Peritoneal Specializations and Associated Structures
|
| Specialization |
Location/Description |
Notes |
| gastrocolic ligament (N261,TG5-12,N264,TG5-18) |
peritoneum connecting the greater curvature of the stomach with the transverse colon |
part of the greater omentum; derived from the dorsal mesogastrium in the embryo |
| gastrolienal ligament |
peritoneum connecting the greater curvature of stomach with the hilum of the spleen |
part of the greater omentum; derived from the dorsal mesogastrium in the embryo; also known as: gastrosplenic ligament |
| gastrophrenic ligament (TG5-29) |
peritoneum connecting the fundus of the stomach to the left side of the diaphragm above the spleen |
part of the greater omentum; derived from the dorsal mesogastrium in the embryo |
| gastrosplenic ligament (N264,TG5-18) |
peritoneum connecting the greater curvature of stomach with the hilum of the spleen |
part of the greater omentum; derived from the dorsal mesogastrium in the embryo; also known as: gastrolienal ligament |
| greater omentum (adult dorsal mesogastrium) (N261,TG5-12) |
apron-like specialization of peritoneum attaching along the greater curvature of the stomach |
subdivisions: gastrophrenic ligament, gastrosplenic ligament, gastrocolic ligament, omental apron (Latin, omentum = the membrane which encloses the bowels) |
| greater peritoneal sac |
the portion of the peritoneal cavity that is not located posterior to the stomach |
the lesser peritoneal sac is the only part of the peritoneal cavity that is not part of the greater peritoneal sac |
| hepatoduodenal ligament (N267,TG5-18, TG5-19) |
part of the lesser omentum connecting the liver to the 1st part of duodenum |
hepatoduodenal ligament contains the bile duct, proper hepatic a. and portal v.; it forms the anterior wall of the omental (epiploic) foramen |
| hepatogastric ligament (N267,TG5-18) |
part of the lesser omentum connecting the liver to the lesser curvature of the stomach |
hepatogastric ligament forms the anterior wall of the lesser peritoneal sac |
| omental bursa (N264,TG5-18,N265,N335,N336,TG5-42) |
part of the peritoneal cavity located posterior to the stomach and lesser omentum |
omental bursa is continuous with the greater peritoneal sac at the omental (epiploic) foramen; also known as: lesser peritoneal sac |
| omental foramen (N264,TG5-18,N267,TG5-18) |
passageway between the greater peritoneal sac and the lesser peritoneal sac |
located posterior to the hepatoduodenal ligament; also known as: epiploic foramen |
| lesser omentum (adult ventral mesogastrium) (N267,TG5-18) |
peritoneum stretching between the lesser curvature of the stomach and the visceral surface of the liver |
subdivisions of the lesser omentum are the heptogastric and hepatoduodenal ligaments; lesser peritoneal sac (omental bursa) lies posterior to the lesser omentum and stomach (Latin, omentum = the membrane which encloses the bowels) |
| lesser peritoneal sac (TG5-18) |
part of the peritoneal cavity located posterior to the stomach and lesser omentum |
lesser peritoneal sac is continuous with the greater peritoneal sac at the omental (epiploic) foramen; also known as: omental bursa |
| lienorenal ligament |
peritoneum that attaches the spleen to the posterior abdominal wall over the left kidney |
lienorenal ligament develops from the dorsal mesogastrium of the embryo; also known as: splenorenal ligament |
Nerves
|
| Nerve |
Source |
Branches |
Motor |
Sensory |
Notes |
| vagus n.(TG5-40, TG7-13, TG7-15, TG7-25) |
medulla: dorsal motor nucleus (GVE preganglionic parasympathetic); inferior ganglion (GVA); nucleus ambiguus (SVE); superior ganglion (GSA); inferior ganglion(SVA) |
auricular br., pharyngeal br., superior laryngeal, superior and inferior cervical cardiac brs., recurrent laryngeal n., thoracic cardiac brs., brs. to the pulmonary plexus, brs. to the esophageal plexus, anterior and posterior vagal trunks |
