PERITONEAL CAVITY

1.0 Introduction

Peritoneal cavity or space is a apace between the parietal and visceral portion of the peritoneum.
This space is really only a potential cavity because normally is filled with various organs. This
cavity also contains some serous lubricating type fluid which allows organs to move against each
other without friction.

2.0: SURFACE ANATOMY LANDMARKS FOR ORGANS IN THE PERITONEAL

CAVITY.

2.1: SURFACE ANATOMY.

Surface anatomy is the study of anatomical structures that can be seen from the outside of the
body. It also includes the surface projections and landmarks of deeper structures that are required
to perform clinical examinations, investigations and treatments.

3.0: STOMACH

The stomach is a dilated portion of the gastrointestinal track situated under the left lower ribs and
costal cartilages in the left hypochondrium. The stomach can be divided into:) Cardiac region,
Fundus, the body and Pylorus
The cardiac region: It can be identified on the anterior abdominal wall at the level of the seventh
costal cartilage on the left-hand side 2.cm from the midline.
The Fundus: It protrudes superiorly to reach as high as the fifth intercostal space.
The body: The body of the stomach has greater and lesser curvatures. The greater curvature turns
medially and depending on the individual, may dip into the left flank region.
The pylorus is oriented horizontally, at the level of the transpyloric plane.
3.1: SMALL INSTESTINE
The small intestine consists of the duodenum, Jejunum and ileum. It is approximately six meters
in length.
The first part begins immediately distal to the pyloric sphincter and continues in a transverse
direction along the transpyloric plane towards the right midclavicular line.
The second part starts at the level of L2, where thee duodenum takes a 90o to the left to become
the fourth part, which runs superiorly to the level of L2.
The jejunum is located in the left flank and left groin regions.
The ileum is mainly located in the right flank and umbilical region as well as the right iliac fossa.
3.2 :LARGE INTENSTINE.
The large intestine consists of the cecum and the ascending, transverse, descending and sigmoid
sections of the colon. The large intestine is approximately 1.5m long
The appendix is usually located a third of the way along a line from right anterior superior iliac
spine to umbilicus.
The cecum is situated in the right inguinal region and it is palpated 2-3cm medially from the
anterior superior iliac spine.
The ascending colon rises superiorly through the right flank to the right hypochondrium where it
makes 90 degrees turn (hepatic flexure) to the left, to continue as transverse colon.
The transverse colon crosses the midline of the body below the transpyloric plane and reaches
the left hypochondrium.

The descending colon passes through the left flank region and into the left groin region.
The descending colon is continuous with sigmoid colon, which lies mainly in the left groin
region, before passing medially into the public region, to continue as the rectum and anal canal.
3.3: LIVER AND GALL BLADDER.
The liver lies in the right hypochondrium, epigastrium and left hypochondrium. The liver
anatomically divided into right and left lobes by the presence of falciform ligament.
The right lobe lies superiorly against the diaphragm at the level of the forth intercostal space. It
continues towards the midline at the level of the xiphisternal junction and as far inferiorly as the
level of the seventh rib.
The left lobe is continuous with the right lobe, extending 5cm across midline into left
hypochondrium.
The Gallbladder is located just inferior to the liver and is adherent to the undersurface of the
right lobe of the liver.
The fundus of the gall bladder lies at the midclavicular line on the transpyloric plane at the level
of ninth costal cartilage close to the lateral margin of the right rectus abdominal muscle.
3.4: SPLEEN
located in the left hypochondrium, inferior to the diaphragm on the posterior abdominal wall
between the ninth and eleventh ribs.
It’s most superior point is at the level of spinous process of the ninth thoracic vertebrae. The
most inferior point is at the level of lumbar vertebra.
3.5 PANCREAS
The pancreas is a retroperitoneal organ consisting of: Head, neck, body uncinate process and tail.
It lies at the level of the second lumbar vertebra, posterior to the stomach.
The head of the pancreas lies within the C-Shape of the duodenum.
The body and tail continues along transpyloric line.
The head uncinate process and body lie within the epigastric region with the tail extending into
the left hypochondrium.
3.6 KIDNEY.
The kidneys are paired retroperitoneal organs located on the posterior abdominal wall.
The left kidney is located between T12 and L3.
The right kidney is slightly lower and located between L1 and L4 because of the position of the
liver.
The renal hilum is most commonly located at L2.

3.7:SUPRARENAL GLANDS
They are paired endocrine glands located at the superior pole of the kidneys. The extend
superiorly for 2-3cm.
4.0: DISCUSSING IMAGING MODALITIES.
MODALITY
Computed tomography
(CT). The process of
creating a cross sectional
tomographic plane of
anybody part. For CT a
patient is scanned by an X-
Ray tube rotating around
the body part being
examined.
Magnetic Resonance
Imaging.
MRI creates images of
structures through the
interaction of magnetic
fields and radio waves with
tissues without the use of
ionizing radiation.
  
DIAGNOSTIC VALUE STRUCTURE/MORPHOLOGY
DEMONSTRATED
Cranial CT (Head CT) Sella turcica, sinuses, temporal
Evaluation. bones and temporal mandibular
joints.
Neck CT Tumors of oral pharynx,
nasopharanyx, infections or
abscess.
Spine CT Common pathologic indications
include: disk herniation, tumor,
spinal stenosis, Trauma or
fractures
Interventional CT Percutaneous biopsy,
Percutaneous Abscess drainage.
Central Nervous system Differentiation of gray and white
evaluation matter of the brain, Visualize
lesions, posterior fossa imaging of
cerebrum and brain stem.
Pelvis Evaluation Bladder tumors, detecting
 neoplasms and its spread.
Musculoskeletal System Staging of soft tissues and bone
tumors, visualization of bone
marrow.
Vessels Evaluation (MRI Vascular structures to obtain
Angiograms) images of blood flow
Diagnostic Ultrasound Liver and biliary Tree Liver, Gallbladder, intrahepatic
Examination. and extrahepatic bile ducts
Superficial structures Breast, scrotum, thyroid.
Gynecologic Application Female pelvis
Obstetric Application Monitor developing embryo and
featus.
Nuclear Medicine Bone scans Detect Metastasis, stress fracture.
Thyroid uptake studies Hyperthyroidism, hypothyroidism
5.0: THE LIVER.

The liver is a large, complex organ with numerous functions which include metabolic and
hematologic regulation and bile production. It is the largest organ of the abdomen, occupying a
major portion of the right hypochondriac and umbilical regions.

5.1: ORGANS BORDERING THE LIVER.

Superior: Diaphragm

Inferior: Gallbladder.

Anterior: Diaphragm.

Posterior: Right Kidney.

Lateral: Diaphragm.

Medial: Stomach, duodenum, Transverse Colon.