peritoneium
DESCRIPTION
Peritoneum block 5TRANSCRIPT
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PERITONEUM AND MESENTERIES
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L
SB
Aorta
IVC
TrCol
PsUb
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MESENTERY OVERVIEW
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PERITONEUM
• Functions:
1. Minimize friction
2. Resist infection
3. Store fat
4. Pathway for neurovascular structures
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PERITONEAL FLUID
• Derived from interstitial fluid of adjacent tissues
• Contains water, electrolytes, proteins, macrophages and lymphocytes
• Peritoneum is a semi-permeable membrane that allows fluid and cells to move in both directions
• Composition varies according to pathological condition
• Condition when there is excess fluid, usually due to inflammation or infection is called ascites
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PERITONEAL STRUCTURES
• Parietal and visceral layers – single layer of peritoneum
• Mesentery – double layer that suspends gut tube, ie., dorsal mesentery and ventral mesentery
• Omentum – special type of mesentery that attaches stomach to another structure, ie., greater omentum and lesser omentum
• Peritoneal ligaments – double layer that attaches more solid viscera to abdominal wall or other organs
• Peritoneal folds – raised, single layer of peritoneum coursing over blood vessels and ligaments
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MESENTERY
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Dorsal Root of the Mesentery
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Mesentery
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VISCERAL PERITONEUM
• Intraperitoneal
– Organs nearly completely surrounded by peritoneum
– Organs suspended by mesentery, omentum or ligament
• Retroperitoneal
– Organs only partially covered by peritoneum
– Organs have no mesentery
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MESENTERY OVERVIEW
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DORSAL MESOGASTRIUM
• Rotation of stomach causes dorsal mesogastrium to balloon out to left
• Creates the lesser sac or omental bursa
28 days
48 days
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DORSAL MESOGASTRIUM
• Splenorenal (lienorenal) ligament
• Gastrosplenic (gastrolienal) ligament
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DORSAL MESOGASTRIUM – GREATER OMENTUM
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DORSAL MESOGASTRIUM – GREATER OMENTUM
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DERIVATIVES OF DORSAL MESOGASTRIUM
• Greater omentum (gastrocolic ligament)
• Gastrosplenic ligament
• Splenorenal ligament
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VENTRAL MESENTERY
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VENTRAL MESENTERY
• Rotation of stomach moves liver and lesser omentum to right
• Falciform ligament remains in midline
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GREATER AND LESSER SACES
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VENTRAL MESENTERY – LESSER OMENTUM
• Falciform ligament
Ligamentum teres
• Lesser omentum
Hepatogastric lig.
Hepatoduodenal lig.
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DERIVATIVES OF VENTRAL MESENTERY
• Falciform, coronary & triangular ligaments
• Visceral peritoneum of liver
• Lesser omentum
– Hepatogastric ligament
– Hepatoduodenal ligament
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MESENTERY PROPER AND MESOCOLON
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PERITONEAL FOLDS
• Median umbilical fold – median umbilical ligament
• Medial umbilical folds – median umbilical ligaments
• Lateral umbilical folds – inferior epigastrics
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PARACOLIC GUTTERS
• Longitudinal channels running along medial and lateral sides of ascending and descending colon
• Form where parietal peritoneum reflects onto colon as visceral peritoneum
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PARACOLIC GUTTERS
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HEPATORENAL RECESSRIGHT SUBHEPATIC RECESS
(MORRISON’S POUCH)
• One of the lowest points in the peritoneal cavity
• Excess fluid/blood will pool in this area when patient is supine
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Summary• Dorsal Mesentery
• Dorsal mesogastrium
• Greater omentum
• Gastrosplenic ligament
• Lienorenal (splenorenal) ligament
• Dorsal Mesoduodenum
• Mesocolons (transverse and sigmoid)
• Ventral Mesentery
• Falciform ligament
• Coronary and triangular ligaments
• Lesser omentum - hepatogastric and hepatoduodenal ligaments