Peritoneum and Retroperitoneum PDF

Peritoneum Peritoneum and Peritoneal Cavity Lesson Readings: Rumack pgs 504 – 506 The Noted Anatomist - Peritoneum Peritoneum - Anatomy Zone PERITONEUM Serous membrane Abdomen & Pelvis Lines Abdominal walls and contents Functions:...

Peritoneum Peritoneum and Peritoneal Cavity Lesson Readings: Rumack pgs 504 – 506 The Noted Anatomist - Peritoneum Peritoneum - Anatomy Zone PERITONEUM Serous membrane Abdomen & Pelvis Lines Abdominal walls and contents Functions: Holds viscera in position Secretes lubricating fluid COMPONENTS OF THE PERITONEUM Continuous – No start or end! Like a deflated balloon Parietal peritoneum Lines abdominal and pelvic walls Visceral peritoneum Covers the organs Windham, C. (2006-2013) [Visceral and parietal peritoneum][Diagram] Retrieved from http://www.gistsupport.org/media/windham/Windhamfig3small.jpg. With permission  Peritoneal/Retroperitoneal Organs Gray, H. (1918) [Transverse Peritoneum][Diagram] Retrieved from http://www.theodora.com/anatomy/images/image1038.gif. Public Domain PERITONEAL CAVITY POTENTIAL SPACE BETWEEN PARIETAL & VISCERAL PERITONEUM NO ABDOMINAL ORGANS HERE! OVARIES AND FIMBRIATED ENDS OF THE FALLOPIAN TUBES ARE WITHIN THE CAVITY. CONTAINS PERITONEAL FLUID 50-75ML IS NORMAL AMOUNT PERITONEAL CAVITY SUBDIVIDED INTO: Lesser Sac Greater Sac (Omental Bursa) The big part spanning entire Posterior to Inferior to the width of stomach liver abdomen Gray, H. (1918). [Greater and Lesser sacs][Diagram] Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/8/8d/Gray1035.png/250px-Gray1035.png. Public Domain PERITONEAL REFLECTION THE PERITONEUM FOLDS BACK ON ITSELF CREATING A DOUBLE LAYER. DEPENDING ON WHAT IT IS CONNECTING, IT IS CALLED DIFFERENT THINGS: MESENTERY OMENTUM LIGAMENT MESENTERY A DOUBLE FOLD OF PERITONEUM WHICH CONNECTS VISCERA (BOWEL) TO POSTERIOR ABDOMINAL WALL SMALL BOWEL MESENTERY TRANSVERSE MESOCOLON SIGMOID MESOCOLON MESOAPPENDIX Clemente, C. (2011). Anatomy: A regional atlas of the human body. (6 th ed). Baltimore, MD.: Lippincott Williams & Wilkins Plate 249  MESENTERY GRAY, H. (1918). [SMALL BOWEL MESENTERY]. RETRIEVED FROM HTTP://COMMONS.WIKIMEDIA.ORG/WIKI/FILE:GRAY1038_VECTOR.SVG. PUBLIC DOMAIN  MESENTERY Tortora, G.,& Grabowski, S. (2003). Principles of Anatomy & Physiology. (10 th ed). New York, NY.: John Wiley & Sons. Page 856.  MESENTERY Kawamura, D.,& Lunsford, B. (2012). Diagnostic Medical Sonography: Abdomen and Superficial Structures. (3 rd ed). Baltimore, MD.: Lippincott Williams & Wilkins. Page 48 Gray, H. (1918). [Inframesocolic spaces][Illustration] Retrieved from http://en.wikipedia.org/wiki/File:Gray1040.png. Public Domain OMENTUM A double fold of peritoneum that connects the stomach Greater Omentum Lesser Omentum to adjacent organs or to the abdominal wall. GREATER OMENTUM “Apron-like” fold of Attached to greater peritoneum curvature of stomach Clemente, C. (2011). Anatomy: