The peritoneum SHANDONG UNIVERSITY Liu Zhiyu General features

The peritoneum SHANDONG UNIVERSITY Liu Zhiyu

General features n n n The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities Parietal peritoneum －lines the walls of the abdominal and pelvic cavities Visceral peritoneum － covers the organs

General features n Peritoneal 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.

Function n Secretion: serous fluid that moistens the organs. Absorption Support and protection abdominal organs

The relationship between viscera and peritoneum n Intraperitoneal viscera － viscera completely surrounded by peritoneum, such as： stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen ，ovary and uterine tube Intraperitoneal viscera

n Interperitoneal viscera － most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colon, upper part of rectum, urinary bladder and uterus Interperitoneal viscera

n Retroperitoneal viscera － some organs 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 ureter Retroperitoneal viscera

Structures formed by peritoneum Omentum －two-layered fold of peritoneum that extends from stomach to adjacent organs

Lesser omentum －two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum n

Lessor omentum n Hepatogastric ligament － from porta hepatis to lesser curvature of stomach n Hepatoduodenal extends from porta hepatis ligament to superior part of duodenum, it contains common bile duct, proper hepatic a. hepatic portal v.

Greater omentum A four-layered fold of peritoneum connecting the greater curvature of stomach and superior part of duodenum to transverse colon, which hangs down like an apron in front of coils of small intestine.

Lessor omentum Greater omentum

Omental bursa Position－situated behind the lesser omentum and stomach Walls： n Superior－peritoneum which covers the caudate lobe of liver and diaphragm n Anterior－lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum

Omental bursa n Inferior－conjunctive area of anterior and posterior two layers of greater omentum n Posterior－posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering posterior abdominal wall.

Omental bursa n Left－ spleen, gastrosplenic ligament splenorenal ligament n Right－omental foramen

Omental (epiploic)foramen n Position: The omentallies bursa (lesser sac) between the liver and communicates with the duodenum, behind the greater sac through lesser omentum andthe omental infront offoramen. the inferior vena cava

Mesenteries or mesocolons －two-layered fold of peritoneum that attach the intestines to the posterior abdominal wall

Mesentery -suspends the small intestine from the posterior abdominal wall -Broad and a fanshaped n Radix of mesentery q q 15 cm long Directed obliquely from left side of L 2 vertebra to right sacroiliac joint

Mesoappendix n n Triangular mesentery－ extends from terminal part of ileum to appendix Appendicular artery runs in free margin of the mesoappendix

Transverse mesocolon －a double fold of peritoneum which connects the transverse colon to the posterior abdominal wall. Sigmoid mesocolon －attaches the sigmoid colon to the pelvic wall, the sigmoid.

Ligaments of liver n Falciform ligament of liver q Consists of double peritoneal layer q Extends from anterior abdominal wall (umbilicus) to live q Free border of the ligament contains ligamentum teres

n Coronary ligament －the area between upper and lower layer of the coronary ligament is the bare area of liverwhich contract with the diaphragm; n Left and right triangular ligaments －formed by left and right extremity of coronary ligament

n n Hepatogastric ligament Hepatoduodenal ligament

Ligaments of spleen n Gastrosplenic ligament －connects the fundus of stomach to hilum of spleen. the short gastric and left gastroepiploic vessels pass through it. n. Splenorenal ligament －extends between the hilum of spleen and left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreas

Ligaments of spleen n n Phrenicosplenic ligament Splenocolic ligament

Ligaments of stomach n n Hepatogastric ligament Gastrosplenic ligament Gastrophrenic ligament Gastrocolic ligament

Folds and recesses of posterior abdominal wall n n n Superior duodenal fold and recess Inferior duodenal fold and recess Intersigmoid recess － between posterior wall of abdomen and sigmoid mesocolon

n Retrocecal recess －in which the appendix frequenty lies n 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

Folds and fossas of anterior abdominal wall n Medial umbilical fold － contain the remnant of urachus (median umbilical ligaments) n Medial umbilical fold － contains remnants of the umbilical arteries n Lateral umbilical fold － contains the inferior epigastric vessels

Folds and fossas of anterior abdominal wall n Supravesical fossa n Medial inguinal fossa n Lateral inguinal fossa

★ Pouches In male－rectovesical pouch In female Rectouterine pouch －between rectum and uterus Vesicouterine pouch －between bladder and uterus

Peritoneal subdivisions The transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic compartments Supracolic compartment (subphrenic space)－ may be divided into Suprahepatic space and Infrahepatic space by the liver.

Peritoneal subdivisions Suprahepatic space nlies between the diaphragm and liver; n. It is divided into right and left suprahepatic spaces by the falciform ligament

n Left suprahepatic space q q left anterior suprahepatic spaces left posterior suprahepatic spaces n. Right space suprahepatic right anterior suprahepatic spaces q bare area of live (extraperitoneal space) q

Infrahepatic space - lies between the live and n transverse colon and transverse mesocolon; -the ligamentum teres hepatic divides it into Right infrahepatic space (hepatorenal recess) n Left infrahepatic space

Infrahepatic space n Left infrahepatic space divieded into(by the leser omentum and stomach) q left anterior infrahepatic space q left posterior infrahepatic space (omental bursa)

Infracolic compartment －lies below the transverse colon and transverse mesocolon n Right paracolic sulcus (gutter) － lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity.

Infracolic compartment Left paracolic sulcus (gutter) －lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament.

Infracolic compartment n Left mesenteric sinus －triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon n Right mesenteric sinus －lies between root of mesentery, descending colon, right 1/3 of transverse colon, and is continuous with the cavity of the pelvis