peritoneal reflections PERITONEUM & peritoneal reflections 9/12/2018 G.LUFUKUJA

As a result the peritoneum is divided into: An outer parietal layer It is a large serous membrane lining the abdominal cavity in the form of a closed sac which is invaginated by a number of viscera As a result the peritoneum is divided into: An outer parietal layer In visceral layer 9/12/2018 G.LUFUKUJA

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Peritoneal cavity The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall 9/12/2018 G.LUFUKUJA

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Peritoneal attachments/reflections 9/12/2018 G.LUFUKUJA

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The greater& lesser omentum The greater omentum is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature of the stomach, passing in front of the small intestines and reflects on itself to ascend to the transverse colon before reaching to the posterior abdominal wall. The lesser omentum is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach (hepatogastric ligament) and the first part of the duodenum(hepatoduodenal ligament).   9/12/2018 G.LUFUKUJA

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Mesentery/ mesocolon The transverse mesocolon is a broad, meso-fold of peritoneum, which connects the transverse colon to the posterior wall of the abdomen. The mesentery is a double fold of peritoneum attached to the posterior abdominal wall. Within it are the arteries and veins that supply the intestine. 9/12/2018 G.LUFUKUJA

Mesentery/ mesocolon… DJF ICJ 9/12/2018 G.LUFUKUJA

Mesentery/ mesocolon… Extent of mesentery It is fan-shaped with a root of about 15 cm extending obliquely from the left L2 transverse process level to the right sacroiliac joint and crossing a third part of the duodenum, aorta and inferior vena cava (IVC) & right ureter. 9/12/2018 G.LUFUKUJA

Mesentery/ mesocolon… The duodenum continues into the jejunum at the duodenojejunal junction or flexure, which lies to the left of L2 vertebra and is fixed to the retroperitoneum by a suspensory ligament of Treitz. The inferior mesenteric vein (IMV) lies to its left. There are several peritoneal fossae around the flexure, which may be the sites of an internal herniation of the small bowel.  The ligament of Treitz, a peritoneal fold, from the right crus of diaphragm, is an identification point for the duodenojejunal flexure at operation 9/12/2018 G.LUFUKUJA

Intra & retroperitoneal organs 9/12/2018 G.LUFUKUJA

infraperitoneal organs 9/12/2018 G.LUFUKUJA

Clinical significance The peritoneal cavity is a common injection site, used in intraperitoneal injection. An increase in the capillary pressure (portal hypertension) in the abdominal viscera can cause fluid to leave the interstitial space and enter the peritoneal cavity, a condition called ascites. In cases where cerebrospinal fluid builds up, such as in hydrocephalus, the fluid is commonly diverted to the peritoneal cavity by use of a shunt placed by surgery. 9/12/2018 G.LUFUKUJA

Peritoneocentesis 9/12/2018 G.LUFUKUJA

STOMACH 9/12/2018 G.LUFUKUJA

Stomach: It is a muscular bag forming the widest and most distensible part of the digestive system It is connected above to the lower end of oesophagus and below to the duodenum Function: It acts as a reservoir of food and helps in digestion of proteins and fats oesophagus Duodenum 9/12/2018 G.LUFUKUJA

Location: It occupies the Epigastric, Umbilical and Left Hypochondriac region 9/12/2018 G.LUFUKUJA

Capacity of stomach: Presenting parts: In new born : 30-50ml In adult : 1000-1500ml Presenting parts: It presents: Two orifices: Cardiac and Pyloric b) Two curvatures: Lesser and Greater c) Two surfaces: Antero-superior and Postero-inferior Three subdivisions: Fundus, Body, Pyloric part 9/12/2018 G.LUFUKUJA

GERMANUS 9/12/2018 G.LUFUKUJA

Orifices: Cardiac orifice: It is situated about 2.5cm to the left of the median plane, behind left 7th costal cartilage, opposite T11 vertebra. Pyloric orifice: It is situated half an inch to the right of median plane at the level of the lower border of L1 Pre-pyloric vein of Mayo 9/12/2018 G.LUFUKUJA

The stomach is supplied by braches of coeliac trunk Blood supply: Arterial supply: The stomach is supplied by braches of coeliac trunk 1) Left gastric artery: A branch of Coeliac trunk 2) Right gastric artery: A branch of the Common hepatic 3) Right gastroepiploic artery: A branch of the Gastroduodenal 4) Left gastroepiploic artery: A branch of Splenic artery 5) 5–7 short gastric arteries: Branches from Splenic artery 9/12/2018 G.LUFUKUJA

GERMANUS 9/12/2018 G.LUFUKUJA

Braches of coeliac trunk: 9/12/2018 G.LUFUKUJA

GERMANUS Blood Supply Arteries The arteries are derived from the branches of the celiac artery which is anterior branch of abdominal aorta. The left gastric artery arises from the celiac artery. It passes upward and to the left to reach the esophagus and then descends along the lesser curvature of the stomach. It supplies the lower third of the esophagus and the upper right part of the stomach. The right gastric artery arises from the hepatic artery at the upper border of the pylorus and runs to the left along the lesser curvature. It supplies the lower right part of the stomach. 9/12/2018 G.LUFUKUJA

GERMANUS Blood Supply… The short gastric arteries arise from the splenic artery at the hilum of the spleen and pass forward in the gastrosplenic omentum (ligament) to supply the fundus. The left gastroepiploic artery arises from the splenic artery at the hilum of the spleen and passes forward in the gastrosplenic omentum (ligament) to supply the stomach along the upper part of the greater curvature. The right gastroepiploic artery arises from the gastroduodenal branch of the hepatic artery. It passes to the left and supplies the stomach along the lower part of the greater curvature. 9/12/2018 G.LUFUKUJA

GERMANUS Blood Supply… Veins The veins of the stomach drain into the portal circulation. The left and right gastric veins drain directly into the portal vein. The short gastric veins and the left gastroepiploic veins join the splenic vein. The right gastroepiploic vein joins the superior mesenteric vein 9/12/2018 G.LUFUKUJA

Venous drainage: VEINS DRIANAGE 1) Right & left gastric Trunk of portal vein 2) Short & left gastro-epiploic Splenic vein 3) Right gastro-epiploic vein Trunk of superior mesenteric vein 9/12/2018 G.LUFUKUJA

GERMANUS 9/12/2018 G.LUFUKUJA

THANKS 9/12/2018 G.LUFUKUJA 36