1. WINDSOR UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF ANATOMY
ABDOMEN
Dr. SREEKANTH THOTA

2. Peritoneum Parietal and Visceral peritoneum
Intra and retroperitoneal organs
Peritoneal cavity

3. Peritoneum
A thin membrane (the peritoneum) lines the walls of the abdominal cavity and covers much of the viscera.
The parietal peritoneum lines the walls of the cavity and the visceral peritoneum covers the viscera.
Between the parietal and visceral layers of peritoneum is a potential space (the peritoneal cavity).

4. Parietal peritoneum and Visceral peritoneum
The parietal peritoneum is served by the same blood and lymphatic vasculature and the same somatic nerve supply as is the region of the wall it lines.
The visceral peritoneum and the organs it covers are served by the same blood and lymphatic vasculature and visceral nerve supply.

5. Intraperitoneal organs
Completely covered with visceral peritoneum (e.g., the stomach and spleen).

6. Retroperitoneal organs
Outside the peritoneal cavity, external, posterior, or inferior to the parietal peritoneum and are only partially covered with peritoneum (usually on just one surface).

7. Peritoneal Formations
Various terms are used to describe the parts of the peritoneum that connect organs with other organs or to the abdominal wall, and the compartments and recesses that are formed as a consequence.
1. Peritoneal ligaments
2. Omentum
3. Mesentery

8. Peritoneal ligaments
Consists of a double layer of peritoneum that connects an organ with another organ or to the abdominal wall.
The liver is connected to the:
1. Anterior abdominal wall by the falciform ligament
2. Stomach by the hepatogastric ligament
3. Duodenum by the hepatoduodenal ligament

10. The stomach is connected to the:
1. Inferior surface of the diaphragm by the gastrophrenic ligament.
2. Spleen by the gastrosplenic ligament .
3. Transverse colon by the gastrocolic ligament, the apron-like part of the greater omentum.

12. Omentum
Is a double-layered extension or fold of peritoneum that passes from the stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity
1. Greater omentum
2. Lesser omentum

13. Greater omentum
Is a prominent peritoneal fold that hangs down like an apron from the greater curvature of the stomach and the proximal part of the duodenum.
After descending, it folds back and attaches to the anterior surface of the transverse colon and its mesentery.

16. Lesser omentum
Connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver

17. Mesentery
Is a double layer of peritoneum that occurs as a result of the invagination of the peritoneum by an organ and constitutes a continuity of the visceral and parietal peritoneum.
It provides a means for neurovascular communication between the organ and the body wall
1. Small intestine mesentery is usually referred to simply as the mesentery
2.Transverse and sigmoid mesocolons
3. Mesoesophagus, Mesogastrium, and Mesoappendix

19. Subdivisions of Peritoneal cavity
Greater sac
Lesser sac

20. Greater sac
The greater sac is the main and larger part of the peritoneal cavity.
A surgical incision through the anterolateral abdominal wall enters the greater sac.

21. Lesser sac (omental bursa )
The omental bursa (lesser sac) lies posterior to the stomach and lesser omentum.
The omental bursa communicates with the greater peritoneal sac through the omental foramen (epiploic foramen), an opening situated posterior to the free edge of the lesser omentum (hepatoduodenal ligament).
The omental foramen can be located by running a finger along the gallbladder to the free edge of the lesser omentum

23. The boundaries of the omental foramen are
1.Anteriorly: the hepatoduodenal ligament containing the portal vein, hepatic artery, and bile duct
2. Posteriorly: the IVC and right crus of the diaphragm
3. Superiorly: the liver, covered with visceral peritoneum
4. Inferiorly: the superior or first part of the duodenum

24. Walls and recesses of omental bursa

25. Clinical correlates

26. Paracentesis of the Abdomen
Paracentesis of the abdomen may be necessary to withdraw excessive collections of peritoneal fluid, as in ascites secondary to cirrhosis of the liver.
Under a local anesthetic, a needle or catheter is inserted through the anterior abdominal wall.
The underlying coils of intestine are not damaged because they are mobile and are pushed away by the cannula.

27. Ascites
Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity. The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum .
Although most commonly due to cirrhosis and severe liver disease, its presence can exhibit other significant medical problems.

28. Abdominal paracentesis

29. Paracentesis of the abdominal cavity in midline (1) and laterally (2).