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(lecture 1)
Disclaimer: Presentation is for educational purposesonly and not for commercial activity
Presented by: Dr. Archana RaniProfessorDepartment of AnatomyKGMU, UP, Lucknow
27.04.2020
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Peritoneum
• The peritoneum (Greek stretched over) is a large serousmembrane (serosa) lining the abdominal cavity.
• It is divided into:
a. An outer or parietal layer
b. An inner or visceral layer
c. Folds of peritoneum by which the viscera are suspended
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Histology of Peritoneum
Histologically, composed of:•Outer fibrous layer-
provides strength
• Inner layer of mesothelial cells-secrete a serous fluid for lubrication
https://www.slideshare.net/ahmedsalah925/anatomy-of-peritoneum
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Diagrammatic transverse section of the abdomen showing the
arrangement of the peritoneum
Human Anatomy. BD Chaurasia, 8th ed, Vol. 2, 2020
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Parietal Peritoneum
• It lines the inner surface of theabdominal and pelvic wallsand the lower surface of thediaphragm.
• Can be easily stripped.
• Derived from somato-pleuriclayer of lateral platemesoderm.
• Its blood supply and nervesupply are the same as thoseof the overlying body wall.
• Because of the somatic innervation, parietal peritoneum is pain sensitive.
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Visceral Peritoneum
• It lines the outer surface of theviscera. In fact it forms a part andparcel of the viscera.
• Cannot be stripped.
• Derived from splanchno-pleuriclayer of lateral plate mesoderm.
• Its blood supply and nerve supplyare the same as those of theunderlying viscera.
• Because of the autonomicinnervation, visceral peritoneumevokes pain when viscera isstretched, ischaemic or distended.
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Folds of Peritoneum
• Many organs within the abdomen are suspended by folds of
peritoneum. Such organs are mobile.
• Other organs are fixed and immobile. Such organs are said to be
retroperitoneal.
• Some are partially covered.
• Few are sub-peritoneal (infra-peritoneal).
• Provide pathways for passage of vessels, nerves and
lymphatics.
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Process of zygosis
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https://www.pinterest.com/pin/37717715609967916/
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Intraperitoneal Organs(completely surrounded by peritoneum)
S= StomachA= AppendixL= LiverT= Transverse colonD= Duodenum (1st part only)S= Small intestinesP= Pancreas (tail only)R= Rectum (upper 3rd only)S= Sigmoid colonS= Spleen
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Retroperitoneal Organs(covered by peritoneum on anterior surfaces only)
S= Suprarenal glands
A= Aorta/Inferior Vena Cava
D= Duodenum (except for 1st part)
P= Pancreas (head and neck)
U= Ureters
C= Colon (ascending and descending parts)
K= Kidneys
E= Esophagus
R= Rectum
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https://www.pinterest.com/pin/179440366384610456/
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https://www.studyblue.com/notes/note/n/liver-pancreas-spleen/deck/21887610
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https://www.proprofs.com/quiz-school/story.php?title=fsadfds
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• Provide passage for nerves, vessels & lymphatics
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CLINICAL ANATOMY
• Ascites: Collection of free fluid in the peritoneal cavity is known as ascites.
Common causes of ascites are cirrhosis of the liver, tubercular peritonitis,
congestive heart failure, and malignant infiltration of the peritoneum. Veins
also get prominent in cirrhosis of liver.
• Peritonitis
• Pneumoperitoneum
• Laparoscopy
• Laparotomy
• Greater omentum limits the spread of infection by sealing off the site of
ruptured vermiform appendix or gastric ulcer and tries to delay the onset of
peritonitis. It is called ‘‘abdominal policeman’’.
• Peritoneal dialysis
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Paracentesis
X sites for paracentesis
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Peritoneal Folds
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Derivatives of the different parts of gut
https://quizlet.com/7308810/stomach-small-intestine-flash-cards/
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VENTRAL
DORSAL
https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/dorsal-mesentery
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• Cranial most part forms the
gastrophrenic ligament
https://www.memorangapp.com/flashcards/84729/Abdominal+Wall+and+Peritoneal+Sac+(Lecture+%231
https://anatomyqa.com/stomach-anatomy/
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Greater Omentum• The greater omentum (Latin apron) is a large fold of peritoneum which hangs down from the
greater curvature of the stomach like an apron and covers the loops of intestines to a varying
extent.
• Made up of 4 layers.
Contents
• Right and left gastroepiploic vessels
• Fat
Functions
1. It is a storehouse of fat
2. It protects the peritoneal cavity against infection
(collection of macrophages form milky spots)
3. Also known as “policeman of the abdomen”
https://m.youtube.com/watch?v=_bGjvdc5Sqk
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Attachments
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LESSER OMENTUMThis is a fold of peritoneum which extends from the lesser curvature of the stomach and the
first 2 cm of the duodenum to the liver. The portion of the lesser omentum between the
stomach and the liver is called the hepatogastric ligament, and the portion between the
duodenum and the liver is called the hepatoduodenal ligament.
Attachments:
Inferiorly: lesser curvature of stomach and duodenum
Superiorly: liver in the form of an inverted ‘L’
Contents:The right free margin of the lesser omentum contains:
1. The proper hepatic artery
2. The portal vein
3. The bile duct
4. Lymph nodes & lymphatics
5. Hepatic plexus of nerves
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The attachments and contents of the lesser omentum. The liver has been
turned upwards so that its posteroinferior surface can be seen
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MESENTERY
The mesentery (Greek fold of intestine) of the small intestine or
mesentery proper is a broad, fan-shaped fold of peritoneum
which suspends the coils of jejunum and ileum from the posterior
abdominal wall.
https://www.kenhub.com/en/library/anatomy/mesentery
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Borders
• The attached border, or root of themesentery, is 15 cm long, it crosses thefollowing structures:
1.The third part of the duodenum
where the superior mesenteric
vessels enter into it
2.The abdominal aorta
3.The inferior vena cava
4.The right ureter
5.The right psoas major
• Free or intestinal border is 6 metres long.
• The breadth of the mesentery ismaximum and is about 20 cm in thecentral part, but gradually diminishestowards both the ends.
https://www.kenhub.com/en/library/anatomy/mesentery
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Contents
1. Jejunal and ileal branches of the superior mesenteric artery
2. Accompanying veins
3. Autonomic nerve plexuses
4. Lymphatics or lacteals
5. 100–200 lymph nodes
6. Connective tissue with fat
https://www.slideshare.net/DrSherifFahmy/jejunum-ileum-anatomy-of-the-abdomen
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Mesoappendix
It is a small, triangular fold of peritoneum which
suspends the vermiform appendix from the posterior
surface of the lower end of the mesentery close to the
ileocaecal junction.
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Transverse Mesocolon
Attachments
• The root of the transversemesocolon is attached to theanterior surface of the head, andthe anterior border of the body ofthe pancreas.
Contents
• It contains the middle colic vessels;the nerves, lymph nodes andlymphatics of the transverse colon.
https://www.memorangapp.com/flashcards/71585/Inferior+Mesenteric+Artery+and+Large+intestine/
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Sigmoid Mesocolon
Features
• This is a triangular (Greek ‘S’ shape)fold of peritoneum which suspendsthe sigmoid colon from the pelvic wall.
Attachments
• The root is shaped like an inverted ‘V’.
Contents
• The sigmoid vessels in the left limb;superior rectal vessels, nerves, lymphnodes and lymphatics in the right limbof the sigmoid colon.
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