ch 14 peritoneal cavity and abdominal wall

the peritoneal cavity is made up of multiple

peritoneal ligaments and folds

the folds and ligaments connect the _____ to each other as well as to the _____ walls

viscera; abdominopelvic

smooth membrane that lines the entire abdominal cavity and is reflected over the contained organs

peritoneum

peritoneum that lines the entire abdominal cavity

parietal peritoneum

peritoneum that covers the abdominal organs

visceral peritoneum

the peritoneal cavity contains:

lesser and greater omentum

mesenteries

ligaments

multiple fluid spaces

male peritoneum is a

closed cavity

female peritoneum is an

open cavity

in the female peritoneum, "communication" occurs outside the peritoneum through the

uterine tubes

uterus

vagina

complex linings of the uterus and fallopian tubes tend to ___ off any potential space and ___ the entrance of air into the peritoneal cavity

close; prohibits

a double fold of peritoneum where the transverse colon and sigmoid colon are suspended from the posterior abdominal wall

mesentery

also known as the "greater sac" of the peritoneum

general peritoneal cavity

also known as the "omental bursa"

lesser sac

a smaller sac with the development of the stomach and spleen; is the peritoneal recess posterior to the stomach and anterior to the pancreas

lesser sac

the greater and lesser sac communicate through a small vertical opening known as the

epiploic foramen

location of the epiploic foramen

just inferior to the liver

superior to the first part of the duodenum

anterior to the IVC

posterior to the portal vein

attachments of the peritoneum to the abdominal walls and organs helps to determine how __ can ___ or ___.

fluid; collect; move

fluid accumulates in the

lowest parts of the body (follows gravity and dependent on patient position; doesn't always mean most inferior!)

when the patient is lying supine, what is the lowest part of the body?

pelvis

on a transverse view, what is considered lower/deeper than the mid abdomen?

the flanks

fluid accumulates in the lowest parts of the body, therefore what two structures should be evaluated carefully for pathological collections of fluid?

pelvis

lateral flanks (paracolic gutters)

Double layer of peritoneum, extending from the liver to the lesser curvature of the stomach; acts as a sling for the stomach suspending it from the liver

lesser omentum

the anterior layer of the lesser omentum is formed by

the visceral peritoneum that covers the anterior surface of the stomach

the lesser curvature of the stomach

the lesser omentum has a free border on the ___ where it folds around the:

right; CBD; HA; PV

the free border of the lesser omentum forms the ___ margin of the opening into the lesser sac

anterior

an apron-like fold of peritoneum that hangs from the greater curvature of the stomach

greater omentum

function of the greater omentum:

seals off infection and cancers from spreading to the rest of the body

the parietal peritoneum along the anterior abdominal wall may be traced from the

falciform ligament to the diaphragm

the visceral peritoneum covers the

anterior and posterior surfaces of the liver to the porta hepatis

from the porta hepatis, the lesser omentum passes to the ___ curvature of the stomach as the ___ layer of the lesser omentum.

lesser; anterior

peritoneum covers the anterior surface of the ___ to form the ___ ___.

stomach; greater omentum

the apron fold of the greater omentum hangs anterior to the ___ and contains part of the ___ sac within it

intestines; lesser

the peritoneum then folds ___ and forms the ___ layer of the greater omentum

upwards; posterior

at the transverse colon, the peritoneum forms the

posterior layer of the transverse mesocolon

peritoneum passes over the ___ border of the pancreas abdominal runs ___ anterior to the ___ part of the duodenum

anterior; downward; third

the peritoneum leaves the posterior abdominal wall as the anterior layer of the ____ of the small intestine

mesentery

the peritoneum returns to the posterior abdominal wall into the ___ to cover the anterior ___.

pelvis; rectum

in the female, the peritoneum reflects onto the ___ vagina to form the ___ pouch or ___ pouch; it passes over the vagina to its ___ surface to the upper surface of the ___ to the ___ abdominal wall.

posterior; rectouterine; Douglas'; anterior; bladder; anterior

in the male, the peritoneum reflects off the ___ and ___ vesicles to form the _____ pouch

bladder; seminal; rectovesical

because of the coronary ligament attachments, collections in the right posterior subphrenic space cannot extend between

the bare area of the liver and the diaphragm

Because the right pleural space extends medially to the attachment of the right superior coronary ligament, pleural collections may appear:

apposed to the bare area

pleural fluid will tend to distribute

posteromedially

pleural vs subdiaphragmatic

pleural = above diaphragm

subdiaphragmatic= below diaphragm

Subcapsular liver and splenic collections are seen when they are ________ to the diaphragm unilaterally, and they conform to the shape of an organ capsule.

