Overview of Peritoneum Vertical & Horizontal Reflection of Peritoneum

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Overview of Peritoneum  Vertical & Horizontal Reflection of Peritoneum Powered By Docstoc
					      Overview of
       Peritoneum
  Vertical & Horizontal
Reflection of Peritoneum
    Dr. Muhammad Rafique
        Anatomy, DIMC
                Objectives
Defined the Peritoneum
Mention the abdominal cavity
Discuss the extent of peritoneum and formation of
 peritoneal cavity
Describe the Parietal and Visceral Peritoneum
Discuss formation of peritoneum and formation of
 folds, ligaments, mesenteries and omenta
Know gross anatomy of liver
Have the knowledge of development of peritoneum
 and peritoneal cavity
Discuss the vertical and horizontal reflections of
 peritoneum
         Definition of Peritoneum
The Peritoneum is
  largest serous
  membrane of the
  body. The
  peritoneum lines the
  internal surfaces of
  abdominal cavity. In
  male, it forms a
  closed sac while in
  female it connected
  to exterior by means
  of lateral ends of
  fallopian tubes of
  uterus.
               Abdominal Cavity
The abdominal cavity extends above
  the costal margin usually up to
  the level of fifth intercostals
  space
Above it is bounded by the
  diaphragm
Laterally and above by the lower
  part thoracic cage
Below and laterally flat muscles of
  abdomen
Below it becomes continuous with
  pelvic cavity
Inner surface of abdominal cavity
  lines by the peritoneum
            Extent of Peritoneum
The peritoneum lines the
 internal surfaces of
 abdominal cavity, it
 covers the posterior
 surface of anterior
 abdominal wall, under
 (abdominal) surface of
 diaphragm and then
 anterior surface of
 posterior abdominal wall;
 and then it enters the
 pelvic cavity where it
 covers the anterior,
 posterior and lateral walls
 of pelvic cavity.
      Extent of Peritoneum Cont…
When it lines the walls
 of abdominal cavity,
 it called as
 abdominal parietal
 peritoneum and
 when lines the walls
 of pelvic cavity then
 it called as pelvic
 parietal
 peritoneum.
   Reflection of Parietal Peritoneum
From the walls of abdominal
  cavity or from the walls of
  pelvic cavity, the folds of
  parietal peritoneum are
  reflected towards viscera’s;
  these folds of peritoneum are
  surround the viscera and then
  reflected back towards the
  walls. The layers of
  peritoneum that surround the
  viscera are called as visceral
  peritoneum, which form the
  outer most coat of viscera that
  is serous coat.
  Formation of Visceral Peritoneum
That means the peritoneum
  consists of two layers,
  the outer layer which
  lines the internal
  surfaces of abdominal &
  pelvic cavities is called
  as parietal peritoneum
  and inner layer which
  closely applied to the
  viscera is called as
  visceral peritoneum. In
  between this two layers,
  there is potential space,
  the peritonea cavity
Formation of Peritoneal Folds, Ligaments, Omenta, Mesenteries

The parts of peritoneum,
  which are reflected from
  the cavities of body walls
  towards viscera, they have
  different names for e.g.
  peritoneal folds,
  ligaments, mesenteries,
  and omenta. These
  reflected parts of
  peritoneum usually always
  consist of two layers, and
  these are usually parts of
  parietal peritoneum.
                   Peritoneal Cavity
Between the parietal peritoneum
  and visceral peritoneum, there is
  a potential space, the peritoneal
  cavity. The free adjacent
  surfaces of two layers of
  peritoneum are lined by the
  flattened mesothelial cells
  which secret the serous fluid.
  The serous lubricates the
  adjacent surfaces of two layers
  of peritoneum. This forms a thin
  and smooth film of serous fluid.
  This allows the free movement
  of viscera along the walls of
  cavity and free movement
  between viscera.
                 Anatomy of Liver
Liver is the largest organ and
  endocrine glands of the
  body. 1.5 kg in weight.
  The liver consists of two
  surfaces diaphragmatic
  surface and Visceral
  surface. The liver has five
  surfaces
Anterior
Superior
Right
Posterior
Inferior
               Anatomy of Liver
All the surfaces of liver
 continuous with each
 other without
 demarcation because
 the intervene borders
 are round excepts the
 inferior border, which
 sharp and separates
 anterior surface from
 inferior surface.
