Transcript بسم الله الرحمن الرحيم

‫بسم هللا الرحمن الرحيم‬
‫‪Peritoneum‬‬
Objectives
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Define Peritoneum.
Enumerate its functions.
Explain the general organization of the peritoneum.
Distinguish between Intraperitoneal and
Retroperitoneal Structures.
Describe Peritoneal Ligaments.
Define lesser and greater omenta.
Understand the location of epiploic foramen.
Discuss mesentery and mesocolon.
Explain the Peritoneal sacs.
Peritoneum
Is a double-layer serous membrane.
1.Parietal layer:
lines abdomino pelvic wall & folds
back on itself forming a double
Membrane: mesentery
Functions of mesentery:(1)Provides support:
Intestines: Mesentery & Mesocolon.
Stomach: Omenta.
Liver: Falciform ligament.
(2) Prevents intestinal twisting
(3) Stores fat
(4) Pathway for vessels & nerves
2. Visceral Layer:
covers the organs.
Peritoneal cavity:
Potential space containing a bit of
serous fluid.
The Peritoneum
The parietal peritoneum
The visceral peritoneum
The peritoneal cavity
The visceral
peritoneum
The peritoneal
cavity
Peritoneum in sagittal section
Peritoneum in transverse section
Peritoneal versus Retroperitoneal
(transverse section)
• Most of the internal organs are
surrounded by visceral
peritoneum:
INTRAPERITONEAL
Structures.
• Some organs (e.g. kidneys) are
between peritoneum on one
surface, and the body wall on
the other:
RETROPERITONEAL
Structures.
Peritoneal versus Retroperitoneal
(sagittal section)
The retroperitoneal Structures
kidneys
suprarenal glands
ureters
duodenum
pancreas
aorta
inferior vena cava
nerves
ascending colon
descending colon
Peritoneal ligaments, Omenta & Mesenteries
• Peritoneal ligaments:
Two layers fold of peritoneum that connect solid viscera to
the abdominal walls, e.g. Falciform ligament, Triangular
ligaments & Coronary ligaments of the liver.
• Omenta:
Two layers fold of peritoneum that connect the stomach to
another viscus, e.g. greater & lesser omenta.
• Mesenteries:
Two layers fold of peritoneum connecting parts of the
intestine to the posterior abdominal wall, e.g. mesentery of
small intestine, transverse mesocolon, sigmoid mesocolon.
Peritoneal folds related to the stomach
• The greater
omentum:
• Lies between the
Stomach and the
anterior abdominal
wall.
Peritoneal folds related to the stomach
• The lesser
omentum
Passes from the
lesser curvature of
the stomach and first
part of the
duodenum to the
inferior surface of
the liver.
Greater omentum
Peritoneal folds related to the stomach and Kidney
• The gastrosplenic
(gastrolienal) ligament:
Passes from the greater
curvature of the stomach
to the spleen.
• Splenorenal (lienorenal)
ligament:
Connects the spleen to
the posterior abdominal
wall over the left
kidney.
Peritoneal folds related to the Stomach
• The gastrophrenic ligament :
Connects the superior part of the greater curvature
of the stomach to the diaphragm.
Peritoneal folds related to the Liver
• The Falciform ligament:
Passes from the parietal
peritoneum on the anterior
abdominal wall to the
visceral peritoneum on the
surface of the liver.
• The round ligament of the
liver (ligamentum teres
hepatis):
• Is the obliterated umbilical
vein and it is found in the
inferior free margin of the
Falciform ligament.
Peritoneal folds related to the Liver
• Coronary ligament:
Attaches the liver to the
diaphragm. Two peritoneal
ligaments are parts of the
coronary ligament:
1. Left triangular ligament:
Is between the left lobe of
the liver and the diaphragm.
2. Right triangular ligament:
Is between the right lobe of
the liver and the diaphragm.
Mesentery of the small intestine
• The mesentery
suspends the
jejunum and ileum
from the posterior
abdominal wall.
• Mesoappendix:
Attaches the
appendix to the
posterior abdominal
wall and it contains
the appendicular
artery.
Peritoneal folds & ligaments of colon
• Transverse mesocolon:
Attaches the transverse
colon to the posterior
abdominal wall.
• Phrenicocolic ligament:
Attaches the left colic
flexure to the diaphragm.
• Sigmoid mesocolon:
Suspends the sigmoid colon
from the posterior
abdominal wall.
Peritoneal sacs
• Peritoneal structures all are
found within a subdivision of
the peritoneal cavity called the
greater peritoneal sac. Posterior
to the stomach and lesser
omentum is a smaller
subdivision of the peritoneal
cavity called the lesser
peritoneal sac (omental bursa).
• The omental foramen (epiploic
foramen, foramen of Winslow)
connects the greater and lesser
peritoneal sacs.
The Omental foramen
Boundaries:
• Anterior: Hepatic portal vein,
hepatic artery and bile duct
contained within the lesser
omentum.
• Posterior: Inferior vena cava &
right crus of the diaphragm
covered with parietal
peritoneum.
• Superior: Caudate lobe of the
liver covered with visceral
peritoneum.
• Inferior: First part of the
duodenum covered with
visceral peritoneum.
2. Lesser and Greater Omenta
Lesser and Greater Omenta
hepatogastric ligament
hepatoduodenal ligament
the epiploic foramen
(of Winslow)
Lesser
Omentum
Greater Omentum
3. The mesenteries
The mesenteries
Contents ?
mesentery of the
small intestine
transverse mesocolon
sigmoid mesocolon
Lesser Sac
The supra-colic compartment
Rt. anterior subphrenic space
Rt. posterior subphrenic
(Rt. Subhepatic)
Lt. anterior subphrenic space
left subhepatic
Space
(Lt. posterior subphrenic)
Morison’s pouch
Nerve supply to the peritoneum
The parietal peritoneum
phrenic nerve
intercostal
first lumbar nerves
obturator nerve
The visceral peritoneum
autonomic
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