inferior

Subcapsular liver and spleen collections are confined to the_____________; may extend ____ to the attachment of the superior coronary ligament

falciform ligament; medially

subcapsular vs intraperitoneal

subcapsular= fluid confined inside organ

intraperitoneal= fluid outside organ

a mass is confirmed when:

anterior renal displacement

anterior displacement of dilated ureters can be documented

a mass interposed anteriorly or superiorly to kidneys can be located either

intraperitoneally or retroperitoneally

retroperitoneal lesions displace

ventrally and superiorly

hepatic and sub hepatic lesions produce

inferior and posterior displacement

retroperitoneal vs intraperitoneal

retroperitoneal: organs posterior to the peritoneum; ventral and superior displacement

intraperitoneal: organs located in the peritoneum; posterior and inferior displacement

retroperitoneal when anterior displacement of:

SMA

SMV

SV

RV

IVC

large right- sided retroperitoneal masses rotate the intrahepatic portal veins to the

left

right posterior hepatic masses of similar dimension produce

minor displacement of the intrahepatic portal vein

Primary liver masses should move __________ with the liver

simultaneously

delineation of the undisrupted peritoneal line demarcates

extraperitoneal from intraperitoneal locations

demonstration of posterior bladder displacement suggests an

extraperitoneal location

demonstration of lateral bladder displacement suggests a

retroperitoneal location

ligaments on the right side of the liver form the

subphrenic and subhepatic spaces

What divides the subphrenic space into right and left components?

falciform ligament

Ascends from the umbilicus to the umbilical notch of the liver within the free margin of the falciform ligament before coursing in the liver

ligamentum teres

extraperitoneal vs intraperitoneal

extraperitoneal= outside peritoneum

intraperitoneal = inside peritoneum

the bare area is delineated by the right ______ and _______ coronary ligaments, which separates the ______ subphrenic space from the _____ _____ subhepatic space (_______ pouch)

superior; inferior; posterior; superior; morison's

Morisons pouch location:

between right kidney and right lobe of liver

lateral to the bare area, the posterior ____ and ___ spaces are continuous

subphrenic; subhepatic

the left sub hepatic space is divided into ___ compartment (___ recess) and ___ compartment (___ sac) by the lesser omentum and stomach

anterior; gastrohepatic; posterior; lesser

the lesser sac lies ___ to the pancreas and ___ to the stomach

anterior; posterior

with fluid in the lesser and greater omental cavities, the lesser omentum may be seen as

linear echo density extending from the stomach to the porta hepatis

The left lateral extension of the greater omentum that connects the gastric greater curvature to the superior splenic hilum is called the ______________ ligament; forms a portion of the left lateral border of the lesser sac.

gastrosplenic

formed by the posterior reflection of the peritoneum off the spleen and passing inferiorly to overlie the left kidney; forms the posterior portion of the left lateral border of the lesser sac and separates the lesser sac from the renosplenic recess

splenorenal ligament (aka. lienorenal)

the lesser sac itself is subdivided into:

a larger lateroinferior and a smaller mediosuperior recess

the smaller mediosuperior recess of the lesser sac is created by the ___ folds and produced by the left ___ and ___ arteries

gastropancreatic; gastric; hepatic

the lesser sac extends to the

diaphragm

lesser sac vs lesser omentum

The lesser omentum is a double-layered fold of peritoneum that connects the stomach and liver, while the lesser sac (or omental bursa) is the potential space located behind the lesser omentum and stomach

Superior recess of the bursa surrounds the anterior, medial, and posterior surfaces of the____ ____, making it a ____ sac structure

caudate lobe; lesser

supravesical space and medial and lateral inguinal fossae represent _______ paravesical spaces formed by an indentation of the anterior parietal peritoneum by the bladder, obliterated umbilical arteries, and inferior epigastric vessels.

intraperitoneal

retrovesical space is divided by the ___ into the anterior ___ recess and posterior ___ sac (___ pouch)

uterus; vesicouterine; rectouterine; douglas'

Ascites displaces the distended urinary bladder _______ but not _______

inferiorly; posteriorly

Intraperitoneal fluid compresses the bladder from its lateral aspect in cases of ____

loculation

Fluid in the extraperitoneal prevesical space (space of retzius) displace the bladder ______________, compressing it from the ___ along its entire length.

posteriorly; sides

paired rectus abdominis muscles are delineated medially in the midline of the body by the

linea alba

the sheath of three anterolateral abdominal muscles (external oblique, internal oblique, and transversus abdominis) unite to form the

linea semilunaris (towards side of body)

aponeurotic sheath passes ___ to the ___ muscle only

anteriorly; rectus

aponeurotic sheath

big, flat tendon on top of rectus abdomens from pubic bone to sternum

rectus muscles are a ____ muscle group delineated by the:

biconvex; linea alba; linea semilunaris

sonographic appearance of the peritoneal line

a discrete linear echogenicity in the deepest layer of the abdominal wall