A regional atlas of the human body. (6 th ed). Baltimore, MD.: Lippincott Williams & Wilkins Plate 250 GREATER OMENTUM Gray, H. (1918). [Greater and Lesser sacs][Diagram] Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/8/8d/Gray1035.png/250px-Gray1035.png. Public Domain  LESSER OMENTUM BETWEEN LESSER CURVATURE OF STOMACH AND LIVER Clemente, C. (2011). Anatomy: A regional atlas of the human body. (6 th ed). Baltimore, MD.: Lippincott Williams & Wilkins Plate 258 PERITONEAL LIGAMENT A DOUBLE FOLD OF PERITONEUM THAT CONNECTS TWO ORGANS OR AN ORGAN TO THE ABDOMINAL WALL EX. FALCIFORM LIGAMENT HEPATODUODENAL LIGAMENT LIGAMENTS OF THE GREATER OMENTUM Gastrosplenic Gastrophrenic Gastrocolic Ligament Ligament Ligament Stomach to Stomach to Stomach to spleen diaphragm transverse Forms the colon lateral margin of the lesser sac GASTROSPLENIC LIGAMENT GASTROPHRENIC & GASTROCOLIC LIGAMENT GASTROPHRENIC LIGAMENT LESSER OMENTUM BETWEEN LESSER CURVATURE OF STOMACH AND LIVER Clemente, C. (2011). Anatomy: A regional atlas of the human body. (6 th ed). Baltimore, MD.: Lippincott Williams & Wilkins Plate 258  HEPATODUODENAL LIGAMENT LIVER TO 1ST PART OF THE DUODENUM LIGAMENTS CONTAINS THE “PORTAL TRIAD” MAIN PORTAL VEIN OF THE HEPATIC ARTERY LESSER COMMON BILE DUCT OMENTUM GASTROHEPATIC LIGAMENT LESSER CURVATURE OF THE STOMACH TO LIVER THE LESSER OMENTUM Hepatoduodenal Gastrohepatic Ligament Ligament THE LESSER OMENTUM  Connection between greater and lesser sacs EPIPLOIC Posterior to lesser omentum FORAMEN, Anterior to Pancreas “FORAMEN OF Superior to 1st part of Duodenum WINSLOW” Inferior to Caudate Lobe of Liver EPIPLOIC FORAMEN, “FORAMEN OF WINSLOW” EPIPLOIC FORAMEN, “FORAMEN OF WINSLOW”  CORONARY LIGAMENT ATTACHES THE LIVER TO THE INFERIOR SURFACE OF THE DIAPHRAGM. FALCIFORM LIGAMENT OTHER CONNECTS THE ANTERIOR SURFACE OF THE LIVER LIGAMENTS TO THE ANTERIOR ABDOMINAL WALL AND UMBILICUS.(THIS IS AN IMPORTANT LANDMARK WHEN SCANNING THE LIVER). SEPARATES THE R&L SUBPHRENIC SPACES SPLENORENAL (LIENORENAL) LIGAMENT SPLEEN TO POSTERIOR ABDOMINAL WALL/SUPPORTS LEFT KIDNEY CORONARY LIGAMENT FALCIFORM LIGAMENT Splenorenal Ligament  ATTACHES THE LEFT COLIC/SPLENIC FLEXURE OF THE COLON TO THE DIAPHRAGM SUPPORTS THE SPLEEN PHRENOCOLIC LIGAMENT CAN PREVENT FLUID FROM COMMUNICATING BETWEEN THE PERISPLENIC SPACE AND LEFT PARACOLIC GUTTER PHRENOCOLIC LIGAMENT [Phrenicolic Ligament][GIF Image]. (n.d.). Retrieved from http://www.sciamsurgery.com/sciamsurgery/institutional/figTabPopup.action?bookId=ACS&linkId=part05_ch19_fig17&type=fig. Fair Dealings “SPACES” Right and left Subhepatic Space Perisplenic Space subphrenic Spaces (Morrison’s Pouch) Pelvic Spaces – Paracolic Gutters vesicouterine, Lesser Sac and Inframesocolic rectouterine, (Omental Bursa) Spaces rectovesical (males only) Gray, H. (1918). [Greater and Lesser sacs][Diagram] Retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/8/8d/Gray1035.png/250px- Gray1035.png. Public