SVE: intrinsic muscles of the larynx, pharynx (except stylopharyngeus), and palate (except tensor veli palatini); GVE: smooth muscle of the respiratory tree & gut (proximal to the left colic flexure), heart; secretomotor: mucous glands of the larynx, respiratory tree, pharynx and gut; secretomotor to digestive glands |
GSA: skin of the external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to the left colic flexure; SVA: taste from the epiglottis |
also known as: CN X, 10th cranial nerve; the vagus n. passes through the jugular foramen to exit the posterior cranial fossa; (Latin, vagus = wanderer, so called because of its wide distribution to the body cavities) |
| celiac ganglion (TG5-39, TG5-40) |
preganglionic sympathetic axons arrive via the greater thoracic splanchnic n. |
postganglionic sympathetic axons distribute via the celiac plexus along brs. of the celiac trunk |
vascular smooth muscle of the brs. of the celiac trunk |
pain from the stomach, liver & biliary system, spleen, upper half of the duodenum & pancreas |
a sympathetic ganglion; usually 2 celiac ganglia are located on the abdominal aorta at the origin of the celiac trunk; brs. of the vagal trunks pass through the celiac ganglion without synapsing (Greek, celiac = belly + ganglion = a swelling or knot) |
Arteries
|
| Artery |
Source |
Branches |
Supply to |
Notes |
| celiac trunk (N255,TG5-33) |
abdominal aorta at the level of the T12-L1 intervertebral disc |
left gastric a., splenic a., common hepatic a. |
stomach, lower esophagus, liver, upper duodenum, pancreas, spleen |
celiac trunk supplies the foregut derivatives (Greek, celiac = belly) |
| gastric, left (N290,TG5-19) |
celiac a. |
esophageal brs. |
superior part of the stomach near the lesser curvature |
left gastric a. anastomoses with the right gastric a. on the lesser curvature of the stomach; it also anastomoses with the esophageal brs. of the thoracic aorta |
| splenic (N291,TG5-27B,TG5-27C) |
celiac trunk |
dorsal pancreatic, pancreatic brs., pancreatica magna, caudal pancreatic, short gastric, left gastro-omental, splenic brs. |
pancreas, spleen, greater curvature of stomach |
|
| gastric, right (N290,TG5-19) |
proper hepatic a. |
no named branches |
inferior part of the stomach near the lesser curvature |
right gastric a. anastomoses with the left gastric a. on the lesser curvature of the stomach |
| gastric, short (N291,TG5-27B,TG5-27C) |
splenic a. |
no named branches |
fundus and upper part of the stomach near the greater curvature |
short gastric aa. reach the stomach by passing through the gastrosplenic ligament; they are usually 4-5 in number |
| gastro-omental, left (N290,TG5-19,N291) |
splenic a. |
gastric brs., omental brs. |
mid-part of the stomach near the greater curvature; greater omentum |
left gastro-omental a. anastomoses with the right gastro-omental a. near the greater curvature of the stomach; also known as: left gastroepiploic a. |
| gastro-omental, right (N290,TG5-19,N291) |
gastroduodenal a. |
gastric brs., omental brs. |
lower part of the pyloric region of the stomach, right part of greater curvature of the stomach, greater omentum |
right gastro-omental a anastomoses with the left gastro-omental a. near the greater curvature of the stomach; also known as: right gastroepiploic a. |
| gastroduodenal (TG5-27,TG5-27) |
common hepatic a. |
supraduodenal aa., retroduodenal aa., posterior superior pancreaticoduodenal a., anterior superior pancreaticoduodenal a., right gastro-omental a. |
upper duodenum, upper part of the head of the pancreas; greater curvature of the stomach on the right |
gastroduodenal a. supplies the lowest portion of the foregut and its derivatives (Latin, duodeni = 12 each, the duodenum is about 12 finger breadths long) |
