Marilyn Rose Abdomen Part One

Abdominal cavity ***Between the diaphragm and sacral promontory***** Peritoneum Thin serous membrane Parietal- lines abd walls Visceral- covers organs The cavity houses- liver (except bare area), GB, spleen, stomach, ovaries and most intestines Males- closed cavity Females- communicates with exterior though fallopian tubes, UT, and vagina

Peritoneum contd. Greater Sac communicates with the lesser Sac by the Foramen of Winslow (epiploic foramen) Folds in the peritoneum= mesentery, omenta and peritoneal ligaments. Mesentery encloses intestines and attaches them to the abd wall Omentum- mesentery attaching to stomach Greater- connects > curve of sto to spleen/ TRV colon Lesser- connects duodenum, < curve to liver.

Ligaments 3: > omental ligaments: 2: < omental: Gastrocolic, gastrosplenic and gastrophrenic 2: < omental: Hepatogastric, hepatoduodenal 2: Liver ligaments: Round (ligamentum teres) Falciform Diaphragm to liver: Coronary ligaments Margins of the “bare area”

Bare Area of the Liver The coronary ligaments represent reflections of the visceral peritoneum covering the liver onto the diaphragm. As such, between the two layers of the coronary ligament there is a large triangular surface of the liver devoid of peritoneal covering; this is named the bare area of the liver, and is attached to the diaphragm by areolar tissue.

Peritoneal spaces Supracolic compartment Above transverse colon R/L subphrenic spaces Between diaph and anterior liver- R/L by falciform ligament R/L subhepatic spaces Post/ inferior btw liver and abdominal viscera Rt= Morison’s Pouch– deepest in supine pt and common site for fluid collections!!

Peritoneal spaces Infracolic compartment Below transverse colon R/L infracolic spaces Divided by mesentery of small intestine paracolic gutters Lateral to ascentind and descending colon Deeper RT is also a common site for fluid collections….

Peritoneal Spaces What is the inflammation of the peritoneum and what is the most common cause???

Retroperitoneum Structures located posterior to peritoneum and still lined by it. Kidneys/ ureters Adrenal glands Pancreas Duodenum/ ascending/descending colon AO Inferior vena cava Bladder Uterus Prostate gland

Retroperitoneum

Retroperitoneal Spaces Anterior pararenal space Between Grota’s fascia/ post peritoneum Ascending/descending colon and pancreas and duodenum. Posterior pararenal space Posterior renal fascia and muscles of posterior abd wall (only fat and vessels in this space) LT/RT perirenal space areas directly around kidney This space contains the kidneys, adrenal glands, lymph nodes, blood vessels and perirenal fat

Abdominal Aorta

Abdominal Aorta Retroperitoneal Delivers O2 blood to abdominopelvic structures L4- bifurcates- Rt/Lt- Common iliac arteries

Abdominal Aorta Celiac Trunk SMA Renal arteries Off anterior wall- 3 arteries 1. left gastric 2. common hepatic- (divides into the hepatic artery and gastroduodenal artery) 3. splenic SMA L1- inferior to celiac and descends behind pancreas Renal arteries Arise from lateral walls of AO Below SMA RRA longer than left and passes posterior to IVC FYI: Renal artery stenosis can lead to HTN!!!!!

Normal Abnormal

Inferior Vena Cava Largest vein in the body Carries blood to the heart from the lower limbs, pelvic organs and abdomen L5- is formed by the common iliac veins Ascends superiorly through the retroperitoneum along the anterior verterbal column to the RT of the AO. Renal veins- empty into IVC @ L2 Lt renal vein- posterior to SMA and anterior to the aorta with the LT gonadal vein draining into it Hepatic veins 3 – Rt/ Middle/ Lt Collects blood from liver parenchyma Drain from inferior liver to the superior where they empty into the IVC below the diaphragm and proximal to the Rt atrium

Inferior Vena Cava

Where is the IVC???

TIPS- RA-stent

IVC- what is wrong?

IVC Thrombosis

If the IVC thrombosis…what then? AZYGOUS RECANALIZATION

Biliary Atresia… Leads to cirrhosis & MPV thrombosis

Hepatoblastoma How do we fix these??

Liver Transplant: