1. peritoneal reflections
PERITONEUM
&
peritoneal reflections
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2. 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
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3. 9/12/2018
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5. 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
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8. Peritoneal attachments/reflections
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10. 9/12/2018
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11. 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).  
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12. 9/12/2018
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14. 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.
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15. Mesentery/ mesocolon…
DJF
ICJ
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16. 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.
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17. 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
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18. Intra & retroperitoneal organs
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19. infraperitoneal organs
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20. 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.
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21. Peritoneocentesis
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22. STOMACH
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23. 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
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24. Location:
It occupies the Epigastric, Umbilical and Left Hypochondriac region
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25. Capacity of stomach: Presenting parts: In new born : 30-50ml
In adult : ml
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
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26. GERMANUS
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27. 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
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28. 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
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29. GERMANUS
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30. Braches of coeliac trunk:
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31. 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.
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32. 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.
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33. 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
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34. 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
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35. GERMANUS
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36. THANKS
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