| hepatic, common (N290,TG5-19) |
celiac trunk |
gastroduodenal a., proper hepatic a. |
liver, upper parts of the duodenum, upper part of the pancreas, right side of the stomach |
common hepatic a. supplies some of the foregut derivatives |
| hepatic, proper (N290,TG5-19) |
common hepatic a. |
right gastric, right & left hepatic |
liver, lesser curvature of the stomach |
proper hepatic a. supplies the foregut derivatives associated with the liver bud |
| celiac trunk |
abdominal aorta at level of T12-L1 intervertebral disc |
left gastric, splenic, common hepatic |
stomach, lower esophagus, liver, upper duodenum, pancreas, spleen |
(Greek, celiac = belly; the celiac artery supplies the principal organs of the belly) |
| gastroduodenal (TG5-27) |
common hepatic |
supraduodenal aa., retroduodenal aa., posterior superior pancreaticoduodenal a., anterior superior pancreaticoduodenal a., right gastro-omental a. |
upper duodenum, upper part of head of pancreas; greater curvature of stomach on right |
|
| gastro-omental, left (TG5-27) |
splenic |
gastric, omental |
mid-part of greater curvature of stomach; greater omentum |
anatomoses with right gastro-omental a.; also known as: left gastroepiploic a. |
| gastro-omental, right (TG5-27) |
gastroduodenal |
gastric, omental |
lower part of pyloric part of stomach, right part of greater curvature of stomach, greater omentum |
anastomoses with left gastro-omental; also known as: right gastroepiploic a. |
| supraduodenal |
gastroduodenal |
|
1st part of duodenum superiorly |
|
| pancreatic, caudal (TG5-27) |
splenic |
|
tail of pancreas |
|
| pancreatic, dorsal (TG5-27) |
splenic |
right br., left br. |
pancreas near neck |
right br. anastomoses with anterior superior pancreaticoduodenal in prepancreatic arcade |
| pancreatic, inferior (TG5-27) |
dorsal pancreatic, left br. |
|
lower part of body of pancreas |
|
| pancreatic, superior (TG5-27) |
splenic (multiple small brs.) |
|
superior part of body of pancreas |
|
| pancreatica magna (great pancreatic) (TG5-27) |
splenic |
|
body of pancreas |
|
| pancreaticoduodenal, anterior inferior (TG5-27) |
inferior pancreaticoduodenal, from superior mesenteric |
pancreatic brs., duodenal brs. |
lower duodendum & head of pancreas |
anastomoses with anterior superior pancreaticoduodenal in anterior pancreatic arcade |
| pancreaticoduodenal, anterior superior (TG5-27) |
gastroduodenal |
pancreatic brs., duodenal brs. |
upper duodenum & head of pancreas |
anastomoses with anterior inferior pancreaticoduodenal in anterior pancreatic arcade |
| pancreaticoduodenal, inferior (TG5-27) |
superior mesenteric |
anterior & posterior inferior pancreaticoduodenal |
lower duodenum & head of pancreas |
|
| pancreaticoduodenal, posterior inferior (TG5-27) |
inferior pancreaticoduodenal, from superior mesenteric |
pancreatic brs., duodenal brs. |
lower duodendum & head of pancreas |
anastomoses with posterior superior pancreaticoduodenal in posterior pancreatic arcade |
| pancreaticoduodenal, posterior superior (TG5-27) |
gastroduodenal |
pancreatic brs., duodenal brs. |
upper duodenum & head of pancreas |
spiral around the bile duct; anastomoses with posterior inferior pancreaticoduodenal in posterior pancreatic arcade |
Veins
|
| Vein |
Tributaries |
Drains Into |
Regions Drained |
Notes |
| esophageal (TG4-40) |
|
azygos and hemiazygos vv. |
esophagus |
connect with esophageal brs. of left gastric, forming potential portal-caval anastomosis (esophageal varices when enlarged) |
| portal (TG5-22, TG5-26) |
formed by union of superior mesenteric & splenic vv.; tributaries: posterior superior pancreaticoduodenal v., right & left gastric vv. |
right & left branches of portal v., into liver sinusoids |
|
