The Peritoneal Cavity Part I: Abdominal Sonography

The Peritoneal Cavity

Part I: Abdominal Sonography

Abdomen and Superficial Structures

Objectives

The Peritoneal Cavity

Part I: Abdominal Sonography

Abdomen and Superficial Structures

Objectives

Identify the potential spaces of the peritoneum and the organs and/or ligaments that divide them on diagram.Identify

Identify the potential spaces of the peritoneum on sonogram.Identify

State the organs located in the peritoneum.State

Explain the role greater omentum and mesentery play in limiting the extent of pathology.Explain

Recognize the sonographic appearance of benign and malignant changes seen in the peritoneum. Recognize

Analyze sonographic images of the peritoneum for pathology.Analyze

THE PERITONEUM

The Peritoneum is the serous membrane lining the walls of the abdominal cavity. It covers the abdominal viscera.

• The peritoneum that covers the abdominal organs is known as the visceral peritoneum.https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj0u-yHjbHTAhXC7SYKHaDWCncQjRwIBw&url=https://www.slideshare.net/VischaMarvidiantika/23-peritoneum&psig=AFQjCNGbFIGVxjEL18_Xt51SusKpth5meg&ust=1492711166307051https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj0u-yHjbHTAhXC7SYKHaDWCncQjRwIBw&url=https://www.slideshare.net/VischaMarvidiantika/23-peritoneum&psig=AFQjCNGbFIGVxjEL18_Xt51SusKpth5meg&ust=1492711166307051

The peritoneum that lines the abdominal cavity is known as the parietal peritoneumhttps://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj0u-yHjbHTAhXC7SYKHaDWCncQjRwIBw&url=https://www.slideshare.net/VischaMarvidiantika/23-peritoneum&psig=AFQjCNGbFIGVxjEL18_Xt51SusKpth5meg&ust=1492711166307051https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj0u-yHjbHTAhXC7SYKHaDWCncQjRwIBw&url=https://www.slideshare.net/VischaMarvidiantika/23-peritoneum&psig=AFQjCNGbFIGVxjEL18_Xt51SusKpth5meg&ust=1492711166307051

Layers

• The outer layer: parietal peritoneum

• The inner layer: visceral peritoneum

Parietal peritoneum

is attached to the abdominal wall.

Visceral peritoneum

is wrapped around the internal organs that are located inside the abdominal cavity.

The peritoneum both supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves.

Peritoneal cavity

• The peritoneal cavity is a potential space between the parietal and visceral peritoneum.

• Contains peritoneal fluid having (water, electrolytes, leukocytes and antibodies)

Peritoneal cavity

The fluid functions are:

It acts as a lubricant, enabling free movement of the abdominal viscera.

The antibodies fight infection.

Peritoneal cavity

Ordinarily, the peritoneal cavity is only of capillary thinness; however, it is referred to as a potential space because excess fluid can accumulate in the peritoneal cavity resulting in the clinical condition of ascites.

• The peritoneal cavity forms a completely closed sac in the male; in the female there is a communication with the retroperitoneal cavity through the uterine tubes, uterus, and vagina.

Subdivisions of the Peritoneal Cavity

The peritoneal cavity can be divided into the greater and lesser peritoneal sacs.http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwjm1Z_uv67TAhXBTCYKHaFlC80QjRwIBw&url=http://teachmeanatomy.info/abdomen/areas/peritoneal-cavity/&psig=AFQjCNFOWGcRHFrehP4clyqHD5V73Ef7wg&ust=1492621857645381http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwjm1Z_uv67TAhXBTCYKHaFlC80QjRwIBw&url=http://teachmeanatomy.info/abdomen/areas/peritoneal-cavity/&psig=AFQjCNFOWGcRHFrehP4clyqHD5V73Ef7wg&ust=1492621857645381

Subdivisions of the Peritoneal Cavity

The greater sac comprises the majority of the peritoneal cavity.

Greater sac

The Greater Sac

Divided into two compartments by the mesentery of the transverse colon .

• The supracolic compartment

• The infracolic compartment

The Greater Sac

The supracolic compartment lies above the transverse mesocolon and contains the stomach , liver and spleen.

The Greater Sac

The infracolic compartment lies below the transverse mesocolon and contains the small intestine, ascending and descending colon.

