Abdominal Cavity 1: Peritoneum Recommended Textbooks Clinical Anatomy by Region. Author: Richard S. Snell. Publisher: Wolters Kluwer/Lippincott Williams & Wilkins Principles of Human Anatomy Authors: Gerard Tortora, Mark Nielsen Publisher: John Wiley & Sons, Inc. Grant’s Atlas of Anatomy Authors: Anne Agur, Arthur Dalley

(G, To stretch or cover around ) Peritoneum A serous membrane of 2 continuous layers that covering the abdominal organs (G, To stretch or cover around ) Parietal: lining internal abdominal wall Visceral: lining abdominal organs (viscera) Peritoneal cavity: space between parietal & visceral layers fluid filled  reduce friction * NO organs in peritoneal cavity

Abdominal Organs Relation to Peritoneum Intraperitoneal: completely covered by visceral peritoneum Retroperitoneal: posterior (behind) the peritoneum touched anteriorly by parietal peritoneum

Peritoneal Cavity 2 parts Greater sac: main part of peritoneal cavity Lesser sac (omental bursa): extensional cavity behind the stomach allows free movement of stomach it has 3 recesses: sup., inf., & splenic connects with greater sac through epiploic foramen

Epiploic Foramen Foramen of Winslow Connects lesser sac to greater sac Boundaries: Ant.: portal triad (p. vein, h.a., & bile duct) Post.: IVC Sup.: Liver (caudate lobe) Inf.: duodenum (1st part)

Foramen of Winslow & Lesser Sac

Terms describing parts of peritoneum Peritoneum has special names at specific regions: omentum mesentry & mesocolon ligaments

Greater curvature of stomach Omentum Broad, double layered sheet of peritoneum that connects stomach to another abdominal organ 2 parts 1. Greater Omentum: Greater curvature of stomach  Down (like apron) Reflects up again Ant. transverse colon

Greater Omentum 3 parts Reflection

Internal Omental Herniation A loop of intestine may pass through foramen of winslow  lesser sac  None of the boundaries can be incised to reduce the hernia Rx.: 1st: aspirating the gut content 2nd: pushing the herniated loop out of lesser sac by inserting the index finger into it through ant. 2 layers of ??

Lesser curvature of stomach & small part of dudenum (2cm) 2. Lesser Omentum Lesser curvature of stomach & small part of dudenum (2cm)  Liver Post. to it = lesser sac * The free edge of lesser omentum is called: hepatoduodenal ligament  contains portal triad

Hepatoduodenal Ligament

Mesentery & Mesocolon Mesentry: Mesocolon: double layer of peritoneum connects small intestine to posterior abdominal wall mesentry of small intestine Mesocolon: double layer of peritoneum connects large transverse mesocolon sigmoid mesocolon mesoappendix

Mesentery & Mesocolon

Ligaments Double layer of peritoneum that is usually attached to solid organs (liver & spleen) Falciform Lig.: Attachs the liver to ant. abdominal wall & ends by enclosing ligamentum teres Hepatoduodenal Lig.: The free edge of …? 1st 2 cm of duodenum to liver Contents?

Peritoneal Nerve Supply Parietal Peritoneum: (sensations) T7 – T12 L1 (iliohypogastric) Obturator nerve (in the pelvis) Visceral Peritoneum: Autonomic nerve supply (only for stretch)

Organs Relations to Peritoneum Stomach (intra) Duodenum (retro, except 1st 2 cm) Jejunum & ileum (intra) Cecum (??) Appendix (intra) Ascending (retro) Transverse (intra) Descending (retro) Sigmoid (intra) Rectum: within the pelvis upper part (ant. & lat.) middle part (ant.) lower (no covering, subpertoneal) Liver: Intraperitoneal except over 3 areas Pancreas: Retroperitoneal except for the tail Spleen: Kidneys: