1. Abdominal Cavity: Peritoneum & GIT

2. (G, To stretch or cover around )
Peritoneum
A serous membrane of 2 continuous layers that covering the abdominal organs
(G, To stretch or cover around )
Parietal: lining internal abdominal wall
Visceral: lining abdominal organs (viscera)
Peritoneal cavity: space between parietal & visceral layers
fluid filled  reduce friction
* NO organs in peritoneal cavity

4. Abdominal Organs Relation to Peritoneum
Intraperitoneal:
completely covered by visceral peritoneum
Retroperitoneal:
posterior (behind) the peritoneum
touched anteriorly by parietal peritoneum

5. Peritoneal Cavity 2 parts Greater sac: main part of peritoneal cavity
Lesser sac (omental bursa):
extensional cavity behind the stomach
allows free movement of stomach
connects with greater sac through epiploic foramen

7. Epiploic Foramen Foramen of Winslow Connects lesser sac to greater sac
Boundaries:
Ant.: portal triad
(p. vein, h.a., & bile duct)
Post.: IVC
Sup.: Liver (caudate lobe)
Inf.: duodenum (1st part)

8. Foramen of Winslow & Lesser Sac

9. Terms describing parts of peritoneum
Peritoneum has special names at specific regions:
omentum
mesentry & mesocolon
ligaments

10. Greater curvature of stomach
Omentum
Broad, double layered sheet of peritoneum that connects stomach to another abdominal organ
2 parts
1. Greater Omentum:
Greater curvature of stomach 
Down (like apron)
Reflects up again
Ant. transverse colon

11. Lesser curvature of stomach & small part of dudenum (2cm)
2. Lesser Omentum
Lesser curvature of stomach
& small part of dudenum (2cm) 
Liver
Post. to it = lesser sac
* The free edge of lesser omentum is called: hepatoduodenal ligament
 contains portal triad

12. Hepatoduodenal Ligament

13. Mesentery & Mesocolon Mesentry: Mesocolon:
double layer of peritoneum connects small
intestine to posterior abdominal wall
mesentry of small intestine
Mesocolon:
double layer of peritoneum connects large
transverse mesocolon
sigmoid mesocolon
mesoappendix

14. Mesentery
&
Mesocolon

15. Ligaments
Double layer of peritoneum that usually attached to the liver
Falciform Lig.:
Attachs the liver to ant. abdominal wall
& ends by enclosing ligamentum teres
Hepatoduodenal Lig.:
The free edge of …?
1st 2 cm of duodenum to liver
Contents?

17. Peritoneal Nerve Supply
Parietal Peritoneum: (sensations)
T7 – T12
L1 (iliohypogastric)
Obturator nerve (in the pelvis)
Visceral Peritoneum:
Autonomic nerve supply
(only for stretch)

18. Organs Relations to Peritoneum
Stomach (intra)
Duodenum
(retro, except 1st 2 cm)
Jejunum & ileum (intra)
Cecum (??)
Appendix (intra)
Ascending (retro)
Transverse (intra)
Descending (retro)
Sigmoid (intra)
Rectum: within the pelvis
upper part (ant. & lat.)
middle part (ant.)
lower (no covering, subpertoneal)
Liver:
Intraperitoneal
except over 3 areas
Pancreas:
Retroperitoneal
except for the tail
Spleen:
Kidneys:

19. Gastro-Intestinal Tract (GIT) in Abdomen
Esophagus (abdominal part, 1.25cm)
Stomach
Small intestine
Large intestine

20. Esophagus Enters through esophageal opening (T10)
Pass about 1.25cm before entering stomach
Ends at cardiac orifice (T11)

21. Stomach (Read your text for detailed anatomy)
*Intraperitoneal
4 regions
Cardia:
surrounds esophag. opening
Fundus
most sup. Part (dome shape)
Body
central part, largest
Pylorus (gate guard)
antrum & canal

22. Stomach 2 openings: Cardiac orifice esophagus  stomach
(Physiologic sphincter)
Pyloric sphincter
stomach  duodenum
(Anatomic & Physiologic)
Anat = thickened circular m. layer
2 curves:
greater (lf.) & lesser (Rt.)