               Lobes of Liver
On the anterior &
 Superior surfaces of
 liver there is an
 attachment of falciform
 ligament which
 actually folds of
 peritoneum, which
 divides the liver into
 right and left lobes on
 anterior and superior
 surfaces.
                      Lobes of Liver
On the visceral surface the
  features are
Groove for Vena cava
Ligamentum Venosum
Porta Hepatis
Ligamentum Teres
Fossa for Gall Bladder
Lobes of liver on surface are
Right Lobe lies from right
  border of liver to the groove
  for inerior veva cava, right
  margin of Porta hepatis and
  fossa for gall bladder
                    Lobes of Liver
Left Lobes from the left
  border to the groove for
  ligamentum venosum, left
  margin of porta hepatis
  and groove for
  ligamentum teres.
Quadrate lobe, it is
  reangular in shape,
  ligamnetum teres on left
  side, fossa for gall bladder
  on right side, inferior
  border on anterior aspect
  the anterior margin of
  porta hepatis on posterior
  aspect
            Caudate Lobe of Liver
The caudate lobe lies on
  the posterior surface, it is
  bounded on the left side
  groove for ligamentum
  venosum, on the right
  side groove for inferior
  vena cava, anteriorly
  posterior margin of porta
  hepatis and posteriorly
  superior border of liver
  which rounded and not
  well demarcated
 Development of Peritoneal Cavity & Peritoneum

The developing
embryo consists of
three germ layers,
outer, Ectoderm,
middle Mesoderm
and inner
Endoderm
 Development of Peritoneal Cavity & Peritoneum
The intra embryonic
  mesoderm on
  each side of the
  mid line
  differentiates into
  three potions, the
  medial potion i.e.
  paraxial potion,
  an intermediate
  potion and a
  lateral plat of
  mesoderm.
 Development of Peritoneal Cavity & Peritoneum
The lateral plate again sub-
  divided into two layers, the
  somatic mesoderm layer
  and splanchnic mesoderm
  layer. The splanchnic
  mesoderm layer becomes
  continuous with the wall of
  the yolk sac and then they
  collectively surround a
  longitudinal body cavity,
  which is called intra
  embryonic coelom that will
  form long cavity of trunk
Three layers of
  body
Ectoderm
Mesoderm
Endoderm
Primitive foregut
  is suspended in
  the cavity by
  means ventral
  mesogastrium
  and dorsal
  mesogastrium
During the lateral
 stages of
 development
 most of ventral
 mesogastrium
 degenerated &
 only Abdominal
 part of esophagus,
 stomach and
 initial 2-3 cm
 suspended by
 ventral
 mesogastrium,
 while in some of
 region of dorsal
 mseogastrium
 degenerated
  FORMATION OF
    VNTERAL
 MESOGASTRIUM

The ventral mesogastrium
is actually mesoderm
between the posterior
surface of anterior
abdominal wall and
anterior aspect of gut
tube. The ventral
mesogastrium
degenerated in the most of
part of coelomic cavity
      Fate of Ventral Mesogastirum
   Falciform ligament
   Lesser omenta
   Coronary ligament
   Right triangular
    ligament
   Left triangular
    ligament
Fate of Dorsal
   Mesogastrium
1. Gastrophrenic
   ligament.
2. 2. Gastroslenic
   ligament
3. 3. Greater Omentum
4. 4. Leinorenal ligament
5. Mesentery Proper
6. Transverse Mesocolon
7. Sigmoid Mesocolon
8. Mesoappendix
 Intraperitoneal,
 Retroperitoneal
 Extra
  Peritoneal
           Reflections of Peritoneum
The parietal peritoneum lines the
  cavity of abdomen & pelvis.
  From the wall of these cavities
  the peritoneum is reflected
  towards the different organs. A
  layer of peritoneum is reflected
  towards the, invaginates the
  organ and reflected back
  towards the wall of cavity, this
  is called as reflections of
  peritoneum. The reflections of
  peritoneum have got different
  names; these are folds,
  mesentery, ligaments & omenta
         Reflections of Peritoneum
By means of reflections of
  peritoneum the peritoneal
  cavity is divided into
  different compartments.
