hello all this is dr alsup and in this
video we are going to be discussing the peritoneum which is always something
that seems conceptually difficult but as we kind of work our way through i think
you'll become more more comfortable so the goal of this video is not to get down
into the fine details or specific mesenteries and omenta but more to discuss what is a mesentery
or what is the omentum what even is peritoneum so more of what these things are some more
definitions then we're going to do the discussions of the specific parts associated
with viscera when we get to those organs so let's start with just what is peritoneum
peritoneum is a serous membrane lining the in fact it's the the largest serious serous membrane
of the body and it lines the abdominopelvic cavity and note that i did say pelvic cavity as
well so as it does extend and end in the pelvic cavity so we'll be talking about that peritoneum
even when we move into that region of anatomy so similar to what we had with the pleura of the
thoracic cavity there's going to be a parietal and a visceral peritoneum parietal peritoneum is
attached to the muscular layers of the abdominal wall so it's going it's going to line those
walls of the abdominal cavity and it's going to be connected by extra peritoneal connective tissue
and we talked a little bit about that when we were talking about the anterior abdominal wall now the
visceral peritoneum is going to be firmly adhered to at least some surface or surfaces if not
all of them of abdominal viscera and it's going to be it's going to suspend that viscera
into or within that abdominal cavity region now the space between the parietal and
visceral peritoneum is the peritoneal cavity this is often referred to as a potential
space and Gray's is going to describe it as of capillary thinness so you can get
an idea of just how small we're talking but it's often depicted as much much larger in
images like the one on this previous slide here obviously you're going to have viscera
that's going to invaginate into this area so the peritoneal cavity is not going to be
nearly as large as what you see in illustrations it does contain peritoneal fluid which plays a
role in lubrication to allow that mobility that you need in the visceral in this region as well as
it has some defensive properties now the majority of the peritoneal cavity is referred to as the
greater sac and this is the largest portion it's going to surround most of the abdominal and pelvic
viscera and it's a bit hard to conceptualize with any image really because you have to imagine the
abdominal wall was also here and so that space between the parietal peritoneum on the wall on
the abdominal wall and the visceral peritoneum that's associated with the organs that would be
the greater sac portion of the peritoneal cavity there's also a lesser sac often referred to as the
omental bursa which is located posterior to the stomach and the lesser omentum so this is your
stomach this is the lesser omentum right here and so it's going to be located behind these
structures but anterior to the pancreas so that it's just going to be just posterior
to this and that greater and lesser sac can communicate or are connected via
the epiploic or omental foramen of winslow so many different names associated with
that connection between the greater and lesser sac all right let's begin to explore how this
peritoneum particularly the visceral peritoneum can be organized into very discrete invisible
structures within the abdominal pelvic cavity and those generalized terms that are used to describe
them so let's start with mesentery as it's kind of the the most important of these mesentery just
generalized is a double layer of peritoneum that attaches intra peritoneal viscera to the posterior
abdominal wall so that is how it's going to have that connection to more retroperitoneal
structures specifically neurovasculature so it's going to allow neurovasculature from the
posterior abdominal wall to kind of move through and actually supply or drain these intraperitoneal
viscera also it serves as an anchoring point much of the abdominal viscera is intraperitoneal
and we will be using and we will have a whole other video regarding what intraperitoneal
viscera is but in short intraperitoneal organs are almost completely covered in visceral
peritoneum now mesenteries are often quite visible and you can often very clearly see
neurovasculature associated with it these mesenteries are usually named um based on
their like location and most will have a meso associated with it so you're you have a transverse
mesocolon which is going to be an attachment to the transverse colon and then you have a mesoappendix
that would be attached to the appendix but if you ever hear someone referring to the mesentery you
know this is the a capital t-h-e they are likely talking about the mesentery of the jejunum and
ilium or the majority of the small intestine and it's named the because of its size it is
hard to miss the mesentery during a surgery or dissection so it'd be this portion here
that is connected to that small mesentery so very large very dominant within the
abdominal cavity moving to the omenta omenta and mesentery are made of the same thing
but what is unique is that the omenta all have some form of attachment to the stomach and
the proximal duodenum or the first part of the first parts of the duodenum all right so therefore
it is special and it gets its own name so this is kind of the key is that you it's basically a
mesentery associated with these two structures now let's start with the lesser omentum which is
which is like a mesentery in terms of it being a double layer of peritoneum it's going to extend
from the lesser curvature of the stomach and um i'm kind of putting that lesser curvature here
because that's what helps me remember where it's located but it also will extend uh to the
proximal duodenum so this area right here is going to be the lesser omentum now once again
it can be subdivided into peritoneal ligaments which are different name for the same thing
just broken down into more specific parts but does give you a better indication
of location when you use these terms so you'll have a hepatogastric which i'm kind of
outlining that portion here and then you'll have a hepatoduodenal all parts of the lesser omentum so
we'll come back to this term ligaments in a moment the greater momentum has some attachment to the
greater curvature of the stomach so the the larger portion of the curvature as well as extending
to the proximal duodenum it like the lesser momentum is is going to be further subdivided into
small segments of ligaments the most prominent of these ligaments is the gastrocolic ligament
often referred to as the omental apron and so this right here is going to be what's referred
to as the elemental apron which is a component of the gastrocolic ligament this is going to hang
down like an apron from the greater momentum and proximal dual duodenum over the small intestines
it'll actually cover this small intestine and then it will loop back superiorly to attach to
the anterior surface of the transverse colon thus this portion of the greater momentum is
actually four layers now some people think that the omental apron is synonymous with the
greater omentum as in they're the same thing but that's not true it is a part of the greater
momentum there will be other ligaments associated with the greater momentum that we'll talk about
more detail as we get to those specific viscera now we keep talking about those peritoneal
ligaments so let's actually define it now ligaments are going to peritoneal ligaments
are double layers of peritoneum that connect and you see i have that in italics so that's a key
to understanding what a peritoneal ligament is so it's connecting viscera with other organs
or viscera to the wall so again same thing as a mesentery or omenta but just a bit more
specific in regards to describing what is connected and these are typically one of
those seemingly rare cases in anatomy where names are helpful i know it doesn't always seem
like that so these names are can often be broken down to tell you exactly which organs they connect
so in the case say of the hepato-duodenal ligament you have hepato which means liver and
you have duodenal which means duodenum so the hepatoduodenal ligament is connecting
the liver to the duodenum and again these ligaments are typically just subdivisions
of the larger mesenteries or omenta lastly i did want to review peritoneal folds even
though we have discussed them in another learning objective video as their name would suggest they
certainly do have something to do with peritoneum so in the case of folds the peritoneum more
covers a structure than say connecting them so they think putting a sheet of peritoneum
over an already existing structure and this structure will create a little bump in that
sheet and that is those peritoneal folds so the most prominent these and we've talked
about these are the umbilical folds so you have that median medial and lateral umbilical folds
that are lying over say developmental structures that are occluded or neurovasculature in
the case of the lateral umbilical fold all right and that brings us to our summary slide
which i know contains a bit more information than typical but this learning objective really
defines a lot of the terms that we will be using throughout the rest of our time in
our discussions of gastrointestinal anatomy most of these terms are describing the
same thing so specific areas of peritoneum what differs are what they connect and where they
are located so i highly advise taking some time to be comfortable with these terms because we're
going to be using them throughout the course and we'll get a bit more specific as we do as you
review if you have any questions always feel free to reach out with any questions and
i hope you have a great rest of your day