib, its long axis corresponds roughly to the 10th ribShape－reddish in colour
59Two surfacesDiaphragmatic: smooth, convexVisceral: concave, hilum of spleenTwo extremitiesAnterior－widerPosterior－rounderTwo borderSuperior－has 2-3 splenic notch, which serve as a landmark on palpation when it is enlarge; normally it is not palpableInferior－rounderFunctions: the spleen is considered to be important in:Formation of lymphocytes and monocytePhagocytosis of bacteria, inert particles and white blood cells and plateletsDestroying effete or abnormal red blood cellsMaking antibodies
60Spleen Function Erythrocyte storage Phagocytosis Cytopoiesis Immune responses
61Relationships of spleen Diaphragmatic surface－diaphragmVisceral surfaceAnteriorly－fundus of stomachPosteriorly－left suprarenal gland and kidneyInferiorly－tail of pancreas and left colic flexure