peritoneal cavity

functions of the peritoneum

makes serous fluid to keep organs moving smoothly

holds and supports organs- mobile but not fixed

provides a place for nerves and blood vessels to live

cushion for organs

in males the cavity is completely

sealed

in females, cavity communicates with the external enviorment via

fallopian tubes

the hila of intraperitoneal organs are ____ ____ lacking peritoneal covering

bare area

organs secrete how much serous fluid

50mL (allows movement without friction)

periotneal cavity contains:

lesser and greater omentum

mesenteries

ligaments

multiple potential fluid space

ligaments and folds that connect the organs to each other

HOW do organs stay in place

suspension by the mesenteries

small intestine suspended from the

posterior abdominal wall by mesentery

transverse colon suspended from the

posterior abdominal wall by the transverse mesocolon

sigmoid colon suspended from the

posterior abdominal wall by the sigmoid mesocolon

mesentery:

double fold of continous peritoneum that attatches the small intestine to the posterior abdominal wall

general peritoneal cavity is known as the

greater sac of the peritoneum

the epiploic foramen:

a small vertical opening allowing communication between the greater and the lesser sacs

with the development of the stomach and the spleen, a smaller sac is called the

peritoneal recess posterior to the stomach

peritoneal cavity is divided into what two compartments

greater and lesser sac

greater sac contains:

liver,spleen, stomach, first portion of duodenum, jejunum, cecum, transverse cpolo, sigmoid colon, upper two-thirds of the rectum

lesser sac contains:

NO organs

potential space posterior to stomach, extending superiorly to left suprahepatic recess between posterior LT lobe and LT hemidiaphragm

whats the greater omentum

apron-like fold of peritoneum that hangs from the greater curvature of the stomach and transverse colon

greater omentum is anterior to the

bowel

greater omentum is located in the

greater sac

greater omentum lies freely over the intestine except for the

upper part, which is fused with the transverse colon and mesocolon

the greater omentum prevents parietal peritoneum of anterior abdominal wall from adhering to…

visceral peritoneum

the greater omentum cushions the abdominal organs to prevent

trauma and prevents the loss of body heat from the abdominal organs

why does the greater omentum move to areas of inflammation

surrounds the inflamed area by creating adhesions to wall of infection

why is the greater omentum useful in fighting disease process

adheres to diseased organs

profusely supplied with blood vessels

brings phagocytes to the areas it adheres

helps limit spread of infection

whats the lesser omentum?

double layer of peritoneum extending from the liver to the lesser curvature of the stomacg

the lesser omentum acts as a sling for the stomach, suspending it from the ___

liver

whats the dependent portion

when fluid will accumulate in the lowest parts of the body

what should be examined for collections of fluid

pelvis (lowest part of body in supine postion) and lateral flanks

gastrohepatic ligament:

connects lesser curvature of stomach and sag fissure for ligamentum venosum of liver

gastrohepatic ligament is also known as

lesser omentum, smaller omentum, gastrohepatic omentum

Hepatoduodenal ligament:

connects liver to the duodenum

thickened free edge of lesser omentum through which courses portal triad

falciform ligament:

double layer fold of peritoneum that connects umbilicus to liver

contains ligamentum teres

falciform ligament passes anterior and then _____ surface of ____

superior, liver

_____ ligament forms borders of bare area of liver

coronary

coronary ligament suspended liver from

diaphragm, rt branch becomes coronary ligament and LT branch becomes LT triangular ligament

__ ___ ___ formed by LT branch of falciform ligament and parietal peritoneum

LT triangular ligament (forms LT border of bare area of liver

spelnorenal ligament is also known as

lienorenal ligament

splenorenal ligament:

connects splenic hilum to posterior abdominal wall, through splenic vein and artery travel

gastrosplenic ligament:

connects stomach to spleen and inferior diaphragm

broad ligament contains what organs

uterus and ovaries

broad ligament extends from

lateral uterine sidewalls to pelvic sidewalls (divides pelvis into anterior and posterior compartments in females)

remnant of the fetal umbilical vein

ligamentum teres

ligamentum teres is contained within the

falciform ligament

ligamentum teres passed into fissure on…

visceral liver surface to join left branch of portal vein in porta hepatis

in fetal circulation, oxygenated blood flows to liver via

the umbilical vein

most of blood bypasses liver via

ductus venosus and enters IVC

appears as a fibrous band attatched to the left branch of the portal vein

ligamentum venosum

potential spaces for the peritoneum:

areas created by the peritoneal layer that extend between two organs or an organ and the peritoneal wall (typically posterior)

many pathologies produce what kind of excretions in peritoneal cavity

ascitic fluid, blood, pus

left anterior subphrenic space ( aka suprahepatic space)

an extension of the greater sac between diaphragm and anterior superior liver leftward of falciform ligament

left posterior suprahepatic space (aka superior recess of lesser sac):

an extension of the lesser sac between diaphragm and posterior superior liver

right subphrenic space (aka suprahepatic space)

an extension of the greater sac between right hemidiaphragm and anterior superior rightward of the falciform ligament

hepatorenal space (aka morrisons pouch)

created by peritoneum, from liver over rt kidney and rt posterior peritoneal wall

morrisons pouch collects fluid from

supracolic area and lesser sac

lesser sac/ omental bursa

sandwitched between posterior stomach and parietal peritoneum covering anterior pancreas

in cases of posterior gastric wall perforation or inflammation or trauma to the pancreas, fluid or a pseudocyst may be identified in this space:

lesser sac/ omental bursa

groovers found along lateral ascending and descending colon that conduct fluid between supracolic compartment of abdomen and infracolic department of inferior abdomen and pelvis:

right and left paracolic gutters

vesicorectal space (AKA cul de sac in male)

created by peritoneal reflection over the rectum and posterior bladder wall

this space is most gravity- dependent potential space of pelvic cavity draining fluid from infracolic area in males

vesicorectal space i

rectouterine space (aka pouch of douglas, posterior cul-de-sac in female)

created by parietal peritoneum, draping over anterior rectum, posterior vaginal wall and posterior uterus

this space is most gravity- dependent potential space of pelvic cavity draining fluid from infracolic area in females

rectouterine space

uterovesicle space (AKA anterior cul de sac in females)

created by peritoneal reflection over the uterine fundus, anterior uterus, broad ligament, and the posterior urinary bladder

space of retzius (AKA prevesicle space or retropubic space)

an extraperitoneal potential space located between the anterior wall of the urinary bladder and the pubic symphysis

__ ____ lines the inner anterior abdominal wall

parietal peritoneum (thin hyperechoic continuous line)

bowel filled with gas, fluid, fecal material, and with peristalsis will be ___/___

deep/ posterior

parietal peritoneum seen posterior to moderately hypoechoic…

internal oblique and rectus abdominis abdominal wall and muscles

reasons to scan parietal peritoneum:

evaluating an abdominal wall hernia

determining position of abscess or hematoma

visceral and parietal peritoneum of the posterior peritoneal wall not easily visualized or appreciated due to

depth

FAST scan is usually preformed by

ER physician or sonologist (interpreted by performing physician)

FAST scans is used to assess:

peritoneal potential spaces for free fluid

trauma situations

usually done in ER

FAST scan usually images what spaces

hepatorenal, posterior/ rt hemidiaphragm/ liver interface, the spleen/ left kidney interface in the LUQ, and the rectouterine space

indications for FAST exams:

abdominal trauma

evaluate for free fluid

peritoneal fluid

pericardial fluid

pleural fluid

pelvic fluid

REGIONS scanned in a FAST exam

-RUQ

-LUQ

-pelvis

-pericardial