The infracolic compartment is further divided into left and right infracolic spaces by the mesentery of the small intestine.

The Greater Sac

The supracolic and infracolic compartments are connected by the paracolic gutters

Subdivisions of the Peritoneal Cavity

The lesser sac (also known as the omental bursa) is smaller and lies posterior to the stomach and lesser omentum.http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwjm1Z_uv67TAhXBTCYKHaFlC80QjRwIBw&url=http://teachmeanatomy.info/abdomen/areas/peritoneal-cavity/&psig=AFQjCNFOWGcRHFrehP4clyqHD5V73Ef7wg&ust=1492621857645381http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwjm1Z_uv67TAhXBTCYKHaFlC80QjRwIBw&url=http://teachmeanatomy.info/abdomen/areas/peritoneal-cavity/&psig=AFQjCNFOWGcRHFrehP4clyqHD5V73Ef7wg&ust=1492621857645381

Lesser Sac (Omental Bursa)

The omental bursa allows the stomach to move freely against the structures posterior and inferior to it.

Lesser Sac (Omental Bursa)

Lesser Sac (Omental Bursa)

The omental bursa is connected with the greater sac through an opening in the omental bursa, the epiploic foramen.

Lesser Sac (Omental Bursa)

The epiploic foramen is situated posterior to the free edge of the lesser omentum (the hepatoduoden al ligament).

Omental Foramen(epiploic foramen)

OMENTUM

The omentum is made up of two layers of fatty tissues and both supports and covers the organs and intestines found in this area of the body.

OMENTUM

There are two parts of the omentum:

• the greater omentum

• the lesser omentum.

OMENTUM

The omentum is responsible for storing fat deposits and connecting the intestines and stomach to the liver respectively.

OMENTUM

Hangs in front of the stomach and intestine

It is an apron-like flap of tissue which hangs from the underside of the stomach and aids circulation in the abdomen

The greater omentum is given off from the greater curvature of the stomach, forms a large sheet that lies over the intestines.

Contains blood vessels, nerves, and other structures between these layers.

Functions of the greater omentum

The functions of the greater omentum are:

• Fat deposition, having varying amounts of adipose tissue.

• Infection and wound isolation; It may also physically limit the spread of intraperitoneal infections.

Greater Omentum

Lesser omentum

Also known as the gastrohepatic omentum or small omentum.

A double layer structure located from the beginning of the duodenum and stomach’s lesser curvature to the liver.

Lesser Omentum

The term mesentery is often used to refer to a double layer of visceral peritoneum

Mesentery

Attaches the small intestine and much of the large intestine to the posterior abdominal wall.

Mesentery vs omentum

Mesentery is the support tissue that the intestine is rooted into, and the omentum is a fatty blanket that hangs down in front of all of the intestines.https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiz0KLdkrHTAhVH4CYKHWc4DwcQjRwIBw&url=https://www.pinterest.com/pin/397090892129861390/&psig=AFQjCNF_ed0PM3ZtdEwD1hMIl5AWjzMIZA&ust=1492712820198775https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiz0KLdkrHTAhVH4CYKHWc4DwcQjRwIBw&url=https://www.pinterest.com/pin/397090892129861390/&psig=AFQjCNF_ed0PM3ZtdEwD1hMIl5AWjzMIZA&ust=1492712820198775

Retroperitoneal Organs and Vascular Structures

• Retroperitoneal organs and vascular structures remain posterior to the cavity and are covered anteriorly with peritoneum:

• Urinary system

• Aorta

• Inferior vena cava

• Colon

• Pancreas

• Uterus

• Bladder.

Potential spaces of the peritoneum

• Left anterior subphrenic space

• Right subphrenic space

• Left posterior suprahepatic space

• Hepatorenal space also known Morrison pouch or space

• Omental bursa

• Right and left paracolic gutters

• Vesicorectal space

• Rectouterine space also known as posterior cul de sac or pouch of Douglas or rectovaginal pouch

• Uterovesicle space also known uterovesicle pouch or anterior cul de sac

• Space of Retzius also called prevesicle or retropubis space

Subphrenic spaces

The subphrenic spaces are recesses in the greater sac of the abdominal cavity between the anterior diaphragmatic surface of the liver and diaphragm.

Subphrenic spaces

They are separated into left and right subphrenic spaces by the falciform ligament of the liver.

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