The peritoneum

General features
The peritoneum is a thin serous
membrane that line the walls of the
abdominal and pelvic cavities and
cover the organs within these cavities
Parietal peritoneum lines the
walls of the abdominal and pelvic
cavities
Visceral peritoneum covers the
organs
Peritoneal cavity the potential
space between the parietal and
visceral layer of peritoneum, in the
male, is a closed sac, but in the
female, there is a communication with
the exterior through the uterine tubes,
the uterus, and the vagina
Function
Secretes a lubricating
serous fluid that
continuously moistens
the associated organs
Absorb
Support viscera
The relationship between viscera and peritoneum
Intraperitoneal viscera viscera completely surrounded by peritoneum,
example, stomach, superior part of duodenum, jejunum, ileum, cecum,
vermiform appendix, transverse and sigmoid colons, spleen and ovary
Interperitoneal viscera most part of viscera surrounded by peritoneum,
example, liver, gallbladder, ascending and descending colon, upper part of
rectum, urinary bladder and uterus
Retroperitoneal viscera some organs lie on the posterior abdominal wall
and are covered by peritoneum on their anterior surfaces only, example,
kidney, suprarenal gland, pancreas, descending and horizontal parts of
duodenum, middle and lower parts of rectum, and ureter

Intraperitoneal viscera

Interperitoneal viscera

Retroperitoneal viscera
Interperitoneal viscera
 Structures which are formed by
peritoneum
Omentum
two-layered fold of
peritoneum that
extends from stomach
to adjacent organs
Lessor omentum
two-layered fold of
peritoneum which extends from
porta hepatis to lesser
curvature of stomach and
superior part of duodenum
Hepatogastric ligament
extends from porta hepatis
to lesser curvature of stomach
Hepatoduodenal ligament
Extends from porta hepatis to
superior part of duodenum
Contains common bile duct,
proper hepatic a. and hepatic
portal v.
Omental foramen
Behind the right border
of hepatoduodenal
ligament
Superior caudate lobe
of liver
Inferior superior part
of duodenum
Anterior
hepatodudenal ligament
Posterior peritoneum
covering the inferior
vena cava
Greater omentum
four-layered fold of
peritoneum, the anterior two
layers descend from the
greater curvature of stomach
and superior part of
duodenum and hangs down
like an apron in front of coils
of small intestine, and then
turns upward and attaches to
the transverse colon. If an
infection occurs in the
intestine, plasma cells
formed in the lymph nodes
combat the infection and help
prevent it from spreading to
the peritoneum.
 Lessor omentum

Greater omentum
 Omental bursa
Position situated behind the lesser
omentum and stomach
Walls
Superior peritoneum which covers
the caudate lobe of liver and diaphragm
Anterior formed by lesser omentum,
peritoneum of posterior wall of stomach,
and anterior two layers of greater
omentum
Inferior conjunctive area of anterior
and posterior two layers of greater
omentum
Posterior formed by posterior two
layers of greater omentum, transverse
colon and transverse mesocolon,
peritoneum covering pancreas, left
kidney and suprarenal gland
 Left formed by
the spleen,
gastrosplenic
ligament and
splenorenal ligament

Right formed by
omental foramen
The Omental bursa (lesser
sac) communicates with
the greater sac through
the omental foramen.
Mesenteries or mesocolons
two-layered fold of
peritoneum that attach part
of the intestines to the
posterior abdominal wall
Mesentery
suspends the small
intestine from the
posterior abdominal wall
Broad and a fan-shaped
Consists of two peritoneal
layers
Intestinal border
folded, 7 m long
Radix of mesentery
15 cm long
Directed obliquely from
left side of L2 to in front
of right sacroiliac joint
Mesoappendix
Triangular mesentery
extends from terminal
part of ileum to
appendix
Appendicular artery
runs in free margin of
the mesoappendix
Transverse mesocolon
a double fold of
peritoneum which
connects the transverse
colon to the posterior
abdominal wall
Sigmoid mesocolon
inverted V-shaped, with
apex located in front of left
ureter and division of
common iliac artery
Ligaments
two-layered folds of
peritoneum that attached the
lesser mobile solid visera to
the abdominal wall