connects with caval drainage at 1) esophagus, 2) rectum, 3) umbilicus, 4) retroperitoneal gut structures |
| hepatic, left (TG5-25) |
segmental vv. |
inferior vena cava |
lateral segment & superior portion of medial segment of left lobe of liver |
|
| hepatic, middle (TG5-25) |
segmental vv. |
inferior vena cava |
inferior portion of medial segment of left lobe of liver, & inferior part of anterior segment of right lobe |
|
| hepatic, right (TG5-25) |
segmental vv. |
inferior vena cava |
posterior segment & superior portion of anterior segment of right lobe of liver |
|
| gastric, left (TG5-28) |
esophageal vv. |
portal v. |
lesser curvature of stomach, lower esophagus |
connects with esophageal vv., forming portal-caval venous anastomosis (esophageal varices when enlarged); also known as: coronary v. |
| gastric, right (TG5-28) |
|
portal v. |
lesser curvature of stomach |
also known as: coronary v. |
| gastro-omental, left (TG5-28) |
gastric & omental brs. |
splenic v. |
greater curvature of stomach & greater omentum |
also known as: left gastroepiploic v. |
| gastro-omental, right (TG5-28) |
gastric & omental brs. |
superior mesenteric v. |
greater curvature of stomach & greater omentum |
also known as: right gastroepiploic v. |
| mesenteric, superior (TG5-26, TG5-27) |
pancreticoduodenal, jejunal, right and middle colic |
portal v. |
gut |
|
| pancreaticoduodenal, posterior superior |
|
portal v. |
posterior part of head of pancreas & 1st & 2nd part of duodenum posteriorly |
connects with posterior inferior pancreaticoduodenal |
| pancreaticoduodenal, inferior |
anterior & posterior inferior pancreaticoduodenal |
superior mesenteric v. |
lower part of duodenum & head of pancreas |
connects with anterior & posterior superior pancreaticoduodenal vv. |
| pancreaticoduodenal, anterior superior |
|
unites with right gastro-omental v. to drain to superior mesenteric |
upper duodendum & head of pancreas anteriorly |
connects with anterior inferior pancreaticoduodendal v. |
| splenic v. (N299,N302,TG5-20, TG5-28) |
proper splenic vv., pancreatic brs. |
unites with SMV to form portal v. |
spleen |
multiple proper splenic vv. emerge from the hilum of the spleen and join to form the splenic v. |
| mesenteric, inferior (TG5-28) |
superior rectal, sigmoid, left colic vv. |
splenic v. (or superior mesenteric v.) |
gut from splenic flexure distally |
courses lateral to 4th part of duodenum |
| portal v. (N299,N302,TG5-28) |
formed by the union of the superior mesenteric v. and the splenic v.; tributaries: posterior superior pancreaticoduodenal v., right gastric v., left gastric v. |
divides into right and left branches before entering the liver; into the liver sinusoids |
all of the gut and its glands |
portal v. connects with the vena caval drainage at 1) esophagus, 2) rectum, 3) umbilicus, 4) retroperitoneal gut structures; portal v. courses between two capillary beds (gut and liver) |
| gastric, left (N299,N302,TG5-28) |
esophageal vv.; gastric brs. |
portal v. |
lesser curvature of the stomach, lower part of the esophagus |
left gastric v. communicates with the esophageal vv., forming a portal-caval venous anastomosis (esophageal varices when enlarged); the left gastric v. and right gastric v. are together called the coronary v. because they form a circle |
| gastric, right (N299,N302,TG5-28) |
gastric brs. |
portal v. |
lesser curvature of the stomach |
the left gastric v. and right gastric v. are together called the coronary v. because they form a circle |
Viscera
|
| Organ/Part of Organ |
Location/Description |
Notes |
| esophagus (N228,TG4-37,N267,TG5-18) |
the portion of the gastrointestinal tract between the pharynx and the stomach |
connects: superiorly with laryngopharynx at lower border of cricoid cartilage; inferiorly it passes through diaphragm at the T10 vertebral level to reach the stomach; the upper 1/3 is skeletal muscle innervated by the recurrent laryngeal, the lower 2/3rds is smooth muscle innervated by the vagus nn. via the esophageal plexus |