  These folds of peritoneum
  may present in vertical
  plane, called as
  VERTICAL DISPOTION
  OF PERITONEUM. Other
  folds may present in
  horizontal plane, called as
  HORIZONTAL
  DISPOTION OF
  PERITONEUM.
Reflections of Peritoneum
on the Posterior Surface of
Anterior Abdominal Wall
             Above the Umbilicus
On posterior surface of
 anterior abdominal wall at
 level of umbilicus a doubled
 layered fold of peritoneum
 raised from the wall, called
 as FALCIFORM
 LIGAMENT. It extends
 upwards, in midline from
 the umbilicus to the xiphoid
 process. The falciform
 ligament is triangular in
 shaped, has posterior free
 margin which contained
 LIGAMENTUM TERES.
                Ligamentum Teres
The ligamentum teres is
  remnants of left umbilical
  vein. The falciform
  ligament extends upwards
  in midline behind the
  linea Alba up to xiphoid
  process and up to inferior
  border of liver. At
  inferior border of liver the
  ligamentum teres leave
  the falciform ligament,
  and enters the fissure for
  ligamentum teres on the
  inferior surface of liver.
        Fate of Falciform Ligament
The falciform ligament
  consists of two layers, the
  right layer & the left layer.
  Now falciform ligament
  ascends upwards and
  slightly right of mid line
  between the diaphragm and
  anterior surface of liver. On
  Superior Surface of the
  liver, the two layers of
  falciform ligament diverge
  from each other.
  Fate of Right Layer of Falciform Ligament
The right layer of
  falciform ligament
  diverges towards the
  right lobe of liver.
  Now right layer is
  reflected from the
  diaphragm towards
  superior surface of
  right lobe of liver, this
  reflection of
  peritoneum forms
  Superior layer or
  coronary ligament.
 Right Layer of Falciform Ligament
The right layer of falciform
  ligament covers the
  superior and anterior
  surfaces of liver than it
  extends towards inferior
  border of liver, it turns
  around the inferior border
  of liver, and it covers the
  inferior surfaces of liver.
  It covers the inferior
  surface of liver where it
  forms the visceral
  peritoneum.
  Inferior layer of coronary ligament
From the posterior
  surface of right lobe
  of liver, a layer of
  peritoneum is
  reflected to covers
  right suprarenal
  gland and upper
  part of right kidney,
  this is called as
  Inferior layer of
  coronary ligament.
           Formation of Lesser Sac
From the right kidney the
  peritoneum passes
  downwards to covers the
  front of first or superior
  part of duodenum and right
  colic flexure. It also passes
  medially in front of short
  segment of inferior vena
  cava between the
  duodenum and liver where
  it becomes continuous
  with posterior wall of
  lesser sac.
    Formation of Bare Area of Liver
Superior & inferior layers
  of coronary ligament
  there is a large
  triangular area on
  posterior surface of
  right lobe of liver
  which is not covered
  with peritoneum,
  called as BARE
  AREA of liver. Here
  liver is directly in
  contact with diaphragm
  by means of aerolar
  tissue.
                   Bare area of liver
The Bare area of liver is triangular
  in shape the apex is directed
  towards right side and
  downwards.
BOUNDARIES:
BASE: by the groove for inferior
  vena cava,
SUPERIOR: it is bounded by
  superior layer of coronary
  ligament;
INFERIOR: it is bounded by
  inferior layer of coronary
  ligament.
APEX: On the right side the
  superior & inferior layer of
  coronary ligament approaching
  towards each other and finally
  fused together.
       Right Triangular Ligament
At point where two
  layers are meeting
  together, called as
  Right triangular
  ligament, which
  forms the APEX of
  bare area. By means
  of Right triangular
  ligament the liver
  is connected to
  diaphragm
                Bare Areas of Liver
The areas of liver which are not
  covered with peritoneum are
  called as bare areas of liver.
 Major bare area of liver, These
  Bare Areas of liver are
 Fossa for gall bladder
 Groove for inferior vena cava
 Porta hepatis
 Between attachments of two
  layers of falciform ligament
 Left triangular ligament
 Right triangular ligament
 Fissure for ligamentum teres.