Ligaments of liver
Falciform ligament of liver
Consists of double peritoneal
layer
Extends from anterior
abdominal wall (umbilicus) to
live
Free border of ligament site
of ligamentum teres
 Coronary ligament
the area between
upper and lower parts of
the coronary ligament is
the bare area of live, this
area is devoid of
peritoneum and lies in
contract with the
diaphragm
Left and right triangular
ligaments
formed by right extremity
of coronary ligament and
left leaf of falciform
ligament, respectively
 Hepatogastric ligament
Hepatoduodenal
ligament
Ligamentum teres
hepatis
Ligaments of spleen
Gastrosplenic ligament a double layer of peritoneum that
connects the fundus of stomach to hilum of spleen. In this double layer
of peritoneum are the short gastric and left gastroepiploic vessels
Splenorenal ligament extends between the hilum of spleen and
anterior aspect of left kidney. The splenic vessels lies within this
ligament, as well as the tail of pancreas
Phrenicosplenic ligament
Splenocolic ligament
Ligaments of stomach
Hepatogastric ligament
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament
Gastropancrestic ligament
 Folds and recesses of posterior
abdominal wall
Superior duodenal
fold and recess
Inferior duodenal
fold and recess

Intersigmoid recess
formed by the
inverted V attachment
of sigmoid mesocolon
 Retrocecal recess
in which the
appendix frequenty
lies
Hepatorenal recess
lies between the
right lobe of liver, right
kidney, and right colic
flexure, and is the
lowest parts of the
peritoneal cavity when
the subject is supine
 Folds and fossas of anterior
abdominal wall
Medial umbilical fold
contain the remnant of
urachus (median umbilical
ligaments)
Medial umbilical fold
contains remnants of the
umbilical arteries (medial
umbilical ligaments)
Lateral umbilical fold
contains the inferior
epigastric vessels
Supravesical fossa
Medial inguinal fossa
Lateral inguinal fossa
Pouches
In male
rectovesical pouch
In female
Rectouterine pouch
between rectum
and uterus
Vesicouterine pouch
between bladder
and uterus
 Peritoneal subdivisions
The transverse colon and transverse
mesocolon divides the greater sac
into supracolic and infracolic
compartments.

Supracolic compartments
(subphrenic space) lies between
diaphragm and transverse colon
and transverse mesocolon
Suprahepatic recess lies between
the diaphragm and live the
falciform ligament divides it into
right and left suprahepatic
recesses
 Left suprahepatic
recesses
left anterior
suprahepatic spaces
left posterior
suprahepatic spaces
Right suprahepatic
recesses
right anterior
suprahepatic spaces
right posterior
suprahepatic spaces
bare area of live
(extraperitoneal space)
Infrahepatic recess
lies between the live and
transverse colon and
transverse mesocolon the
ligamentum teres hepatic
divides it into right and left
infrahepatic recesses
Right infrahepatic recesses
(hepatorenal recess)
Left infrahepatic recesses
left anterior infrahepatic
space
left posterior infrahepatic
space
Infracolic compartments
lies below the transverse colon
and transverse mesocolon
Right paracolic sulcus (gutter)
lies lateral to the ascending
colon. It communicates with the
hepatorenal recess and the pelvic
cavity. It provides a route for the
spread of infection between the
pelvic and the upper abdominal
region.
Left paracolic sulcus (gutter)
lies lateral to the descending
colon. It is separated from the area
around the spleen by the
phrenicocolic ligament, a fold of
peritoneum that passes from the
colic flexure to the diaphragm.
 Right mesenteric sinus
triangular space, lies between
root of mesentery, ascending
colon, right 2/3 of transverse
colon and transverse mesocolon
Left mesenteric sinus
lies between root of
mesentery, descending colon,
right 1/3 of transverse colon and
transverse mesocolon, its widens
below where it is continuous with
the cavity of the pelvis
Supracolic region
 abdominal part of esophagus
stomach
duodenum
liver
Extrahepatic Biliary Apparatus
spleen
pancreas
 Abdominal aorta
Continuation of
thoracic aorta at
aortic hiatus of
diaphragm in front of
T12
Terminates at lower
border of L4
vertebra by dividing
into right and left
common iliac
arteries
Parietal branches
Inferior phrenic a.
(one pair)
Lumbar a. (four
pairs of arteries that
supply the posterior
abdominal wall)
Median sacral a.
Visceral branches
Paired branches
Middle suprarenal artery
Renal artery
Testicular (ovarian)
artery
 Unpaired branches
Celiac trunk
a short thick vessel
that arises from the
front of aorta, at the
level of T12
Superior mesenteric
a. arises from the
front of aorta, at the
level of L2
Inferior mesenteric a.
arises from the front
of aorta, at level of L3
 Celiac trunk
Left branch Left gastric a.

