محاضرة دكتورة نورا الطحاوى للفرقة الاولى كلية الطب البشرى يوم الاحد 17 ابريل 2011س Lectures of Anatomy by Dr. Noura El Tahawy for first year Faculty of Medicine, El Minia University. 17-4-211 م

1. The abdominal cavity,
the peritoneum
& the peritoneal cavity
By
Dr. Noura El Tahawy
Faculty of Medicine
El Minia University

2. • Superficial
view of
• the abdominal
• organs

3. Peritoneum

4. • Sagittal section
through the
abdominopelvic
cavity

5. Abdominal cavity
proper
• The larger part of the
abdominopelvic cavity
• BOUNDARIES
• Superiorly: diaphragm
• Inferiorly: Pelvic inlet
• A large part is under the
cover of the
osteocartilaginous thoracic
cage
• Walls are lined by the
parietal peritoneum

6. • Thin transparent
serous membrane
that consists of 2
layers:
• 1. PARIETAL
PERITONEUM –
lines the
abdominal cavity
• 2. VISCERAL
PERITONEUM –
invests the
abdominal viscera

7. • Composed of a single
layer of squamous
epithelial cells
(mesothelium)
• The 2 layers are
separated by a capillary
film of peritoneal fluid.

8. PERITONEAL DERIVATIVES: Definition
Peritoneal From To
Derivatives
Ligaments Solid viscera Abdominal wall
Omentum Stomach Another viscus
Mesentery Parts of the intestine Posterior abdominal wall

9. PERITONEAL DERIVATIVES: Examples
Peritoneal Derivative From To
Ligaments Solid viscera Abdominal wall
Falciform ligament liver Diaphragm and anterior
abdominal wall

11. Peritoneal cavity

12. • DEFINITION
• The potential space between the parietal and
visceral layers of the peritoneum
• MALES: closed cavity
• FEMALES: (+) communication with the
exterior through the reproductive tract
(fallopian tubes, uterus, vagina)

13. Divisions of the peritoneal cavity
• As the fetal
organs assume
their adult
positions, the
parietal cavity
is divided into
the 2 peritoneal
sacs:
1. the greater sac
2. the lesser sac
(omental bursa)

14. Peritoneal cavity
• GREATER SAC • LESSER SAC
• Main compartment of • Smaller
the peritoneal cavity
• Extends from the • Lies behind the
diaphragm into the stomach
pelvis
The communication between
the greater sac and the lesser sac is the
EPIPLOIC FORAMEN

15. PERITONEAL DERIVATIVES: Examples
Peritoneal Derivative From To
Omentum Stomach Another viscus
Greater omentum Greater curvature Transverse colon
Lesser omentum Lesser curvature Undersurface of the liver
Hepatogastric ligament
Hepatoduodenal
ligament
Gastrosplenic Stomach Hilum of the spleen
omentum
(ligament)

16. Greater Omentum

23. Lesser Omentum & Lesser sac

24. • Superficial
view of
• the abdominal
• organs

25. • Sagittal section
through the
abdominopelvic
cavity

27. Hepatogastric Ligament
Hepatogastric
ligament
Epiploic
foramen

28. Hepatoduodenal Ligament
Contents: The Portal Triad
• Proper hepatic a , Portal v, Common bile duct

29. Boundaries of
Epiploic foramen
Proper
Proper
hepatic
hepatic
artery
artery
Portal vein
Portal vein
Common
Common
bile duct
bile duct
Contents: The Portal Triad
• Proper hepatic a
• Portal v
• Common bile duct

30. Boundaries of Epiploic foramen

31. Epiploic foramen

33. Epiploic foramen

35. Mesentery

36. PERITONEAL DERIVATIVES: Examples
Peritoneal Derivative From To
Mesentery Parts of the intestine Posterior abdominal
wall
Mesogastrium Stomach Posterior abdominal wall
Mesentery of the small Small intestine Posterior abdominal wall
intestine
Transverse mesocolon Transverse colon Posterior abdominal wall
Sigmoid mesocolon Sigmoid colon Posterior abdominal wall

37. Transverse
mesocolon
Mesentery
of the small intestine

43. PERITONEAL ORGANS
RETROPERITONEAL ORGANS INTRAPERITONEAL ORGANS
When an organ is When an organ is
partially covered almost entirely covered
by visceral peritoneum. by visceral peritoneum
The organ lies
behind the peritoneum.
Kidneys
Suprarenal glands
Pancreas
Part of the duodenum
Ascending colon
Descending colon

44. Secondary peritoneal
organs Primary peritoneal
PERITONEAL ORGANS organs
RETROPERITONEAL ORGANS INTRAPERITONEAL ORGANS
When an organ is When an organ is
partially covered almost entirely covered
by visceral peritoneum. by visceral peritoneum
The organ lies
behind the peritoneum.
Kidneys
Suprarenal glands
Pancreas
Part of the duodenum
Ascending colon
Descending colon

48. EXTRAPERITONEAL ORGANS
• Organs devoid of
peritoneal lining
• Rectum

49. PERITONEAL RECESSES
• Subphrenic recess
Description and significance
• Hepatorenal recess
• Paracolic gutter

50. SUBPHRENIC RECESS
• The existence is due to
the complicated
arrangement of the
peritoneum in the region
of the liver
• Right and left anterior
subphrenic spaces
• Right posterior
subphrenic space
• Right extraperitoneal
space

51. SUBPHRENIC RECESS
• Right and left anterior
subphrenic spaces
• between the diaphragm and the
Iiver on each side of the falciform
ligament

52. SUBPHRENIC RECESS
• Right posterior subphrenic
space
• between the right lobe of the
liver, the right kidney and the
right colic flexure

53. Anterior and Posterior
Subphrenic Abscess
Anterior
Posterior

54. SUBPHRENIC RECESS
• Right extraperitoneal space
• between the layers of the
coronary ligament

55. HEPATORENAL RECESS
• Located between the
inferior surface of the
right lobe of the liver
and the right kidney

56. PARACOLIC GUTTER
• Results form the
arrangement of the
ascending and
descending colons,
attachment of the
transverse mesocolon,
and the mesentery of
the small intestine to
the abdominal wall

57. PARACOLIC GUTTER
• 4 gutters
• Lie in the lateral and
medial side of the
ascending and
descending colons
respectively

58. PARACOLIC GUTTER
• Right lateral paracolic gutter
– In communication with the
right posterior subphrenic
space
• Right medial paracolic gutter
– Closed off from the peritoneal
cavity by the mesentery of the
small intestines
• Left lateral paracolic gutter
– Separated from the area
around the spleen by the
phrenicocolic ligament
• Left medial paracolic gutter

59. PARACOLIC GUTTER
• Right lateral paracolic gutter
– In communication with the
right posterior
subphrencicspace
• Right medial paracolic gutter
– Closed off from the peritoneal
cavity by the mesentery of the
small intestines
• Left lateral paracolic gutter
– Separated from the area
around the spleen by the
phrenicocolic ligament
• Left medial paracolic gutter

60. PARACOLIC GUTTER
• Right lateral paracolic gutter
– In communication with the
right posterior subphrenic
space
• Right medial paracolic gutter
– Closed off from the peritoneal
cavity by the mesentery of the
small intestines
• Left lateral paracolic gutter
– Separated from the area
around the spleen by the
phrenicocolic ligament
• Left medial paracolic gutter

61. The Subphrenic Spaces
and the Paracolic Gutters
• Clinically important !
• Sites for the collection and movement of
infected peritoneal fluid

62. 62