Domain Gray, H. (1918). [Inframesocolic spaces][Illustration] Retrieved from http://en.wikipedia.org/wiki/File:Gray1040.png. Public Domain Gray, H. (1918). [Inframesocolic spaces][Illustration] Retrieved from http://en.wikipedia.org/wiki/File:Gray1040.png. Public Domain  ASCITES ACCUMULATION OF FLUID IN THE PERITONEAL CAVITY TRANSUDATE = CLEAR EXUDATE = “STUFF” MOST DEPENDENT SPACES PELVIC CUL-DE-SAC RIGHT PARACOLIC GUTTER MORRISON’S POUCH  RT SUBPHRENIC SPACE: RT. AND LT. BETWEEN THE DIAPHRAGM AND THE SUPERIOR SURFACE SUBPHRENIC OF THE LIVER SPACES SEPARATED BY THE FALCIFORM LIGAMENT.  AKA – ‘MORRISON’S POUCH” SUBHEPATIC BETWEEN THE LIVER AND THE RT. SPACE KIDNEY ASCITES – RT SUBPHRENIC / SUBHEPATIC (MORRISON’S) Kawamura, D.,& Lunsford, B. (2012). Diagnostic Medical Sonography: Abdomen and Superficial Structures. (3 rd ed). Baltimore, MD.: Lippincott Williams & Wilkins. (Page 45)  LT. SUBPHRENIC SPACE: LT. BETWEEN THE DIAPHRAGM AND THE SUBPHRENIC/ SPLEEN PERISPLENIC PERISPLENIC SPACE: SPACE AROUND THE SPLEEN LEFT SUBPHRENIC / PERISPLENIC Stroder, R., & Overman, C. (2011). [Left Perisplenic fluid][Sonogram](n.d.). Retrieved from http://2.bp.blogspot.com/-0XaDQBaGjpk/Tuz9- My9y7I/AAAAAAAAFvw/oorMZTdTwLc/s1600/LUQ+subd+fluid.jpg. Fair Dealings PERISPLENIC ASCITES [Perisplenic Ascites][Sonogram](n.d). Retrieved from www.ultrasoundcases.info. With Permission  AKA – THE OMENTAL BURSA LESSER SAC POSTERIOR TO THE STOMACH INFERIOR TO THE LIVER ANTERIOR TO THE PANCREAS LESSER SAC Kawamura, D.,& Lunsford, B. (2012). Diagnostic Medical Sonography: Abdomen and Superficial Structures. (3 rd ed). Baltimore, MD.: Lippincott Williams & Wilkins. Page 42  LESSER SAC American College of Radiology. (1988). [Greater and Lesser Sacs with Ascites]/ Retrieved from ACR ultrasound CD-Rom Series Learning file.  INFRAMESOCOLIC SPACES THE AREA BELOW THE TRANSVERSE MESOCOLON (AROUND THE SMALL PARACOLIC BOWEL MESENTERY) GUTTERS/ INFRAMESOCOLIC SPACES PARACOLIC GUTTERS BETWEEN THE ASCENDING/DESCENDING COLON AND THE ABDOMINAL WALL Baishideng Publishing Group Co. (1995-2014). [Peritoneal Recesses]. Retrieved from http://www.wjgnet.com/1949-8470/full/v5/i3/106.htm. CCA-NC-Open Access ASCITES – SURROUNDING BOWEL Kawamura, D.,& Lunsford, B. (2012). Diagnostic Medical Sonography: Abdomen and Superficial Structures. (3 rd ed). Baltimore, MD.: Lippincott Williams & Wilkins. Page 48 PELVIC CUL-DE-SACS Clemente, C. (2011). Anatomy: A regional atlas of the human body. (6 th ed). Baltimore, MD.: Lippincott Williams & Wilkins Plate 249 FREE FLUID – PHYSIOLOGIC AMOUNT PELVIC ASCITES Brant, W. (2001). The Core Curriculum: Ultrasound. Philadelphia, PA:. Lippincott Williams & Wilkins. Pg. 207 PELVIC ASCITES – TIE FIGHTER SIGN PELVIC ASCITES  THE DIAPHRAGM [Diaphragm][Image]. (n.d.). Retrieved from http://teachmeanatomy.info/thorax/muscles/diaphragm/ Fair Dealings THE COSTODIAPHRAGMATIC