Fate of Left Layer of Flciform Ligament
The left layer of falciform
  ligament extends towards
  superior surface of left lobe of
  liver, at this point a layer of
  peritoneum is reflected from the
  anterior part of inferior surface
  of diaphragm towards the
  superior surface of left lobe of
  liver forming ANTERIOR
  LAYER OF LEFT
  TRIANGULAR LIGAMENT.
  This layer of peritoneum forms
  the visceral peritoneum of left
  lobe.
         Left Triangular Ligament
This layer covers the
  superior, anterior and
  inferior surfaces of left
  lobe of liver. Form
  posterior surface of left
  lobe, a layer of
  peritoneum is reflected
  towards the diaphragm,
  forms Posterior layer of
  left triangular ligament.
  This finally forms
  posterior wall of lesser
  sac and becomes with
  inferior layer of coronary
  ligament.
Reflection of Peritoneum from the Liver
The visceral peritoneum
  also extends into the
  fissure for ligamentum
  venosum. The fissure for
  ligamentum venosum has
  got two margins, the
  right margin which
  posteriorly becomes
  continuous with posterior
  margin of porta hepatis;
  while the left margin of
  fissure for ligamentum
  venosum posteriorly
  becomes continuous with
  anterior margin of porta
  hepatis in this they form
  an “L” shaped continues
  line, which provides
  attachment to
  peritoneum.
                Lesser Omentum
From the margins of
  fissure for ligamentum
  venosum & porta
  hepatis a double
  layered fold of
  peritoneum is reflected
  towards the abdominal
  part of esophagus
  lesser curvature of
  stomach and proximal
  2-3 cm. duodenum,
  which called as
  LESSER
  OMENTUM.
  Anterior Layer of Lesser Omentum
The visceral peritoneum covers
  the liver, and also extends
  into the floor of fissure for
  ligamentum venosum, where
  it covers the floor, and then
  from left margin of fissure for
  ligamentum venosum and the
  anterior margin of porta
  hepatis a layer of peritoneum
  is reflected towards lesser
  curvature of stomach and
  proximal 2-3cm. of
  duodenum, this is called as
  ANTERIOR LAYER of
  lesser omentum.
Posterior Layer of Lesser Omentum
Similarly a layer of
  peritoneum is reflected
  right margin of fissure
  for ligamentum venosum
  and the posterior margin
  of porta hepatis a layer
  of peritoneum are
  reflected towards lesser
  curvature of stomach
  and proximal 2-3cm. of
  duodenum, this is called
  as POSTERIOR
  LAYER of lesser
  omentum.
           Hepatogastric Ligament
The part of the lesser
  omentum connecting the
  liver to stomach is called
  the HEPATO-
  GASTIRC
  LIGAMENT, while the
  part passing from the
  liver to duodenum is
  named as the HEPATO-
  DOUDENAL
  LIGAMENT.
 Right Free Margin of Lesser Omentum
On the right side the
 anterior layer of lesser
 omentum passes in front
 of the HEPATIC
 ARTERY, BILE DUCT
 & PORTAL VEIN and
 then anterior layer turn
 round right side of these
 structures to become
 continuous behind these
 structures with posterior
 layer of lesser omentum.
       Anterior Wall of Lesser Sac
The posterior layer of
  lesser omentum forms
  the ANTERIOR
  WALL OF LESSER
  SAC. That means the
  lesser omentum has got
  right free border, which
  contained the hepatic
  artery, bile duct and
  portal vein. This border
  along with contained
  structures forms the
  anterior boundary of
  EPIPLOIC FORAMEN.
               Lesser Omentum
The anterior layer of lesser
 omentum is continuous
 downwards over the antero-
 superior surface of stomach
 and proximal 2-3 duodenum,
 to form the visceral
 peritoneum on this surface.
 While the posterior layer of
 lesser omentum descends
 downwards to cover the
 postero- inferior surface of
 stomach and proximal 2-3 cm.
 duodenum, to form the
 visceral peritoneum on this
 surface.
              Greater Omentum
After forming the visceral
  peritoneum of stomach
  proximal 2-3 cm. of
  duodenum the two layers
  of peritoneum are
  hanging downwards
  from the greater
  curvature of stomach
  and lower border of
  proximal part of
  duodenum, this called as
  GREATER
  OMENTUM.