Right branch Short gastric a.

Common
hepatic a.
Cystic a. Splenic a.
Right gastric a.

Proper hepatic a.

Gastroduodenal a.
Splemic branches

Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
Celiac trunk
 Middle colic a. Superior
Mesenteric v.

Inf. pancresticodudenal a.
Superior
mesenteric a.
Right colic a.

Ileocolic a. Jejunal and ileal a.

Appendicular a.
Inferior mesenteric v.

Inferior mesenteric a.
Left colic a.

Sigmoid a.

Superior rectal a.
Colic marginal artery
Relations of abdominal
aorta
Anteriorly (from above
downward)
Pancreas
Ascending part of
duodenum
Radix of mesentery
Posteriorly
Upper four lumber
vertebrae
On its right
Inferior vena cava
On its left
Left sympathetic trunk
 Veins of abdomen and pelvis
Internal iliac vein
Parietal tributaries: accompany with arteries
Visceral tributaries

superior rectal veininferior mesenteric

v.
Rectal venous plexus inferior rectal veininternal iliac v.
anal veininternal pudendal v.
Vesical venous plexus vesical v.
Uterine venous plexus uterine v.
 External iliac vein
accompany the artery
Common iliac vein
formed by union of
internal and external
iliac veins in front of
sacroiliac joint, end
upon L4~L5 by
uniting each other to
form inferior vena
cava
 Inferior vena cava
Formed by union of two
common iliac veins
anterior to and just to the
right of L4~L5
Ascends on the right side
of aorta, pierces vena
cava foramen of
diaphragm opposite the
T8 and drains into the
right atrium
Conveys blood from the
whole body below the
diaphragm to the right
atrium
Chief tributaries
Parietal
Paired inferior phrenic v.

paired lumbar v. (four)

Visceral
Right and left renal
veins
Right suprarenal vein
(left drain into left renal
vein)
Right testicular or
ovarian v. (left drain into
left renal vein)
Hepatic veins : right, left
and intermediate
Relations of inferior vena cava
Anteriorly (cranially to caudally)
Liver
Head of pancreas
Horizontal part of duodenum
Right testicular (or ovarian) a.
Radix of mesentery
Posteriorly
Right crus of diaphragm
Upper four lumber vertebrae
Left sympathetic trunk
Parietal branches of abdominal aorta
On its right
Psoas major
Right kidney
Right suprarenal gland
On its left
Abdominal aorta
 Hepatic portal vein
General features
Formed behind the neck of
pancreas by the union of
superior mesenteric vein and
splenic vein
Ascends upwards and to the
right, posterior to the first part
of duodenum and then enters
the lesser omentum to the
porta hepatis, where it divides
into right and left branches
There are no functioning
valves in hepatic portal system
Drains blood from
gastrointestinal tract from the
lower end of oesophagus to
the upper end of anal canal,
pancreas, gall bladder, bile
ducts and spleen
Variation and anomalies
of hepatic portal vein
Tributaries of
hepatic portal
vein
1. Superior mesenteric v.