RECESS PLEURAL EFFUSION AND ASCITES Gupta PK, Gupta K, Dwivedi AD, Jain M. Potential role of ultrasound in anesthesia and intensive care. Anesth Essays Res [serial online] 2011 [cited 2014 May 13];5:11-9. Available from: http://www.aeronline.org/text.asp?2011/5/1/11/84172. CCA-NC-SA PLEURAL EFFUSION, SAGITTAL [Pleural Effusion][Sonogram] (n.d.). Retrieved from http://radiopaedia.org/cases/cardiomegaly-with-bilateral-pleural-effusion-1. CCA-NC-SA 3.0  PLEURAL EFFUSION, SAGITTAL Kawamura, D.,& Lunsford, B. (2012). Diagnostic Medical Sonography: Abdomen and Superficial Structures. (3 rd ed). Baltimore, MD.: Lippincott Williams & Wilkins. (Page 45) RETROPERITONEUM RETROPERITONEUM CONTAINS: AORTA AND IVC KIDNEYS ADRENALS PANCREAS BLADDER PART OF DUODENUM (2ND AND 3RD PARTS) ASCENDING AND DESCENDING COLON RETROPERITONEUM Skalski, M. (2016). [Retroperitoneal Spaces][Diagram]. Retrieved from https://radiopaedia.org/images/21125323. CC-SA-NC-3.0 RETROPERITONEUM RETROPERITONEUM Axial illustration at the level of the kidneys shows the normal tricompartmental retroperitoneal spaces. The anterior pararenal space (shaded blue) is delineated anteriorly by the posterior layer of the parietal peritoneum (dashed blue line), posteriorly by the anterior renal fascia (dashed black circle), and laterally by the lateroconal fascia (dashed red circle). The posterior pararenal space (shaded green) is delineated anteriorly by the posterior renal fascia (dashed white circle) and posteriorly by the transversalis fascia (dotted green line). The perirenal space (shaded orange) is delineated anteriorly by the anterior renal fascia and posteriorly by the posterior renal fascia. The respective fascial layers can expand, giving rise to interfascial planes that allow communication across the retroperitoneal compartments. LCP = lateroconal plane, RMP = retromesenteric plane, RRP = retrorenal plane.  RETROPERITONEUM Sagittal illustration shows the retromesenteric plane (shaded blue, small solid arrow) and the retrorenal plane (shaded green, dashed arrow), which give rise to the combined interfascial plane (shaded red, thick solid arrow), which allows communication to the retroperitoneal portions of the pelvis. RETROPERITONEAL SPACES ANTERIOR PARARENAL SPACE PANCREAS, ASCENDING/DESCENDING COLON, 2ND AND 3RD PARTS OF THE DUODENUM. PERIRENAL/PERINEPHRIC SPACE KIDNEYS AND ADRENALS, RENAL VESSELS AND PROXIMAL COLLECTING SYSTEMS. POSTERIOR PARARENAL SPACE FAT, LYMPHATICS THE AORTA AND IVC HAVE THEIR OWN COMPARTMENT. ANTERIOR PARARENAL SPACE  ANTERIOR PARARENAL SPACE ANTERIOR PARARENAL SPACE  DIVISIONS Anderhub, B. (1995). General Sonography: A Clinical Guide. St. Louis, MO:. Mosby. Pg. 142  REFERENCES KAWAMURA, D., & LUNSFORD, B. (2012). DIAGNOSTIC MEDICAL SONOGRAPHY: ABDOMEN AND SUPERFICIAL STRUCTURES. (3RD ED.). BALTIMORE, MD:. LIPPINCOTT WILLIAMS & WILKINS. CLEMENTE, C. (2011). ANATOMY: A REGIONAL ATLAS OF THE