               Greater Omentum
The two layers of lesser
  omentum after forming
  the visceral peritoneum
  over the antero- superior
  & postero- inferior
  surfaces of stomach,
  approaching towards
  greater curvature of
  stomach & inferior
  border of duodenum and
  two layers descend
  downwards forming
  greater omentum
                  Greater Omentum
The greater omentum extending
  downwards, consists of two
  layer, named layer no; 1 & layer
  no; 2. The greater omentum is
  the most superficial structure of
  abdominal cavity. It lies in front
  of loops of small intestine. The
  two layers of greater omentum
  extending downwards for
  variable distance, then it curves
  backwards, and folded on itself
  and ascends upwards in front of
  loops small intestine. Now the
  greater omentum consists of
  four layers (or two folds the
  Anterior & Posterior),
          Folds Greater Omentum
THE ANTERIOR FOLD
 consists of layer no; 1& 2,
 THE POSTERIOR
 FOLD consists of layer no;
 3 & 4.
Now the 3rd & 4th layers of
 posterior fold ascends
 upwards & adherent to
 anterosuperior aspect of
 transverse colon and
 superior layer of transverse
 mesocolon.
                  Greater Omentum
The two layers ascend upwards and
  backwards to get attached to
  anterior surface of head of
  pancreas and anterior surface of
  body of pancreas. At this level
  the two layers, & get separated
  from each other and have got
  different course.
During the development and in
  children the greater omentum
  consists of four layers the 1st,
  2nd, 3rd & 4th layers, which are
  lined by mesothelial cells, which
  secret serous fluid
 Fate of 2nd & 3rd Greater Omentum
This space rarely found in adult.
  The 2nd & 3rd layer lose their
  mesothelial lining and adherent
  to each other, & they are
  represented by the connective
  tissue. Below the level of
  transverse colon the greater
  omentum consists of two layers
  that are 1st & 4th layers while
  the 2nd & 3rd layers are
  represented by the connective
  tissue which bound 2nd & 3rd
  layers. But above the level of
  transverse colon the greater sac
  consists of all four layers.
  Fate of Third Layer of Greater Omentum
The third layer ascends
  upwards to superior
  surface of head of
  pancreas and anterior
  surface of body of
  pancreas. The 3rd layer
  also extending laterally &
  towards left side, towards
  the tail of pancreas and
  attached to superior &
  inferior margins of Hilum
  of Spleen. This layer
  covers all the surfaces of
  to form visceral layer of
  spleen.
                Lienorenal Ligament
From the inferior margin of hilum
  of spleen a layer of peritoneum
  reflected downwards towards
  anterior surface of Left supra
  renal gland & upper part
  anterior surface of Left kidney,
  this layer of peritoneum is
  called as LIENO-RENAL
  LIGAMENT. Similarly a
  layer of peritoneum is
  reflected from superior margin
  of hilum of spleen towards
  posterior surface of fundus of
  stomach, layer of peritoneum
  is called as GASTRO-
  SPLENIC LIGAMENT.
              Greater Omentum
Now the 3rd layer of
 greater omentum
 ascends upwards
 behind the stomach up
 to inferior surface of
 diaphragm, where
 becomes continuous
 with the posterior
 layer of Left
 Triangular Ligament,
 to take part in the
 formation of posterior
 wall of lesser sac
            Gastropherenic Ligament
As the 3rd layer
  ascends upwards
  from posterior
  surface of fundus of
  stomach, a layer of
  peritoneum is
  reflected to inferior
  surface of
  diaphragm from
  posterior surface of
  fundus of stomach,
  named as
  Gastropherenic
  Ligament.
  Fate of 4th Layer of greater Omentum
The fourth layer of greater
  omentum is reflected
  from the anterior
  surface of head of
  pancreas & the anterior
  border of body of
  pancreas, downwards
  and forwards, towards
  posterior surface of
  transverse colon, this
  layer of peritoneum is
  called as Superior
  layer of transverse
  mesocolon.
   Formation of Transverse Mesocolon
The superior layer of transverse
  mesocolon covers the
  posterior, superior, anterior,
  inferior & posterior surfaces
  of transverse colon to form
  the visceral layer (serous coat)
  of transverse colon. From the
  posterior surface of transverse
  colon the layer of peritoneum
  is reflected back towards the
  anterior surface of head of
  pancreas & the anterior border
  of body of pancreas, named as
  Inferior layer of transverse
  mesocolon.
