Download Abdomen

Marilyn Rose
Abdominal cavity
***Between the diaphragm and sacral promontory*****
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Peritoneum
 Thin serous membrane
 Parietal- lines abd walls
 Visceral- covers organs
 The cavity houses- liver (except bare area), GB,
spleen, stomach, ovaries and most intestines
 Males- closed cavity
 Females- 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.
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 Mesentery encloses intestines and attaches them
to the abd wall
 Omentum- mesentery attaching to stomach
○ Greater- connects > curve of sto to spleen/ TRV
colon
○ Lesser- connects duodenum, < curve to liver.
Ligaments
 3: > omental ligaments:
○ Gastrocolic, gastrosplenic and gastrophrenic
 2: < omental:
○ Hepatogastric, hepatoduodenal
 2: 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 colon
 R/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
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Infracolic compartment
 Below transverse colon
 R/L infracolic spaces
○ Divided by mesentery of small intestine
 paracolic 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.
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Kidneys/ ureters
Adrenal glands
Pancreas
Duodenum/ ascending/descending colon
AO
Inferior vena cava
Bladder
Uterus
Prostate gland
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Retroperitoneum
Retroperitoneal Spaces
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Anterior pararenal space
 Between Grota’s fascia/ post peritoneum
 Ascending/descending colon and pancreas and
duodenum.

Posterior pararenal space
 Posterior renal fascia and muscles of posterior abd
wall (only fat and vessels in this space)

LT/RT perirenal space areas directly around
kidney
 This 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- bifurcatesRt/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
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SMA
○ L1- inferior to celiac and descends behind pancreas

Renal arteries
 Arise from lateral walls of AO
 Below SMA
 RRA longer than left and passes posterior to IVC
FYI: Renal artery stenosis can lead to HTN!!!!!
Normal
Abnormal
Inferior Vena Cava
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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
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Hepatic veins
 3 – Rt/ Middle/ Lt
 Collects blood from liver parenchyma
 Drain 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???
TIPSRA-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: