Abdominal Cavity:

Peritoneum & GIT

Peritoneum
A serous membrane of 2 continuous layers that covering the abdominal organs (G, To stretch or cover around ) Parietal: lining internal abdominal wall Visceral: lining abdominal organs (viscera) Peritoneal cavity: space between parietal & visceral layers fluid filled reduce friction * NO organs in peritoneal cavity

Abdominal Organs Relation to Peritoneum

Intraperitoneal: completely covered by visceral peritoneum

Retroperitoneal: posterior (behind) the peritoneum touched anteriorly by parietal peritoneum

Peritoneal Cavity
2 parts
Greater sac: main part of peritoneal cavity

Lesser sac (omental bursa): extensional cavity behind the stomach allows free movement of stomach connects with greater sac through epiploic foramen

Epiploic Foramen
Foramen of Winslow

Connects lesser sac to greater sac

Boundaries: Ant.: portal triad (p. vein, h.a., & bile duct) Post.: IVC Sup.: Liver (caudate lobe) Inf.: duodenum (1st part)

Foramen of Winslow & Lesser Sac

Terms describing parts of peritoneum

Peritoneum has special names at specific regions: omentum mesentry & mesocolon ligaments

Omentum
Broad, double layered sheet of peritoneum that connects stomach to another abdominal organ
2 parts 1. Greater Omentum: Greater curvature of stomach Down (like apron) Reflects up again Ant. transverse colon

2. Lesser Omentum
Lesser curvature of stomach & small part of dudenum (2cm) Liver Post. to it = lesser sac

* The free edge of lesser omentum is called: hepatoduodenal ligament

contains portal triad

Hepatoduodenal Ligament

Mesentery & Mesocolon

Mesentry:
double layer of peritoneum connects small intestine to posterior abdominal wall mesentry of small intestine

Mesocolon:
double layer of peritoneum connects large intestine to posterior abdominal wall transverse mesocolon sigmoid mesocolon mesoappendix

Mesentery
& Mesocolon

Ligaments
Double layer of peritoneum that usually attached to the liver

Falciform Lig.:
Attachs the liver to ant. abdominal wall & ends by enclosing ligamentum teres

Hepatoduodenal Lig.: The free edge of ? 1st 2 cm of duodenum to liver

Contents?

Gastro-Intestinal Tract (GIT) in Abdomen

Esophagus (abdominal part, 1.25cm) Stomach Small intestine

Large intestine

Esophagus
Enters through esophageal opening (T10) Pass about 1.25cm before entering stomach Ends at cardiac orifice (T11)

Stomach
(Read your text for detailed anatomy)
*Intraperitoneal

4 regions
Cardia: surrounds esophag. opening

Fundus most sup. Part (dome shape)

Body central part, largest Pylorus (gate guard) antrum & canal

Stomach
2 openings: Cardiac orifice esophagus stomach (Physiologic sphincter) Pyloric sphincter stomach duodenum (Anatomic & Physiologic) Anat = thickened circular m. layer

2 curves: greater (lf.) & lesser (Rt.)

Stomach

Muscular Wall of Stomach

???

Outer ??

Middle ?? inner ??

Small Intestine
(Read your text for detailed anatomy) Duodenum (C-shaped) Jejunum Ileum

Duodenum
* Retroperitoneal except over omental attachment (first 2 cm)

4 parts 1. Superior (1st): From pylorus Horizontal (vertebral level?) 2. Descending (2nd): Rt. To L2 & L3 Curves around head of pancreas Receives bile & main pancreatic ducts (Major papilla)

Duodenum

Ampulla of Vater & Major duodenal papilla

3. Horizontal (3rd): Ant. to IVC At level of L3 4. Ascending (4th): At left side of L3 Ends at duodenojejunal jxn. Forms flexure (bending) (flexure = lig. of treitz)

Small intestine enters peritoneum at the lig. of treitz

Jejunum & Ileum

* Intraperitoneal Jejunum: (L, empty) upper left half

Ileum: (G, twisted) lower right half

ends at ileocecal junction (valve)

Large Intestine
(Read your text for detailed anatomy)
Cecum & Appendix

Ascending (retro)
Transverse (intra)

Descending (retro)
Sigmoid (intra)

Rectum (in pelvic cavity)

Clinical Notes

Peptic Ulcer Disease

A discontinuation (erosion) in the mucosal covering in an area of the GIT (esophaguslarge intestine). Most commonly in the ? Causes: 1. Bacteria: Helicobacter pylori ~80% PUD urease urea= ammonia + CO2 2. Drugs & Irritants: NSAIDs (aspirin), smoking, alcohol 3. Hypersecretion of HCl

Rx.: antibiotics: only when ?? Amoxi. + Mitro. gastric acid inhibitors: histamine receptor (H2) blockers Antacids: buffer Diet: irritants Surgical: Vagotomy, antrum removal (out of date) Complications: GI-bleeding: - erosion of a bld. Vessel

- hematemesis (?)

Perforation: - erosion of the whole wall opening into abd. Cavity peritonitis & inflammation of adjacent organs * requires emergency surgical treatment

McBurneys Point
On a straight line : 1/3 from ant. sup. iliac spine 2/3 from the umbilicus
Corresponds to the base of the appendix

The incision site during appendectomy (removal of the appendix)