Abdominal Cavity, Peritoneum, and Esophagus

Catherine C. Lucas, MD
General Surgery

Descending Colon Left

Sigmoid Colon continuation of the of the descending
OUTLINE
colon
(Overview only dont memorize focus on the Topic)
I. Organs of the Abdomen
II. Abdominal Cavity II. Abdominal Cavity
III. Peritoneum A. Boundaries
IV. Peritoneal, Retroperitoneal, and Extraperitoneal
Organs
Superior: Diaphragm
V. Umbilical Folds
VI. Peritoneal Reflections Inferior: Pelvic Brim (at the edge of the pelvic inlet)
VII. Spaces, Recesses, Gutters, and Pouches Anterior: Lower part of the thoracic cage and the abdominal
VIII. Abdominal Esophagus muscles (rectus abdominis, external oblique, & transversus
abdominis)
I. Organs of the Abdomen Posterior: Five lumbar vertebrae (L1 L5) and posterior wall
A. Liver muscles
Laterally: 12th rib, upper part of the pelvis, psoas muscle,
Large organ that occupies the upper part of the abdominal
quadratus lumborum, & aponeurosis of the transversus
cavity
abdominis muscle
Lies almost entirely under ribs and costal cartilages extends
across the epigastric region
III. Peritoneum
Falciform ligament attaches liver to the anterior
A. Definition
abdominal wall
B. Gallbladder Thin serous membrane lining the walls of the abdominal and
Pear-shaped sac that is adherent to the undersurface of the pelvic cavities
right lobe of the liver Clothes the viscera
C. Stomach Peritoneal cavity potential space between parietal and
Dilated part of the alimentary canal between the esophagus visceral layers
and the small intestine. o Males closed peritoneal cavity
It occupies the left upper quadrant, epigastric, and umbilical o Females with communication with exterior via
region. the uterine tubes, uterus, & vagina (prone to
Apron like fatty structure is the GREATER OMENTUM infection)
attached to the greater curvature of the stomach Peritoneal Fluid serous fluid; for lubrication and free
D. Abdominal Esophagus movement
Tubular structure that joins the pharynx to the stomach. B. Layers
Pierces the diaphragm slightly to the left of the midline and
Two layers:
enters the stomach on its right side.
Deeply placed, lying behind the left lobe of the liver 1. Parietal peritoneum lines walls of the abdomen and
E. Small Intestine pelvic cavities
Centrally located a. Sensitive to pain, temperature, and touch
Parts b. Abdominal pain is
i. Somatic
Duodenum ii. Precisely localized
Jejunum iii. Usually severe
Ileum
o Terminal Ileum is connected to the cecum by the
ileocecal junction
F. Large Intestine
Peripherally located
Parts

Cecum
o Appendix at the base of the cecum
Ascending Colon - Right
Transverse Colon Most of the Greater Omentum is
attached to the transverse colon

Huey Javier, RN

1 of 4
 Innervation
Parietal peritoneum lining the
anterior abdominal wall
Central part of the
Diaphragmatic peritoneum
Diaphragmatic peritoneum
Parietal Peritoneum
Lower 6 thoracic nerves
1st Lumbar nerve
Phrenic Nerves
Lower 6 thoracic nerves
Obturator nerve branch of the
lumbar plexus
b. Greater peritoneum may adhere to other
peritoneal surfaces around an infection (infections
are remained localized)
3. Peritoneal Folds suspend the organs in the cavity;
convey blood vessels; lymphatics; and nerves to the organs
4. Large amount of fat for insulation

2. Visceral peritoneum - covers the organs

a. Sensitive to stretch and tearing
b. Over distention of a viscus leads to pain
c. Small and large intestine peritoneum sensitive to
mechanical stretching
d. Innervation: Autonomic afferent nerves pain is
dull and poorly localized

B. Peritoneal Cavity

Peritoneal cavity doesnt contain any structure only peritoneal

fluid in minimal amount so that organs inside can glide along each
other (no friction)

Excess in Peritoneal fluid is called ASCITES:

Portal venous congestion

IV. Peritoneal, Retroperitoneal, and Extraperitoneal Organs
Malignant diseases
A. Peritoneal Organs
Congestive heart failure
Peritoneal organs are almost completely covered by a
visceral peritoneum.
Peritoneal cavity is divided into:
Some books will give you the term intraperitoneal organ, this
is a misnomer, because there are no organs in the
Greater sac
peritoneal cavity.
o Main compartment extends from diaphragm down These organs have increased mobility
to the pelvis Organs involved:
Lesser sac (Omental bursa) o Abdominal Esophagus
o Lies behind the stomach o Stomach
o First part of the Duodenum
Notes: o Jejunum
o Ileum
Greater sac and Lesser sac has an open communication
o Cecum & Appendix
through the Epiploic Foramen of winslow o Transverse & Sigmoid Colon
o Superior Rectum
C. Epiploic Foramen of Winslow o Liver, Gallbladder, and Common Bile Duct
o Spleen
Opening of the lesser sac; oval window
Free communication of the and lesser sac B. Retroperitoneal Organs

