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2011-12-08 21:17:49
17 peritoneal cavity abdominal wall

the peritoneal cavity and abdominal wall
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  1. peritoneum
    smooth membrane that lines abd cavity and covers organs
  2. parietal peritoneum
    lines abd wall
  3. visceral peritoneum
    covers organs
  4. male vs. female
    • closed cavity in male
    • female have communication through uterine tubes, uterus, and vagina
  5. mesentery
    a fold from pertioneum that attaches the small intestine, anchoring it to the posterior abd wall
  6. greater sac
    general peritoneal cavity
  7. lesser sac
    • omental bursa
    • stomach and spleen
    • peritoneal recess posterior to stomach
    • panc enzymes can eat into space
  8. epiploic foramen
    • communication btw greater and lesser sac
    • small vertical opening
    • inferior to liver, superior to duodenum
  9. lesser omentum
    sling like double layer of peritoneum that from liver to lesser curve of stomach which suspends stomach from liver
  10. greater omentum
    • apron like fold of peritoneum that hangs from the freater curvature of the stomach
    • fused with transverse colon and mesocolon
    • profuse blood vessles
  11. abdominal wall
    paired rectus abdominis muscles dilineated medially by linea alba

    • external oblique
    • internal oblique
    • trasnversus abdominis
  12. ascites
    • accumulation of serous fluid in the peritoneal cavity
    • first fills pouch of douglas
    • then lateral paravesiclal recesses
    • down paracolic gutter
    • liver disease/cancers
    • meigs syndrom- ascites ple eff (thecoma/fibroma)

    look for loculation and internal echos for malignancy
  13. abcess
    • cavity formed by necrosis- pus
    • fever, tenederness, infection, increased wbc (leukocytosis), sepsis- bacterial cultures
    • gas filled- see air scattering
  14. 5 pathways bacteria enters liver
    • portal system
    • ascending choloangitis of common bile duct (most common us)
    • hepatic artery- bacteremia
    • direct extension from infection
    • implantation of bact. after trauma to abd wall
  15. biloma abcess
    extrahepatic loculated collections of bile from trauma or rupture of biliary tree
  16. renal carbuncle
    abcess that forms in renal parechyma
  17. abdominal cysts can be from
    • embryologic
    • traumatic/aquired
    • neoplastic
    • infective and degenerative origin
  18. urachal cysyts
    • incomplete regression of urachus during development
    • ligament that runs from apex of bladder to umbilicus (median umbilical ligament)
    • urachus- takes waste out of embryo
  19. urinoma
    • encapsulated collection of urine
    • closed renal injury or surgery
  20. metastasis
    most common primary sites are pancreas, biliary tract, kidneys, testicles, uterus
  21. peritoneal and omental mesothelioma
    middle age men exposed to asbestos
  22. lymphoceles
    collection of fluid that occurs after surgery in pelvis, retroperitoneu. or recess cavities

    looks like fluid collection
  23. extraperitoneal hematoma
    rectus sheath hematomas are acute or chronic colelction of blood luing within the rectus muscle or btw the muscle and sheath.

    trauma, pregnancy, cardiovascular and degenerative muscle diseas, surgical injury, anticoagulation therapy, steroids, excersize
  24. bladder-flap hematoma
    a collection of blood btw the bladder and LUS from lower uterine transverse c-section and bleeding from uterine vessles
  25. subfascial hematoma
    • pervesicular space
    • caused by disruption of inferior epigastric vessles or branches suring c-section
  26. neoplasms of abd wall
    lipomas, desmoid tumors (benign fibrous neoplasm of aponuretic structures), mets
  27. hernia
    protrusion of peritoneal sac through defect in weakened abd wall

    umbilical, femoral/inguinal rings

    • can cause edema and strangulation of bowel- necrotic
    • (sac, contents of sac, covering of sac)

    • can be epigastric, and at rectus abdomonis
    • valsalva manuever helps visualize it