| spleen (N264,TG5-18,N265,N267,TG5-18,N289,TG5-20,TG5-20) |
lymphatic organ suspended within the greater omentum in the upper left quadrant |
spleen is connected to the greater curvature of the stomach by the gastrosplenic (gastrolienal) ligament; it is connected to the left kidney by the splenorenal (lienorenal) ligament; spleen is covered by visceral peritoneum on all of its surfaces |
| stomach (N267,TG5-18) |
dilated portion of the digestive system located primarily in the upper left quadrant |
stomach rotates during embryonic development so that the lesser curvature (originally the anterior surface) faces superiorly and to the right, the greater curvature (originally the posterior surface) faces inferiorly and to the left |
| stomach, body of (N267,TG5-18) |
part of the stomach between the fundus and the pylorus |
mucosal surface of the body of the stomach near the lesser curvature has gastric folds |
| stomach, fundus of (N267,TG5-18) |
expanded superior part of the stomach above the entrance of the esophagus |
fundus may contain a gas bubble in X rays of patients filmed in a standing position (Latin, fundus = bottom) |
| angular notch of stomach (N267,TG5-18) |
bend along lesser curvature |
marks transition from body to pylorus |
| cardiac portion of stomach (N267,TG5-18) |
area around the opening of the esophagus |
joined by esophagus |
| pylorus of stomach (N267,TG5-18) |
constricted lower part, containing pyloric antrum & sphincter |
the antrum exists as the path from the body to the pylorus region of the stomach; the sphincter leads from the pylorus to the duodenum (Latin, pylorus = gatekeeper) |
| rugae of stomach (N268,TG5-19) |
folds of the mucosal lining of the stomach |
(Latin, rugae = a wrinkle) |
| bile duct (N280,TG5-24,N285,TG5-24,N290,TG5-19,N292,TG5-27) |
union of cystic & common hepatic ducts |
drains to hepatopancreatic ampulla & greater duodenal papilla with main pancreatic duct |
| duodenojejunal junction (TG5-17) |
suspended by suspensory muscle (ligament) of duodenum |
inferior mesenteric v. passes to left side |
| intestine, small (TG5-17) |
|
3 parts: duodenum (1 foot long, mostly retroperitoneal); jejunum (8 feet long); ileum (12 feet long) |
| duodenum (TG5-17) |
C-shaped proximal segment of small intestine |
4 parts: 1st or superior, 2nd or descending, 3rd or transverse, 4th or ascending (Latin, duodenum = 12, for it was estimated to be twelve finger-breadths long) |
| fusion fascia (TG5-29) |
a relatively avascular connective tissue plane formed behind secondarily retroperitoneal structures |
|
| greater duodenal papilla (TG5-26) |
an eminence on the posteromedial wall of the descending duodenum |
location of the opening of the hepatopancreatic duct (Latin, papilla = a nipple) |
| lesser duodenal papilla (TG5-26) |
located just superior to the greater duod. papilla |
location of the opening of the accessory pancreatic duct (Latin, papilla = a nipple) |
| pancreas (TG5-27) |
|
functions as digestive & endocrine gland; main pancreatic duct drains tail, body & lower head to greater duodenal papilla within 2nd part of duodenum; accessory pancreatic duct drains upper head to lesser duodenal papilla |
| pancreas, body of (TG5-27) |
stretches to left from neck; continuous with tail |
splenic a. lies on superior border, splenic v. lies posterior to body |
| pancreas, head of (TG5-27) |
right-most part |
lies within C-shaped curve of duodenum |
| pancreas, neck of (TG5-27) |
junction between head & body extending to left |
superior mesenteric a. arises posterior to neck |
| pancreas, tail of (TG5-27) |
left-most extent of pancreas, extending toward hilum of spleen within splenorenal ligament |
