Marilyn Rose

Abdominal cavity ***Between the diaphragm and sacral promontory*****

PeritoneumThin serous membraneParietal- lines abd wallsVisceral- covers organsThe cavity houses- liver (except bare area), GB,

spleen, stomach, ovaries and most intestinesMales- closed cavityFemales- communicates with exterior though

fallopian tubes, UT, and vagina

Peritoneum contd. Greater Sac communicates with the lesser

Sac by the Foramen of Winslow (epiploic foramen)

Folds in the peritoneum= mesentery, omenta and peritoneal ligaments.Mesentery encloses intestines and attaches them

to the abd wallOmentum- mesentery attaching to stomach

○ Greater- connects > curve of sto to spleen/ TRV colon

○ Lesser- connects duodenum, < curve to liver.

Ligaments3: > omental ligaments:

○ Gastrocolic, gastrosplenic and gastrophrenic2: < omental:

○ Hepatogastric, hepatoduodenal2: Liver ligaments:

○ Round (ligamentum teres)○ Falciform

Diaphragm to liver:○ Coronary ligaments○ Margins of the “bare area”

Bare Area of the Liver

The coronary ligaments represent reflections of the visceral peritoneum covering the liver onto the diaphragm. As such, between the two layers of the coronary ligament there is a large triangular surface of the liver devoid of peritoneal covering; this is named the bare area of the liver, and is attached to the diaphragm by areolar tissue.

Peritoneal spaces Supracolic compartment

Above transverse colonR/L subphrenic spaces

○ Between diaph and anterior liver- R/L by falciform ligament

R/L subhepatic spaces○ Post/ inferior btw liver and abdominal viscera○ Rt= Morison’s Pouch– deepest in supine pt

and common site for fluid collections!!

Peritoneal spaces

Infracolic compartmentBelow transverse colonR/L infracolic spaces

○ Divided by mesentery of small intestineparacolic gutters

○ Lateral to ascentind and descending colon○ Deeper RT is also a common site for fluid

collections….

Peritoneal Spaces

What is the inflammation of the peritoneum and what is the most common cause???

Retroperitoneum Structures located posterior to peritoneum and still

lined by it.

Kidneys/ ureters Adrenal glands Pancreas Duodenum/ ascending/descending colon AO Inferior vena cava Bladder Uterus Prostate gland

Retroperitoneum

Retroperitoneal Spaces Anterior pararenal space

Between Grota’s fascia/ post peritoneumAscending/descending colon and pancreas and

duodenum.

Posterior pararenal spacePosterior renal fascia and muscles of posterior abd

wall (only fat and vessels in this space)

LT/RT perirenal space areas directly around kidneyThis space contains the kidneys, adrenal glands,

lymph nodes, blood vessels and perirenal fat

Abdominal Aorta

Abdominal Aorta Retroperitoneal

Delivers O2 blood to abdominopelvic structures

L4- bifurcates- Rt/Lt- Common iliac arteries

Abdominal Aorta Celiac Trunk

Off anterior wall- 3 arteries○ 1. left gastric○ 2. common hepatic- (divides into the hepatic artery and

gastroduodenal artery)○ 3. splenic

SMA○ L1- inferior to celiac and descends behind pancreas

Renal arteriesArise from lateral walls of AOBelow SMARRA longer than left and passes posterior to IVC

FYI: Renal artery stenosis can lead to HTN!!!!!

Normal

Abnormal

Inferior Vena Cava Largest vein in the body Carries blood to the heart from the lower limbs, pelvic

organs and abdomen L5- is formed by the common iliac veins Ascends superiorly through the retroperitoneum along

the anterior verterbal column to the RT of the AO. Renal veins- empty into IVC @ L2

Lt renal vein- posterior to SMA and anterior to the aorta with the LT gonadal vein draining into it

Hepatic veins3 – Rt/ Middle/ LtCollects blood from liver parenchymaDrain from inferior liver to the superior where they empty into

the IVC below the diaphragm and proximal to the Rt atrium

Inferior Vena Cava

Where is the IVC???

TIPS-

RA-stent

IVC- what is wrong?

IVC Thrombosis

If the IVC thrombosis…what then?

AZYGOUS RECANALIZATION

Biliary Atresia…Leads to cirrhosis & MPV thrombosis

Hepatoblastoma

How do we fix these??

Liver Transplant: