Enteric Nervous System and Peritoneum

Enteric Nervous System

A complex system of sensory, motor, and interneurons that supply the GI tract

Parietal Peritoneum

lines the abdominal cavity

What sensations can the parietal peritoneum sense

Pain
Temp
Touch
Pressure

Visceral Peritoneum

covers abdominal organs

What sensation can visceral peritoneum sense

Distension

Peritoneal Cavity

space between the parietal and visceral peritoneum

What occurs with visceral pain stimuli in the abdomen?

It is poorly localized and tends to follow the somatic sensory fiber of the spinal cord

How does appendicitis pain present

• Starts as periumbilical pain (T10 dermatome)
• Migrates to sharp RLQ as inflammation hits parietal peritoneum

What localizes pain to the epigastric region?

Foregut Derivates

• Esophagus
• Stomach
• Pancreas
• Part of Duodenum
• Liver
• Biliary Tee

What localizes pain to the periumbilical region

Midgut Derivates

• Small Intestine
• Cecum
• Appendix
• Ascending Colon
• Most of Transverse Colon

What localizes pain to the hypogastric region

Hindgut derivates

• Distal transverse colon
• Descending Colon
• Sigmoid Colon
• Rectum

McBurnery's Point

RLQ point tenderness indicative of appendicitis

What occurs with somatic pain stimuli of the abdomen

Well Localized due to somatic sensory fibers

Peritoneal Ligaments

Two-layered folds of peritoneum that attach the lesser mobile solid viscera to the abdominal walls

What connects liver to diaphargm

• Falciform Ligament
• Coronary Ligament
• Triangular Ligament

falciform ligament

attaches liver to anterior abdominal wall between left and right lobe

Coronary Ligament

attaches liver to inferior diaphragm

triangular ligament

lateral fusion of the anterior and posterior coronary ligaments on the right and left sides

Omentum

a fold of peritoneum connecting the stomach with other abdominal organs.

Greater Omentum

part of the peritoneum attached to the stomach and to the transverse colon and covering the intestines

Lesser Omentum

Structure attached to the lesser curvature of the stomach to the liver

Hepatoduodenal Ligament

Part of the lesser omentum that connects from the liver to the duodenum
Contains the portal triad and marks opening to omental bursa

Portal Triad

hepatic artery, portal vein, bile duct

Epiploic Foramen (of Winslow)

Communication between greater and lesser sacs

Gastrosplenic Omentum

connects stomach to spleen

Mesentery

structure that suspends the intestine from the posterior body wall

What are the main mesenteries of the abdomen

• Mesentery of Small Intestine
• Transverse Mesocolon
• Sigmoid Mesocolon

What are the divisions of the peritoneal cavity

Greater Sac
Lesser Sac

Greater Sac

peritoneal compartment of the abdominal cavity that extends from the diaphragm to the pelvis and covers the width of the abdomen

What are the divisions of the greater sac

Supracolic
Infracolic

Supracolic Compartment

Region of the greater sac above the transverse mesocolon
Contains liver, spleen, and stomach

Infracolic Compartment

Region of the greater sac below the transverse mesocolon
Contains small intestine

Paracolic Gutters

lateral sides of abdomen, next to colon that connect the supracolic and infracolic compartments

Lesser Sac (Omental Bursa)

lies posterior to the stomach and lesser omentum

Cystic Artery

Supplies blood to the gallbladder.
Branch of hepatic artery

Pringle Maneuver

temporary occlusion of porta hepatis to control hemorrhage

What procedure has concern for hemorrhage via cystic artery

Cholecystectomy

Peritoneal Fossa

depressed area between peritoneal folds
Sites for hernias

Duodenal Fossa

recesses created folds of peritoneum next to the duodenojejunal junction

What are the recesses created by the duodenal fossa?

• Superior
• Inferior
• Paraduodenal
• Retroduodenal

Cecal Fossa

Folds of the peritoneum next to the cecu

What are the recesses created by the cecal fossa

• Superior ileocecal
• Inferior ileocecal
• Retrocecal

Subphrenic Spaces

small spaces between the diaphragm and the liver, on each side of the Falciform Ligament

Morrison's Pouch

Hepatorenal recess continous with right subphrenic sapce