2. Inferior mesenteric v.
3. Splenic v.
4. Left gastric v.
5. Right gastric v.
6. Cystic v.
7. Paraumbilical v.
Portal-systemic anastomoses
1. At the lower end of the oesophagus
Hepatic portal vein left gastric vein esophageal
venous plexus esophageal vein azygos vein
superiorvena cava
2. At rectal venous plexus
Hepatic portal vein splenic vein inferior mesenteric
vein superior rectal vein rectal venous plexus
inferior rectal and anal veins internal iliac vein
inferior vena cava
3. At periumbilical venous plexus
Hepatic portal veinparaumbilical veinperiumbilical
venous plexus
thoracoepigastric and superior epigastric vein
superiorvena cava
superficial epigastric and inferior epigastric veins
inferior vena cava
4. Portal-retroperitoneal anastomosis
Between the retroperitoneal branches of the colic
veins and the lumbar veins,
pancreaticoduodenal veins with the renal veins
and the subcapsular veins of the liver with the
phrenic veins twigs of colic veins (portal)
anastomosing with systemic retroperitoneal
veins
 The lymphatic drainage of
abdomen
Lymphatic drainage of
abdominal wall
To axillary lymph node
from region above
umbilicus
To superficial inguinal
lymph node from region
below umbilicus
To lumbar lymph node
from post wall of
abdomen
Lymphatic drainage of
abdominal viscera
Lumbar lymph nodes
Lie on posterior
abdominal wall, along the
abdominal aorta and
inferior vena cava
Receive lymph from
kidneys, suprarenal
glands, testes, ovaris,
fundus of uterus, ovary,
and common iliac nodes
Right and left lumbar
trunks formed by efferent
vessel
Paired viscera drain to
the lumbar lymph nodes
 Celiac lymph nodes
situated around the
celiac trunk
Superior mesenteric
lymph node situated
around superior
mesenteric a.
Inferior mesenteric
lymph node situated
around inferior mesenteric
a.
Intestinal trunk
formed by efferent vessel
of celiac, superior and
inferior lymph nodes
Thoracic duct
Begins in front of L1 as a dilated sac, the
cisterna chyli, which formed by joining of left
and right lumbar trunks and intestinal trunk
Enter thoracic cavity by passing through the
aortic hiatus of the diaphragm and ascends
along on the front of the vertebral column,
between thoracic aorta and azygos vein
Travels upward, veering to the left at the
level of T5
At the roof of the neck, it turns laterally and
arches forwards and descends to enter the
left venous angle
Just before termination, it receives the left
jugular, subclavian and bronchomediastinal
trunks
Drains lymph from lower limbs, pelvic cavity,
abdominal cavity, left side of thorax, and left
side of the head, neck and left upper limb
 Spleen
Location: lies in the left
hypochondriac region
(between stomach
and diaphragm) deep
to the 9th to 11th rib,
its long axis
corresponds roughly
to the 10th rib
Shape reddish in
colour
Two surfaces
Diaphragmatic: smooth, convex
Visceral: concave, hilum of spleen
Two extremities
Anterior wider
Posterior rounder
Two border
Superior has 2-3 splenic notch, which
serve as a landmark on palpation when it is
enlarge; normally it is not palpable
Inferior rounder
Functions: the spleen is considered to be
important in:
Formation of lymphocytes and monocyte
Phagocytosis of bacteria, inert particles and
white blood cells and platelets
Destroying effete or abnormal red blood cells
Making antibodies
 Spleen
Function
Erythrocyte storage
Phagocytosis
Cytopoiesis
Immune responses
 Relationships of spleen
Diaphragmatic surface
diaphragm
Visceral surface
Anteriorly fundus of
stomach
Posteriorly left
suprarenal gland and
kidney
Inferiorly tail of
pancreas and left colic
flexure