23. Stomach

24. Muscular Wall of Stomach
Outer ??
Middle ??
inner ??
???

25. Small Intestine (Read your text for detailed anatomy)
Duodenum (C-shaped)
Jejunum
Ileum

26. Duodenum * Retroperitoneal except over omental attachment (first 2 cm)
4 parts
1. Superior (1st):
From pylorus
Horizontal (vertebral level?)
2. Descending (2nd):
Rt. To L2 & L3
Curves around head of pancreas
Receives bile & main pancreatic ducts
(Major papilla)

27. Duodenum

28. Ampulla of Vater & Major duodenal papilla

29. 3. Horizontal (3rd):
Ant. to IVC
At level of L3
4. Ascending (4th):
At left side of L3
Ends at duodenojejunal jxn.
Forms flexure (bending)
(flexure = lig. of treitz)
Small intestine enters peritoneum at the lig. of treitz

30. Jejunum & Ileum * Intraperitoneal Jejunum: (L, empty) upper left half
Ileum: (G, twisted)
lower right half
ends at ileocecal junction
(valve)

31. Large Intestine (Read your text for detailed anatomy)
Cecum & Appendix
Ascending (retro)
Transverse (intra)
Descending (retro)
Sigmoid (intra)
Rectum (in pelvic cavity)

32. Distinguishing Features of Large Intestine
Haustra (saccules):
Sacculations or pouches of the colon
Teniae coli:
3 longitudinal bands of muscle that extend from the base of the ?? until the rectum
Epiploic (omental) appendices
Fatty tags attached to the wall of the colon
Rt. & Lf. Colic Flexures

33. Clinical Notes

34. Peritonitis:
inflammation of peritoneum that causes pain in abdomen & overlying skin.
Usually associated with Ascites:
distention of peritoneal cavity by abnormal fluid
Rx:
draining the cavity fluids (paracentesis)
by inserting a needle into peri. Cavity, usually through linea alba

35. Peptic Ulcer Disease
A discontinuation (erosion) in the mucosal covering in an area of the GIT (esophaguslarge intestine).
Most commonly in the ?
Causes:
1. Bacteria: Helicobacter pylori
~80% PUD
urease  urea= ammonia + CO2
2. Drugs & Irritants:
NSAIDs (aspirin), smoking, alcohol
3. Hypersecretion of HCl

36. Rx.:
antibiotics: only when ??
Amoxi. + Mitro. + Clarithromycin
gastric acid inhibitors:
histamine receptor (H2) blockers
or PPI
Antacids: buffer
Diet: irritants
Surgical: Vagotomy, antrum removal
(out of date)
Complications:
GI-bleeding:
- erosion of a bld. Vessel - hematemesis (?)
Perforation:
- erosion of the whole wall  opening into abd. Cavity
 peritonitis & inflammation of adjacent organs
* requires emergency surgical treatment

37. Inflammation of the appendix due to:
Appendicitis
Inflammation of the appendix due to:
1. Bact. Infection or
2. luminal obstruction:
by chyme or foreign objects
Signs & Symptoms:
1. Pain:
Starts: vague pain in peri?? region
(referred pain)
Later: sever pain in  Rt. Quadrant
due to irritation of ??
2. Vomiting, 3. Fever, 4. Leukocytosis
Complications:
perforation of the appendix  peritonitis & gangrene necrosis

38. McBurney’s Point On a straight line : 1/3 from ant. sup. iliac spine
2/3 from the umbilicus
Corresponds to the base of the appendix
The incision site during appendectomy (removal of the appendix)

39. Diarrhea & Constipation
 In frequency, volume & fluid content of the feces
Because of:  motility &  absorption of the intestine
Complication: Dehydration & electrolyte imbalance
Rx.: ?
Constipation
Infrequent & difficult defecation
Because of:  motility & absorption of the intestine
Rx.:
- mild laxative: castor oil or Mg(OH)2
- fibers diet & exercise