Clinical Anatomy -- Enteric Nervous System and The Peritoneum

Enteric Nervous System

highly complex system of sensory, motor, and interneurons

sympathetic nervous system

the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations

parasympathetic nervous system

the division of the autonomic nervous system that calms the body, conserving its energy

Parietal peritoneum

the outer layer of the peritoneum that lines the interior of the abdominal wall; has nerve for pain, temp, touch, and pressure; well-localized

well-localized, pain, temp, touch, pressure

the parietal peritoneum has ___________ nerves for...

Visceral peritoneum

the inner layer of the peritoneum that surrounds the organs of the abdominal cavity; has nerves for stretch only; insensitive to pain, but sensitive to distention; generalized, non-specific

non-specific, stretch

the visceral peritoneum has ___________ nerves for...

pain, distension

the nerves of the visceral peritoneum are insensitive to ______, but sensitive to ______.

Serous fluid

lubricates the organs and allows them glide without friction

Peritoneal cavity

potential space between the parietal and visceral peritoneum

poorly

visceral pain is _______ localized

somatic sensory fibers with same spinal cord segment that receives visceral sensory fibers from viscus concerned (visceral nerve is close to dermatome)

visceral pain radiates to body part supplied by...

epigastric region

pain arising from the foregut derivatives localizes to the...

esophagus, stomach, pancreas, first portion of the duodenum, liver, biliary tree

what are the foregut derivatives?

periumbilical region

pain arising from the midgut derivatives localizes to the...

small intestine, distal to bile duct, cecum, appendix, ascending colon, most of transverse colon

what are the midgut derivatives?

hypogastric region (below the umbilicus)

pain arising from the hindgut derivatives localizes to the...

distal transverse colon, descending colon, sigmoid colon, and rectum

what are the hindgut derivatives?

well

somatic pain is ____ localized

the site of pain origin (because PP is supplied by somatic sensory fibers through the thoracic nerve)

somatic parietal peritoneum pain occurs at...

thoracic nerve

the parietal peritoneum is supplied by somatic sensory fibers through the...

stretching

inflamed parietal peritoneum is extremely sensitive to...

Rebound tenderness

a sign of inflammation of the peritoneum in which increased pain is elicited by the sudden release of the fingertips pressing on the abdomen.

Peritoneal ligaments

two-layered folds of peritoneum that connect solid viscera to the abdominal walls, usually containing remnants of fetal vessels

falciform, coronary, and triangular ligaments

what are the ligaments responsible for connecting the liver to the diaphragm?

Omentum

two-layered folds of peritoneum that connect the stomach to other viscera

stomach

the omentum is responsible for connecting the ______ to other viscera

Greater omentum

connects the stomach to the transverse colon; helps to prevent viscera from adhering to abdominal wall; walls off inflamed organs (prevents spread); cushions organs and insulates against loss of body heat

stomach to transverse colon

the greater omentum connects...

Lesser omentum

connects lesser curvature of stomach to liver

Hepatoduodenal ligament

encloses the portal triad and marks opening (epiploic foramen of Winslow) to the omental bursa)

proper hepatic artery, portal vein, common bile duct

what makes up the portal triad?

Gastrosplenic omentum

ligament that connects the stomach to the spleen

Mesenteries

two-layered folds of peritoneum connecting parts of the intestines to the posterior abdominal wall

connecting parts of the intestines to the posterior abdominal wall

function of mesenteries

more mobility

organs with mesentery have...

mesentery of small intestines, transverse mesocolon, sigmoid mesocolon

examples of mesenteries

closed, open

the peritoneal cavity is a _______ system in males, and _____ in females

greater sac, lesser sac

two divisions of the peritoneal cavity

behind the lesser omentum

the lesser sac of the peritoneal cavity is found...

The Greater Sac

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

transverse colon (transverse mesocolon)

the greater sac is divided by the mesentery of the...

Supracolic compartment

Lies above the transverse mesocolon and contains the stomach, liver and spleen.

liver, spleen, and stomach

what is contained within the supracolic compartment?

Infracolic compartment

lies below the transverse mesocolon and contains the small intestine, ascending and descending colon

small intestine, and sometimes the ascending and descending portions of the colon

what is contained within the infracolic compartment?

Paracolic gutters

spaces between the ascending/descending colon and the abdominal wall

The Lesser Sac

peritoneal pouch located behind the lesser omentum and stomach

Foramen of Winslow (epiploic foramen)

the opening in the lesser sac/omental bursa connects to the greater sac through the...

hepatoduodenal ligament

the lesser sac lies posterior to the free edge of the...

Foramen of Winslow (epiploic foramen)

Allows communication between the lesser and greater sacs

area of potential herniation of small bowel

if cystic artery is cut during a cholecystectomy, hemorrhage is controlled by compressing the proper hepatic artery in this foramen (within hepatoduodenal ligament)

what is the clinical relevance of the Foramen of Winslow?

Pringle maneuver

occulsion of the portal triad aka hepatoduodenal ligament.

proper hepatic artery

if the cystic artery is cut during cholecystectomy, hemorrhage is controlled by compressing the ______________.

Peritoneal fossae

depressions or pouches formed between various peritoneal folds

internal hernias

Peritoneal fossae may be the sites of...

Subphrenic spaces

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

potential spaces for pus/blood/ascites to collect

why are subphrenic spaces clinically important?

hepatorenal recess (Morrison's pouch)

the right subphrenic space is continuous with the...

fluid

the right subphrenic space/hepatorenal recess should be assessed for ____ after trauma, suspected peritonitis, abscess, etc.

provide channels for accumulation and movement of fluid in peritoneal cavity

clinical relevance of parabolic gutters