peritoneum, functions, peritoneal reflections, their anatomy, mesenteries, the omental cake, clinical applications

1. PERITONEAL REFLECTIONS
Mudoogo Edgar

2. quick review
• Peritoneum- thin serous membrane lines the walls of the
abdominal cavity
• 2 KINDS
– Parietal
– Visceral
Any functions???
1. wall off infection & localize it
2. store fat
3. House and protect blood vessels
4. sensitive
– Visceral : Stretch
– Parietal : Pain, Temperature, touch & pressure

4. Dfn:Folding back or bending of the peritoneum
The peritoneal reflections include:
• omenta,
• mesenteries,
• Ligaments-
• folds and fossae.
Many of them contain the blood vessels,
lymphatics, and nerves that from the
abdominal wall passed to viscera.
Peritoneal reflections

5. • Greater Omentum
• Connects the greater
curvature of the
stomach to transverse
colon.
• It hangs like an apron in
front of the small
intestine
• It is folded back on
itself to be attached to
the transverse colon.
• Largest peritoneal
reflection in the body

7. Functions of the Greater
Omentum
• prevents the visceral peritoneum from
adhering to the parietal peritoneum
• considerable mobility
• forms adhesions adjacent to an inflamed
organ such as the appendix
• cushions the abdominal organs against
injury
• forms insulation against loss of body
heat

8. Lesser Omentum
• also called small omentum;
gastrohepatic omentum
• Connects liver to stomach
attached above to porta
hepatis & fissure for
ligamentum venosum
inferiorly to lesser curvature
of the stomach,& 1st inch of
duodenum.
• Its free margin contains:
• Portal vein: Posterior
• Bile duct : Anterior & right
• Hapatic artery: anterior
&left
• Gastrosplenic ligament
• Splenicorenal or lienorenal
ligament

9. Mesentery
 large, fan-shaped, double-layered fold of
peritoneum
 connecting viscera to abdominal wall
 provides a means for neurovascular
communication between the organ and the body
wall .
 The mesentery (of the small intestine) It is a
broad, fan-shaped fold of peritoneum connecting
the coils of jejunum and ileum to the posterior
abdominal wall.
 Mesocolon-mesentery of the colon

10. Mesentery of the
small intestines
Arcades of
arteries and veins

11. The radix (root) of
mesentery is the portion
attached to the posterior
wall of the abdomen.
Transverse mesocolon
Sigmoid mesocolon

13. The mesoappendix (mesentery of the appendix)

14. Mesoappendix-attaches the appendix to the
terminal ileum. Contains the appendicular vessels

15. Peritoneal folds
• reflection of peritoneum that is raised from
the body wall by underlying blood vessels,
ducts, and obliterated fetal vessels.
– Median umbilical fold
– 2 medial umbilical folds
– 2 lateral umbilical folds

16. Median umbilical fold
Lateral umbilical fold
Medial umbilical fold
Median umbilical lig.
Medial umbilical lig.
Inferior epigastric a.Lateral umbilical fossa
Medial umbilical fossa
Supravesical fossa
Urinary bladder

17. In the clinic
Two lateral umbilical folds
• cover the inferior epigastric vessels and therefore
bleed if cut
Peritoneal cavity
• Has a large s.a for administering drugs and operattions
Omentectomy
refers to the surgical removal of the omentum, a relatively
simple procedure with no major side effects, that is
performed in cases where there is concern that there may
be spread of cancerous tissue into the
omentum.(intestinal. Ovarian and appendix cancer)
RESEARCH: affects insulin senstivity

18. Omental infarction
• Necrosis of the greater
omentum caused by an
acute vascular disorder
Omental cake
• thickening of the greater
omentum secondary to
omental peritoneal
metastasis due to
metastatic deposits

19. CT SCAN

20. Any questions?