   Fate of 4th Layer of greater Omentum
Now the 4th layer is extending
  downwards, to cover the
  inferior surface of head of
  pancreas & anterior surface of
  body of pancreas. This layer is
  also extending medially towards
  the right side to cover the 4th &
  3rd parts of duodenum. At the
  third part of duodenum, the
  superior mesenteric vessels are
  arising, here a layer of
  peritoneum is reflected from the
  posterior wall of abdominal
  cavity around the axis of
  superior mesenteric vessels
  towards loops of jejunum &
  ileum, this layer of peritoneum
  is called as Right layer of
  mesentery proper.
     Formation of Mesentery Proper
The right layer of mesentery
  proper covers all the surface of
  loops of jejunum & ileum, to
  form the serous coat or visceral
  peritoneum of small intestine.
  Then this layer is reflected
  back towards posterior wall of
  abdominal cavity as Left layer
  of mesntery proper. The
  mesentery proper begins at
  doudeno-jejuneal flexure at the
  level of transverse process of
  2nd lumbar vertebrae, this is
  called as root of mesentery
  proper, extending obliquely
  downwards and towards right
  side up to ileo- ceacal junction
  or right sacro- iliac joint.
        Parietal Pelvic Peritoneum
Now the 4th layer of mesentery
 proper is descending
 downwards over the posterior
 abdominal wall as the parietal
 layer of peritoneum. As the
 4th layer descending
 downwards it covers the
 Abdominal Aorta, the
 Inferior Vena Cava, the
 Ureters and Psoas Major.
 Finally it enters the pelvic
 cavity where it forms the
 parietal pelvic peritoneum.
   Formation of Sigmoid Mesocolon
From the posterior wall of pelvic
  cavity a layer of peritoneum is
  reflected towards the sigmoid
  colon as the Anterior layer of
  sigmoid mesocolon. The
  anterior layer of sigmoid
  mesocolon covers all the
  surfaces of sigmoid colon to
  visceral peritoneum (serous
  coat). After covering the
  sigmoid colon, this layer of
  peritoneum reflected back
  towards posterior wall of
  pelvic cavity as Posterior
  layer of sigmoid mesocolon.
         Parietal Pelvic Peritoneum
The peritoneum descending
  downwards with in pelvic
  cavity, to cover the anterior
  & lateral surfaces of upper
  one third of rectum, still
  descends downwards to
  cover the middle one third
  of rectum. Up to this level
  the reflections of
  peritoneum are similar in
  two sexes. Beyond this
  level, the reflections of
  peritoneum are different in
  two sexes.
  Reflections of Peritoneum in Male
At level of junction of upper
  two third & lower one
  third of Rectum a layer of
  peritoneum is reflected
  forwards to superior ends
  of Seminal Vesicles &
  upper surface of Urinary
  Bladder, as Recto-vesical
  fold, which dips
  downwards as Recto-
  vesical pouch. The recto-
  vesiclal pouch is most
  dependent part of
  peritoneal cavity in male.
 Vertical Folds of Peritoneum below Umbilicus
This fold of peritoneum covers
  the superior surface of
  urinary bladder up to apex
  of urinary bladder. From the
  apex of urinary bladder a
  fold of peritoneum is from
  posterior surface of anterior
  abdominal wall from the
  apex of urinary bladder up
  to umbilicus. This fold of
  peritoneum is called
  Median umbilical fold
  which is produced by
  Medain umbilical
  ligament.
           Tracing of Peritoneum
The median umbilical
  ligament is produced by
  obliterated remnant of
  URACHUS. Here the
  reflections of
  peritoneum terminate.
  This is point where the
  reflections of
  peritoneum begin as the
  Falciform Ligament and
  terminate as Median
  Umbilical fold.