Covered with peritoneum only on its ANTERIOR surface

Boundaries of the Epiploic Foramen of Winslow Not freely movable because it is PLASTERED
Anterior: Hepatoduodenal ligament Retroperitoneal Organs
Posterior: Inferior vena cava Primary Both are covered NOT derived from
Superiorly: Caudate loop of liver with peritoneum the gut
Inferiorly: Duodenal bulb Secondary ONLY on its Derived from the gut
ANTERIOR surface, but lost their
partly or completely mesentery during
D. Functions of the Peritoneum
development
1. Peritoneal Fluid
a. With leukocytes
Primary Retroperitoneal Organs Not GIT
b. Ensures that mobile viscera glides easily
2. Peritoneal Coverings 1. Kidney
a. Intestine coverings stick together during 2. Ureter
infections 3. Urinary Bladder
[Gross HSB] Abdominal Cavity, Peritoneum, and Esophagus 2 of 4
 4. Uterus 2 layered
5. Fallopian Tube REMEMBER - Supports hollow viscus attaching it to a body
6. Aorta wall or to another organ
7. IVC o Hollow viscus not solid = butas sa loob
8. Suprarenal glands Example:

1. Mesentery of jejunum and ileum

Secondary Retroperitoneal Organ GIT 2. Mesoappendix
3. Transverse mesocolon
1. Duodenum (2nd-4th) 4. Mesosigmoid
2. Pancreas
3. Ascending & descending colon
4. Middle rectum C. Ligaments

Characteristic

2 layered
Connects viscera usually SOLID ABDOMINAL VISCERA to
each other, to a hollow viscus or to the body wall
Solid organ to solid organ
o Example: Lienorenal ligament
Solid organ to hollow viscus
o Example: Hepatoduodeanl and hepatogastric
ligament
Solid organ to abdominal wall
o Example: Falciform ligament

C. Extraperitoneal Organs
D. Omentum
NO PERITONEAL COVERING AT ALL
Inferior or Lower 3rd of the RECTUM
Characteristics:

V. Umbilical ligaments and folds Connects the stomach with other viscera
Types
A. Umbilical Ligaments
Greater omentum
Definition: Embryological Remnants o 4 layered
o Attached to the greater curvature of stomach
1. Median Umbilical Ligament
o Abdominal policeman walls of to prevent
a. Derived from Urachus spread of infection to the whole abdomen
b. Connects the apex of the urinary bladder to the o Composition:
umbilicus
Gastrocolic ligament
2. Medial Umbilical Ligament Gastrosplenic ligament
a. Obliterated umbilical arteries
Gastrophrenic ligament

B. Umbilical Folds
Lesser omentum
o 2 layered
Definition: Peritoneal folds overlying umbilical ligament and inferior o Connects lesser curvature of stomach,
epigastric vessels duodenum and esophagus to the liver
o Composition:
1. Median Umbilical Fold Hepatoduodenal ligament
a. From apex of the urinary bladder to the umbilicus Hepatogastric ligament
b. Covers the median umbilical ligament Hepatoesophageal ligament
2. Medial Umbilical Fold
a. Overlies the medial umbilical ligament
b. Lateral to the median umbilical fold VII. Spaces, Recesses, Gutter, and Pouches
3. Lateral Umbilical Fold
A. Recesses
a. Lateral to the medial umbilical fold
b. Cover the inferior epigastric arteries
1. Retroduodenal recess
2. Paraduodenal recess
VI. Peritoneal Reflection 3. Superior duodenal recess
4. Inferior duodenal recess
A. Definition 5. Rectocecal recess
6. Superior ileocecal recess
Extensions of the peritoneum 7. Inferior ileocecal recess
8. Intersigmoid recess
B. Mesentery

Characteristics: B. Spaces

[Gross HSB] Abdominal Cavity, Peritoneum, and Esophagus 3 of 4

 1. Right and left anterior subphrenic spaces
a. Between the diaphragm and the liver on each
side of the falciform ligament
2. Right posterior subphrenic space
a. Between the diaphragm, the right kidney and the
right colic flexure

C. Gutters

Paracolic gutters
o On the lateral and medial side of the ascending
colon and descending colon

D. Pouch

Males
o Rectovesical pouch
Females
o Vesicouterine pouch
o Rectouterine pouch
Notes:

Urinary bladder is more anterior, then Uterus, and then

Rectum.

VIII. Abadominal Esophagus

A. Characteristic

Tubular structure about 1.5 2.5 cm in length

Cardiac orifice is the opening of esophagus to the abdomen

Arterial Supply Left Gastric Artery

Inferior Phrenic
Arteries
Venous Drainage Left Gastric Vein to the
Portal Venous
Circulation
Some by Azygos Vein
Innervation Sympathetic
Branches of the
thoracic part of the
sympathetic trunk
Anterior and posterior
gastric nerves (vagi)
Lymph Drainage Left gastric ndoes
Celiac Nodes
Thoracic Ducts

Mnemonics for the 3 structures that pass through the

diaphragm:

I Ate 10 Eggs At 12

I Inferior Vena Cava | ATE At T Eight (T8)

10 At level T10 | Eggs Esophagus *******

At Abdominal Aorta | 12 T12

[Gross HSB] Abdominal Cavity, Peritoneum, and Esophagus 4 of 4