Abdominal viscera:

Peritoneum:

The peritoneum is a membrane that lines the walls of the abdominal cavity and covers the
viscera, it has 2 types:

- Parietal: lines the walls of the abdominal cavity

- Visceral: covers the viscera

Between them we have the peritoneal cavity

Abdominal viscera are either in:

- Peritoneal cavity suspended by mesenteries (folds of peritoneum) (intraperitoneal)

- Outside it (retroperitoneal)

Innervation of the peritoneum:

Parietal: somatic aBerents: branches of spinal nerves

- Sense localized pain

Visceral: visceral aBerents following autonomic nerves (symp and parasymp)

- Referred and poor localized discomfort sense and reflex activity

Peritoneal cavity:

Divided to:

- Greater sac: most of space begins at diaphragm superiorly and inferiorly to pelvic
cavity and it is directly behind the parietal peritoneum
- Omental bursa: small subdivision posterior to liver and stomach and connects with
greater sac b omental (epiploic) foramen: (surrounding it structures covered with
peritoneum)
o Anteriorly: portal vein, hepatic artery proper and bile duct
o Posteriorly: inferior vena cava
o Superiorly: caudate lobe of liver
o Inferiorly: 1st part of duodenum

In the clinic:

1- Peritoneum:

Peritoneal fluid is found in the cavity to lubricate the movement of viscera and in case of
pathology (cirrhosis, pancreatitis, heart failure) its volume increases called ascites and
cause abdominal distention. The large peritoneal space allows spread of disease and allow
administering treatment also.

2- Ventriculoperitoneal shunts:

In patients with obstructive hydrocephalus a shunt is done in the skull into ventricles and
then through the peritoneal cavity where CSF will drain and be absorbed.

3- Dialysis and peritoneal dialysis:

People with renal failure require dialysis which has 2 methods:

- Hemodialysis: blood taken from circulation to be purified through arteriovenous

fistula in the upper limb or large-bore cannula in the right atrium to aspirate blood.
- Peritoneal dialysis: peritoneum used as dialysis membrane where small tube is
inserted and dialysis fluid is injected to allow exchange of electrolytes and
molecules and the fluid is drained.
4- Peritoneal spread of disease:

Its large surface area allows spread of disease in abdomen and malignancies and upon
surgery tumor may spread. It is also prevents spread to other body cavities and keeps it
under the diaphragm.

5- Perforated bowel:

Caused by perforated duodenal ulcer causes gas release to peritoneal cavity. In severe
pain and subdiaphragm gas patient needs laparotomy.

Omenta, mesenteries, and ligaments:

folds that develop from original dorsal and ventral mesenteries to connect organs to each
other or to abdominal wall and suspend the GIT. Some have nerves and vessels to viscera
and some to maintain their shape.

Omenta:

Has 2 layers of peritoneum which pass from stomach and 1st part of duodenum to other
viscera:

- greater: derived from dorsal mesentery, large apron like fold that attaches to greater
curvature of stomach and 1st duodenum and descends to transverse colon, jejunum
and ileum and posteriorly adheres to transverse colon and mesocolon and finally to
posterior abdominal wall. Contain fats and 2 arteries and veins: right and left gatsro-
omental vessels below stomach.
 - lesser: from ventral mesentery, extends from the lesser curvature of the stomach
and 1st duodenum to inferior liver. It is divided to:
o medial hepatogastric ligament: between stomach and liver
o lateral hepatoduodenal ligament: between duodenum and liver. Ends
laterally as free margin and is anterior border of omental foramen where
there is a hepatic artery proper, bile duct and portal vein. Also inside the
layers there are right and left gastric vessels

in the clinic:

the greater omentum:

when laparotomy (opening of peritoneal cavity) is done it is 1st encountered (policeman of

abdomen) and fatty double-layered vascular membrane which travels to area of
inflammation to wall it oB. Like in case of inflamed bowel, peristalsis stops (paralytic ileus)
it moves there. Also imp site for metastatic tumor spread common in carcinoma of ovary
(transcoelomic route) and becomes thickened (omental cake).

Mesenteries:

Derived from dorsal mesentery, are peritoneal folds attach viscera to posterior abdominal
wall and harbor vessels and nerves and lymphatics:

- the mesentery: ass with parts of small intestine, a large fan shaped double layered
fold that connects jejunum and ileum to post abd. Wall.
o Superiorly attach to duodenojejunal junction left of upper lumbar vertebra
and pass obliquely and right and end in ileocecal junction near right
sacroiliac joint. In the fat between its 2 layers are arteries, nerves and veins
and lymph for jejunum and ileum.
- transverse mesocolon: ass with transverse colon connect it to post abd. Wall across
ant. Surface of head and body of pancreas. In its layers vessels and nerves. And its
anterior layer connected to post. Layer of greater omentum
- sigmoid mesocolon: ass with sigmoid colon, v-shaped fold which has sigmoid and
superior rectal vessels and nerves.

Ligaments:

2 layers of peritoneum connect organs or to body wall. Splenorenal: spleen and left kidney,
gastrophrenic: stomach o diaphragm.
Organs:

Abdominal esophagus:

Short distal part in abdominal cavity emerges through right crus of diaphragm at TX through
the esophageal hiatus to cardial orifice of stomach. And accompanied with anterior and
posterior vagal trunks:

- anterior vagal trunk: several trunks whose fibers come of left vagus nerve
- posterior vagal trunk: single trunk whose fibers come of right vagus nerve

arterial supply:

- esophageal branches from left gastric artery (celiac trunk)

- esophageal branches from left inferior phrenic artery (abdominal aorta)

stomach:

most dilated GIT part J-shaped. Under the abd. Esophagus and above small intestine, in the
epigastric, umbilical and left hypochondrium regions and divided to 4 regions:

- cardia: surrounds opening of esophagus to stomach

- fundus: area above cardial orifice
- body: largest region
- pyloric part: divided to pyloric antrum and canal and is distal end