HUMAN BODY. (6TH ED.). BALTIMORE, MD:. LIPPINCOTT WILLIAMS & WILKINS. BRANT, W. (2001). THE CORE CURRICULUM: ULTRASOUND. PHILADELPHIA, PA:. LIPPINCOTT WILLIAMS & WILKINS ANDERHUB, B. (1995). GENERAL SONOGRAPHY: A CLINICAL GUIDE. ST. LOUIS, MO:. MOSBY. TORTORA, G.,& GRABOWSKI, S. (2003). PRINCIPLES OF ANATOMY & PHYSIOLOGY. (10TH ED). NEW YORK, NY.: JOHN WILEY & SONS BERESKA, B. PHOTOGRAPHER, NAIT I NSTRUCTOR WINDHAM, C. (2006-2013) [VISCERAL AND PARIETAL PERITONEUM][DIAGRAM] RETRIEVED FROM HTTP://WWW.GISTSUPPORT.ORG/MEDIA/WINDHAM/WINDHAMFIG3SMALL.JPG. WITH PERMISSION GRAY, H. (1918) [TRANSVERSE PERITONEUM][DIAGRAM] RETRIEVED FROM HTTP://WWW.THEODORA.COM/ANATOMY/IMAGES/IMAGE1038.GIF. PUBLIC DOMAIN GRAY, H. (1918). [GREATER AND LESSER SACS][DIAGRAM] RETRIEVED FROM HTTP://UPLOAD.WIKIMEDIA.ORG/WIKIPEDIA/COMMONS/THUMB/8/8D/GRAY1035.PNG/250PX-GRAY1035.PNG. PUBLIC DOMAIN GRAY, H. (1918). [SMALL BOWEL MESENTERY]. RETRIEVED FROM HTTP://COMMONS.WIKIMEDIA.ORG/WIKI /FILE:GRAY1038_VECTOR.SVG. PUBLIC DOMAIN GRAY, H. (1918). [FALCIFORM LIGAMENT][ILLUSTRATION] RETRIEVED FROM HTTP://EN.WIKIPEDIA.ORG/WIKI/FILE:GRAY1085.PNG. PUBLIC DOMAIN GRAY, H. (1918). [PERITONEAL LIGAMENTS][DIAGRAM]. RETRIEVED FROM HTTP://EN.WIKIPEDIA.ORG/WIKI/FILE:GRAY1039.PNG. PUBLIC DOMAIN GRAY, H. (1918). [INFRAMESOCOLIC SPACES][ILLUSTRATION] RETRIEVED FROM HTTP://EN.WIKIPEDIA.ORG/WIKI/FILE:GRAY1040.PNG. PUBLIC DOMAIN BAISHIDENG PUBLISHING GROUP CO. (1995-2014). [PERITONEAL RECESSES]. RETRIEVED FROM HTTP://WWW.WJGNET.COM/1949-8470/FULL/V5/I 3/106.HTM. CCA-NC-OPEN ACCESS GUPTA PK, GUPTA K, DWIVEDI AD, JAIN M. POTENTIAL ROLE OF ULTRASOUND IN ANESTHESIA AND INTENSIVE CARE. ANESTH ESSAYS RES [SERIAL ONLINE] 2011 [CITED 2014 MAY 13];5:11-9. AVAILABLE FROM: HTTP://WWW.AERONLINE.ORG/TEXT.ASP?2011/5/1/11/84172. CCA-NC-SA [PLEURAL EFFUSION][SONOGRAM] (N.D.). RETRIEVED FROM HTTP://RADIOPAEDIA.ORG/CASES/CARDIOMEGALY-WITH-BILATERAL-PLEURAL-EFFUSION-1. CCA-NC-SA 3.0 STRODER, R., & OVERMAN, C. (2011). [LEFT PERISPLENIC FLUID][SONOGRAM](N.D.). RETRIEVED FROM HTTP://2.BP.BLOGSPOT.COM/-0XADQBAGJPK/TUZ9- MY9Y7I/AAAAAAAAFVW/OORMZTDTWLC/S1600/LUQ+SUBD+FLUID.JPG. FAIR DEALINGS [PERISPLENIC ASCITES][SONOGRAM](N.D). RETRIEVED FROM WWW.ULTRASOUNDCASES.INFO. WITH PERMISSION AMERICAN COLLEGE OF RADIOLOGY. (1988). [GREATER AND LESSER SACS WITH ASCITES]/ RETRIEVED FROM ACR ULTRASOUND CD-ROM SERIES LEARNING FILE. [PELVIC ASCITES][SONOGRAM](N.D.). RETRIEVED FROM HTTP://MOON.OUHSC.EDU/JSPITZ/4802IMAGES/PELFLUID.JPG. FAIR DEALINGS [PHRENICOLIC LIGAMENT][GIF I MAGE]. (N.D.). RETRIEVED FROM HTTP://WWW.SCIAMSURGERY.COM/SCIAMSURGERY/INSTITUTIONAL/FIGTABPOPUP.ACTION?BOOKI D=ACS&LINKI D=PART05_CH19_FIG17&TYPE=FIG. FAIR DEALINGS [DIAPHRAGM][I MAGE]. (N.D.). RETRIEVED FROM HTTP://TEACHMEANATOMY.INFO/THORAX/MUSCLES/DIAPHRAGM/ FAIR DEALINGS SKALSKI, M. (2016). [RETROPERITONEAL SPACES][DIAGRAM]. RETRIEVED FROM HTTPS://RADIOPAEDIA.ORG/IMAGES/21125323. CC-SA-NC-3.0