|
| pancreas, uncinate process of (TG5-27 |
lowest part of pancreas |
tip of uncinate process lies posterior to superior mesenteric vessels |
| pancreatic duct, accessory (TG5-26) |
drains upper head of pancreas |
opens onto lesser duodenal papilla |
| pancreatic duct, main (TG5-26) |
drains tail, body & lower head of pancreas |
unites with the bile duct at hepatopancreatic ampulla |
| circular folds of the pyloric sphincter (N279, TG5-26C) |
2nd part of the pyloric sphincter |
more like the duodenum than the stomach |
Clinical Terms
|
| Term |
Definition |
| gastric & duodenal ulcers |
a local defect, or excavation, of the surface of an organ or tissue, which is produced by the
sloughing of inflammatory necrotic tissue. The bacteria H. pylori plays an important role
in the pathogenesis of both types of ulcers. Patients typically present with epigastric pain
(from food in stomach for gastric ulcers and from a lack of food in duodenum for
duodenal ulcers) as well as satiety and possibly nausea. |
| vagotomy |
cutting of the vagus nerve. Effects of bilateral vagotomy (cholinergic denervation), 1) decreased motility of stomach and intestine, 2) decreased gastric secretions, 3) decreased tone of gallbladder and bile duct, 4) increased tone of sphincters (Oddi and lower esophageal sphincter) |
| gastrectomy |
A surgical procedure where all or a portion of the stomach is removed. Indicated in some cases of intractable gastric ulcers. |
| splenectomy |
surgical removal of the spleen. This is sometimes done in leukemia or lymphoma as part of a patient's treatment. The splenic capsule may rupture as a result of trauma. |
| splenomegaly |
enlargement of the spleen. |
| pyloric stenosis |
a congenital disorder in which the pylorus is thickened causing obstruction of the gastric outlet (to the duodenum). More common in males. Symptoms of projectile vomiting begin several weeks after birth, and the emesis is non-bilious. Treatment is a surgical procedure called a pyloromyotomy where the muscular layers of the pylorus are cut all the way down to the mucosa in order to relieve the pressure. (Latin, pylorus = gatekeeper + stenosis = a narrowing) |
| gastroscopy |
examination of the abdomen/stomach with a fiber optic scope. |
| crepitus |
a crackling sound in the lungs or a grating feeling. (Latin, crepo = to rattle) |
| exsanguination |
deprivation of blood or loss of blood. |
| hematocrit |
volume of blood occupied by red blood cells. The average for an adult is 45 mls of packed red blood cells in 100 mls of blood. |
| peritoneal lavage |
a diagnostic technique performed after trauma to wash out the peritoneal cavity. (Latin, lavo = to wash) |
| pancreatitis |
acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic and which is due to autodigestion of pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis or uremia. |
| pancreatic cancer |
a malignant growth of the pancreas. More than 90% are ductal adenocarcinomas with islet cell carcinomas making up the difference. Symptoms include abdominal pain, abdominal swelling, jaundice, weight loss and anorexia. |
| Kocher manuever |
reflecting the duodenum and pancreas medially by cutting through the
fusion fascia along the right side of the descending part of the duodenum.
This maneuver is used to gain access behind the pancreas. |
| duodenal stenosis |
narrowing of the duodenum. May be congenital or the result of neoplastic growth. (Latin, stenosis = a narrowing) |
| duodenal atresia |
congenital duodenal atresia (blind end) of the duodenum, caused by a failure of recanalization of the duodenal lumen during development. It should be noted that 70% of patients with duodenal atresia also have other malformations including Down's Syndrome, cardiac or GI defects. (Greek, atresia = without hole) |