   Reflections of Peritoneum in Female
At level of junction of upper
 two third & lower one
 third of Rectum a layer of
 peritoneum is reflected
 forwards to the posterior
 fornix of vagina, this fold
 of peritoneum is called as
 Recto-uterine fold, which
 dips down to form Recto-
 uterine pouch or Pouch
 of Douglas. The recto-
 uterine pouch is most
 dependant part of
 peritoneal cavity in female
      Visceral Peritoneum of Uterus
From the posterior fornix of
  vagina a layer of peritoneum
  ascends upwards to cover
  posterior wall of cervix and
  posterior wall of body of
  uterus up to posterior aspect
  of fundus of uterus. It covers
  the posterior surface of fundus
  then it curves upwards to
  cover the superior surface of
  fundus then curves forwards
  and downwards on to anterior
  surface of fundus of uterus,
  then extending downwards to
  cover the anterior wall of
  body of uterus up to anterior
  wall of cervix.
                  Uterovesical Pouch
At this level a fold of
   peritoneum is reflected
   forwards on to upper part of
   posterior surface of urinary
   bladder. This fold of
   peritoneum is named as
   Utero-vesical fold which
   dips down and forms Utero-
   vesical pouch. A layer of
   peritoneum is extending
   laterally to cover the lateral
   wall of uterus; similarly a
   layer of peritoneum from the
   anterior wall of uterus is
   extending laterally to cover
   the lateral wall of uterus.
           Broad Ligament of Uterus
At the lateral wall of uterus there
   are two layers of peritoneum,
   the anterior & posterior layers.
   These two layers are reflected
   from the lateral wall of uterus
   towards the lateral wall of
   pelvic cavity on each side of
   uterus. This reflection is called
   as Broad ligament of uterus.
   The broad ligament consists of
   two layers; and upper free
   margin which contained
   fallopian tube. The lateral end
   of fallopian tube opens in to
   peritoneal cavity.
 Vertical Folds of Peritoneum below Umbilicus
From the upper part of
  posterior surface of
  urinary bladder the
  peritoneum extending on
  to superior surface of
  urinary bladder. This layer
  of peritoneum covers the
  superior surface of urinary
  bladder up to apex of
  urinary bladder. From this
  point the reflections of
  peritoneum are similar in
  two sexes.
 The vertical folds
 of peritoneum on
 posterior surface
anterior abdominal
        wall
 Vertical Folds of Peritoneum above Umbilicus
There are six vertical
  folds are present over
  the posterior surface of
  anterior abdominal
  wall,
one above the umbilical,
  that is Falciform
  ligament which is
  triangular in shape has
  posterior free margin
  which contains
  ligamentum teres
 Vertical Folds of Peritoneum below Umbilicus
There are five verticals folds of
    peritoneum on the posterior
    surface of anterior abdominal
    wall below the umbilicus.
Median umbilical fold, produced
    by Median Umbilical
    Ligament which remnant of
    obliterated Urachus.
Right & left medial umbilical
    folds, which are produced by
    the Medial Umbilical
    ligaments. The medial
    umbilical ligament is
    produced by the remnant of
    obliterated distal part of
    Umbilical Artery which is a
    branch of Internal Iliac Artery
    in fetus.
 Vertical Folds of Peritoneum below Umbilicus
Right & left lateral
  umbilical folds,
  which are produced
  by the Lateral
  umbilical
  ligaments. The
  lateral umbilical
  ligament is produced
  by Inferior
  Epigasteric Vessels
  which are branches
  of External Iliac
  vessels.
 Compartments
       of
Peritoneal Cavity
      Division of Peritoneal Cavity
The division of
   peritoneal cavity on
   bases of regions

1. Abdominal
   Peritoneal Cavity
2. Pelvic Peritoneal
   Cavity
        Abdominal Peritoneal Cavity
The abdominal peritoneal cavity
  further subdivided in to two
  compartments.
Greater Sac, which occupied
  entire abdominal cavity.
Lesser Sac, which is actually a
  part of greater sac, it is
  thought that it is a
  Diverticulum from greater
  sac. The lesser sac lies behind
  the lesser omentum stomach,
  & it is potential space. It
  provides space for the
  expansion of stomach, and
  helps in the movement of
  stomach that’s why it is also
  called as Omental Bursa.

				
DOCUMENT INFO
Description: This presentation explains the general features of Abdominal cavity, peritoneum, peritoneal cavity, Greater sac, Lesser sac, reflections peritoneum in vertical and horizontal directions