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Dr. Ahmed Kamal peritoneum

Anatomy433@gmail.com
 Is a thin serous membrane divided to:

Lining the wall of the abdominal

partietal
and pelvic cavities
The peritoneum
Covering the existing
visceral organs(organs inside the abdomen)

peritoneal cavity : The potential space between the two layers and
it is the largest cavity in the body

Parietal

Visceral
 The peritoneal
Cavity

Greater sac Lesser sac

extends from
lies behind the
diaphragm down
stomach
to the pelvis

Both cavities are interconnected through the epiploic

foramen.
In male : the peritoneum is a closed sac .
In female : the sac is not completely closed(Why?)**
because it communicates with the exterior through the
uterine tubes, uterus and vagina

**The abdominal ostia of the uterine tubes opens into the peritoneal
cavity providing a potential pathway between the female genital tract
and the peritoneum.
 describe the relationship between various organs and their peritoneal covering

Intraperitoneal Extraperitoneal (retroperitoneal)

structure nearly totally covered by visceral peritoneum Behind the peritoneum, and partially covered
by visceral peritoneum.

has a supporting mesentery no supporting mesentery

organs stomach & 1st part of duodenum, Primary retroperitoneal organs

liver , spleen Aorta, Inferior vena cava, kidneys, Suprarenal
gallbladder, glands, urinary bladder, vagina, and rectum
jejunum, ileum, cecum, appendix, Secondary retroperitoneal organs**
transverse colon, sigmoid colon, pancreas, duodenum, ascending and
uterus, and ovaries. descending colon.

**develop in mesenteries, but get pushed against the body wall (parietal peritoneum) during growth so that only half of their surface is
covered by peritoneum
o Types of folds: 1
1) Omenta.
3
2) Mesenteries.
3) Ligaments.
-The peritoneal folds
all of them are double
layers (two layers),
and they permit
blood, lymph vessels, 2
and nerves to reach
the viscera. 1
 OMENTA
(Two layered fold of peritoneum connecting the stomach to another viscus).

omenta Greater omentum Lesser omentum

- the greater curvature of the stomach to the
connect
transverse colon.
Description - The largest peritoneal fold, with cribriform
And appearance, contains some adipose tissue.
course - It consists of a double sheet of peritoneum,
folded on itself so that it is made up of four
layers (2 anterior layers + 2 posterior layers).
- The two layers which descend from the
greater curve of the stomach and
commencement of the duodenum, pass
downward in front of the small intestines,
then turn upon themselves, and ascend to the
transverse colon, where they separate and
enclose it.
- Its left border is continuous with the
gastrosplenic ligament.
borders - Its right border extends as far as the
commencement(the beginning) of the
duodenum
Contents - the anastomosis between the right and left
between gastroepiploic vessels.
the two
layers of
omenta
- the lesser curvature of the stomach to the liver.
- It is continuous with the two layers of peritoneum
which cover the anterior & posterior surfaces of
stomach and 1st part of the duodenum.
- Ascend as a double fold to the porta hepatis of
liver, and fissure for ligamentum venosum.
- To the left of porta hepatis it is carried to the
diaphragm.
- Its right border is a free margin; constitutes the
anterior boundary of the epiploic foramen.
-Close to the right free margin, are the hepatic
artery, common bile duct, portal vein, lymphatics,
and hepatic plexus of nerves.
- At the attachment to the stomach, run the right
and left gastric vessels.
 Omental bursa (lesser sac)
- It is a part of the peritonial cavity behind the stomach.
- Boundaries of the omental bursa:
Anterior wall: Posterior wall:
from above downward from below upward
-by the caudate lobe of the -by the posterior two layers of the greater
liver. omentum.
-the lesser omentum. -the transverse colon.
-back of the stomach. -the ascending layer of the transverse
-the anterior two layers of the mesocolon.
greater omentum. -the upper surface of the pancreas.
-the left suprarenal gland.
-the upper end of the left kidney.

