Peritoneum

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• Peritoneum

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Objectives

• Define Peritoneum.
• Enumerate its functions.
• Explain the general organization of the
  peritoneum.
• Distinguish between Intraperitoneal and
  Retroperitoneal Structures.
• Describe Peritoneal Ligaments.
• Define lesser and greater omenta.
• Understand the location of epiploic foramen.
• Discuss mesentery and mesocolon.
• Explain the Peritoneal sacs.

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Peritoneum

• Is a double-layer serous membrane.
• 1.Parietal layer
• lines abdomino pelvic wall folds
• back on itself forming a double
• Membrane mesentery
• Functions of mesentery-
• (1)Provides support
• Intestines Mesentery Mesocolon.
• Stomach Omenta.
• Liver Falciform ligament.
• (2) Prevents intestinal twisting
• (3) Stores fat
• (4) Pathway for vessels nerves
• 2. Visceral Layer
• covers the organs.
• Peritoneal cavity
• Potential space containing a bit of
• serous fluid.

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The Peritoneum
The parietal peritoneum
The visceral peritoneum
The peritoneal cavity
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The visceral peritoneum
The peritoneal cavity
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Peritoneum in sagittal section
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Peritoneum in transverse section
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Peritoneal versus Retroperitoneal (transverse
section)

• Most of the internal organs are surrounded by
  visceral peritoneum INTRAPERITONEAL Structures.
• Some organs (e.g. kidneys) are between peritoneum
  on one surface, and the body wall on the other
  RETROPERITONEAL Structures.

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Peritoneal versus Retroperitoneal (sagittal
section)
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The retroperitoneal Structures
kidneys
suprarenal glands
ureters
duodenum
pancreas
aorta
inferior vena cava
nerves
ascending colon
descending colon
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Peritoneal ligaments, Omenta Mesenteries

• Peritoneal ligaments
• Two layers fold of peritoneum that connect solid
  viscera to the abdominal walls, e.g. Falciform
  ligament, Triangular ligaments Coronary
  ligaments of the liver.
• Omenta
• Two layers fold of peritoneum that connect the
  stomach to another viscus, e.g. greater lesser
  omenta.
• Mesenteries
• Two layers fold of peritoneum connecting parts
  of the intestine to the posterior abdominal wall,
  e.g. mesentery of small intestine, transverse
  mesocolon, sigmoid mesocolon.

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Peritoneal folds related to the stomach

• The greater omentum
• Lies between the Stomach and the anterior
  abdominal wall.

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Peritoneal folds related to the stomach

• The lesser omentum
• Passes from the lesser curvature of the
  stomach and first part of the duodenum to the
  inferior surface of the liver.

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Greater omentum
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Peritoneal folds related to the stomach and Kidney

• The gastrosplenic (gastrolienal) ligament
• Passes from the greater
• curvature of the stomach
• to the spleen.
• Splenorenal (lienorenal) ligament
• Connects the spleen to the posterior
  abdominal wall over the left kidney.

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Peritoneal folds related to the Stomach

• The gastrophrenic ligament
• Connects the superior part of the greater
  curvature
• of the stomach to the diaphragm.

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Peritoneal folds related to the Liver

• The Falciform ligament Passes from the parietal
  peritoneum on the anterior abdominal wall to the
  visceral peritoneum on the surface of the liver.
• The round ligament of the liver (ligamentum teres
  hepatis)
• Is the obliterated umbilical vein and it is found
  in the inferior free margin of the Falciform
  ligament.

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Peritoneal folds related to the Liver

• Coronary ligament
• Attaches the liver to the diaphragm. Two
  peritoneal ligaments are parts of the coronary
  ligament
• 1. Left triangular ligament
• Is between the left lobe of
• the liver and the diaphragm.
• 2. Right triangular ligament
• Is between the right lobe of
• the liver and the diaphragm.

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Mesentery of the small intestine

• The mesentery suspends the jejunum and ileum from
  the posterior abdominal wall.

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• Mesoappendix Attaches the appendix to the
  posterior abdominal wall and it contains the
  appendicular artery.

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Peritoneal folds ligaments of colon

• Transverse mesocolon Attaches the transverse
  colon to the posterior abdominal wall.

• Phrenicocolic ligament Attaches the left
  colic flexure to the diaphragm.
• Sigmoid mesocolon Suspends the sigmoid colon
  from the posterior abdominal wall.

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Peritoneal sacs

• Peritoneal structures all are found within a
  subdivision of the peritoneal cavity called the
  greater peritoneal sac. Posterior to the stomach
  and lesser omentum is a smaller subdivision of
  the peritoneal cavity called the lesser
  peritoneal sac (omental bursa).
• The omental foramen (epiploic foramen, foramen of
  Winslow) connects the greater and lesser
  peritoneal sacs.

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The Omental foramen

• Boundaries
• Anterior Hepatic portal vein, hepatic artery
  and bile duct contained within the lesser
  omentum.
• Posterior Inferior vena cava right crus of
  the diaphragm covered with parietal peritoneum.
• Superior Caudate lobe of the liver covered
  with visceral peritoneum.
• Inferior First part of the duodenum covered with
  visceral peritoneum.

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2. Lesser and Greater Omenta
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Lesser and Greater Omenta
hepatogastric ligament
Lesser Omentum
hepatoduodenal ligament
the epiploic foramen (of Winslow)
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Greater Omentum
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3. The mesenteries
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The mesenteries
Contents ?
mesentery of the small intestine
transverse mesocolon
sigmoid mesocolon
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Lesser Sac
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Lt. anterior subphrenic space
Rt. anterior subphrenic space
Rt. posterior subphrenic (Rt. Subhepatic)
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left subhepatic Space (Lt. posterior subphrenic)
Morisons pouch
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Nerve supply to the peritoneum
The parietal peritoneum
phrenic nerve
intercostal
first lumbar nerves
obturator nerve
The visceral peritoneum
autonomic
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Thank you
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