Epiploic foramen
It is the communication between the greater and lesser sacs .
In front by Above (roof) by
the free border of the lesser the peritoneum on the caudate process
omentum, of the liver.
with its contents : hepatic artery,
common bile duct, and portal vein
between its two layers. Below (floor) by
the peritoneum covering the
commencement of the duodenum and
Behind by the hepatic artery, before ascending
the peritoneum covering the between the two layers of the lesser
inferior vena cava. omentum.
 MESENTRIES LIGAMENTS

- Two-layered fold of peritoneum, - Two-layered folds of peritoneum that

- suspends the small intestine from the attach solid viscera to the abdominal wall
posterior abdominal wall. and diaphragm.
 Broad and a fan-shaped. - Ligaments of liver:
 Intestinal border: folded,7 m long.  Falciform ligament of liver.
 Root of mesentery: 15 cm long.  Coronary ligament.
 Directed obliquely from duodenojejunal  Left and right triangular ligaments.
flexure at the level of left side of L2 to  Ligamentum teres.
the ileocecal junction in the right iliac
fossa at the level of right sacroiliac joint.

oblique
from the
left of L2
to the
right of
sacroiliac
joint
 The parietal peritoneum The visceral peritoneum

sensitive to pain, Supplies by: Supplies by:

temperature, lower 6 thoracic and first sensitive only to
stretch and tearing. autonomic nerves that
touch, and lumbar nerves. supply the viscera or
pressure.
The central part of the traveling in the
diaphragmatic peritoneum is mesenteries
supplied by the phrenic nerves.

Parietal Peritoneum
abdominal pain originating from the parietal peritoneum is
Somatic type ,Usually severe ,Accurately localized

Peritoneal Pain Visceral Peritoneum

including the mesenteries, is innervated by autonomic nerves.
It is due to Stretch caused by over distension of a viscus and pulling on a mesentery
That gives rise to the sensation of pain.
[leading to poorly localized, poorly characterized pain (dull, cramping, aching)

Because the peritoneum is a semi permeable membrane:

Peritoneal Dialysis It allows transfer of substances across itself.
It has been made use of in patients with acute renal insufficiency.
 MCQs
1-which one of the following organs totally coverd with peritoneum ? 8-the greater and lesser sacs are interconnected through :
A.1st part of duodenum A.epiploic foramen
B.kidney B.gastrosplenic ligament
C.ascending colon C.falciform ligament

2-which one of the following organs is a primarily retroperitoneal organ ? 9-anterior to the omental bursa will be :
A.pancreas A.posterior layers of greater omentum
B.aorta B.lesser omentum
C.Duodenum C.Transverse colon

3-which one of the followings is the right border of the lesser omentum ? 10-which one of the followings is half coverd by peritoneum :
A. The gastric arteries A.duodenum
B.the epiploic foramen B.prostate
C.gastrosplenic ligament C.Rectum

4-the left border of the greater omentum is continuous with : 11-the central part of the diaphragmatic peritoneum is supplied by :
A.epiploic foramen A. Phrenic nerves
B.bile duct B. autonomic nerves
C. Gasrtosplenic ligament C.lumbar nerves

5-anterior to epiploic foramen will be : 12-the visceral peritoneum is sensitive to :

A.free border of the lesser omentum A.pain
B.inferior vena cava B. strech
C.both a and b C.Temprature.

6-the mesentry start at what level ? 13-the parietal peritoneum pain is usually :
A. T3 A.dull
B.L1 B.localized
C.L2 C.both a & b

7-nerve supply to the parietal peritoneum is : 14-the largest peritoneum folds is :

A.Autonomic nerve supply. A.greate sac
B.lower 6 thoracic and first lumbar nerves B.greater omentum
C.both a & b C. Mesentery
1.A 2.B 3.B 4.C 5.A 6.C 7.B 8.A 9.B 10.A 11.A 12.B 13.B 14.B Anatomy433@gmail.com
DONE BY:
Arwa alnasseb
Raghad aldhfeeri
Rahma alshehri
REVISED BY:
Hassan Almalak

anatomy433@gmail.com

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