局部解剖學(xué)-結(jié)腸上區(qū)ppt課件

1、peritoneum covers viscera. peritoneum covers viscera. Peritoneal cavity is potential space between parietal and visceral layer of peritoneum. In male, is a closed sac; but in female, there is a communication with outside through uterine tubes, uterus, and vagina. A film of fluid lubricates surfaces

2、of peritoneum and facilitates free movement of viscera, one against another or against abdominal or pelvic walls.Treatment of Renal Failure Continuous Ambulatory Peritoneal Dialysis 3. Based on covering of peritoneum, viscera in abdominal and pelvic cavities can be divided into three kinds: Intraper

3、itoneal viscera viscera are almost completely invested by peritoneum and more mobile than (1) Lessor omentum two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum. The portion of lesser omentum extending between the liver and sto

4、mach is named Hepatogastric ligament. (3) Omental bursa (lesser sac) lies behind stomach and lesser omentum. Its superior wall is peritoneum which covers the caudate lobe of liver and diaphragm; Inferior wall is transverse colon and its mesocolon; Anterior wall is formed by lesser omentum, posterior

5、 wall of stomach and gastrocolic ligament; Posterior wall is formed by peritoneum covering diaphragm, pancreas, left kidney and suprarenal gland; Left wall is bounded by spleen, gastrosplenic ligament and splenorenal ligament; On the right, omental bursa communicates with greater sac through omental

6、 foramen. 2. Mesenteries or mesocolons are two-layered fold of peritoneum that attach part of intestines to posterior abdominal wall. (1) mesentery (of small intestine) is a broad, fan-shaped fold of peritoneum connecting coils of jejunum and ileum to posterior abdominal wall. Root of mesentery (att

7、ached border) is about 15cm long and is directed obliquely from left side of L2 to in front of right sacroiliac joint. Intestinal border of mesentery is folded about 7 m long and contains superior mesentery vessels, lymph nodes, nerve and a certain amount of fat. (2) Transverse mesocolon is a double

8、 fold of peritoneum which connects transverse colon to posterior abdominal wall. Between two layers are blood vessels, nerves and lymphatics of transverse colon. (3) Sigmoid mesocolon is a fold of peritoneum which attaches sigmoid colon to the pelvic wall. Its line of attachment has the form of an i

9、nverted V-shaped, with apex located in front of left ureter and division of common iliac a. (4) Mesoappendix is a triangular fold of peritoneum and extends from terminal part ofileum to appendix. Appendicular a. runs in freemargin of mesoappendix. 3. Ligaments are two-layered folds of peritoneum tha

10、t attached the lesser mobile solid visera to abdominal wall. (1) Falciform lig. of liver is a sickle-shaped fold, extends from anterior abdominal wall (umbilicus) to live. Free border of ligament site of ligamentum teres. (4) Gastrosplenic lig. is a double layer of peritoneum that connects fundus of

11、 stomach to hilum of spleen. It contains short gastric and left gastroepiploic vessels. (5) Splenorenal lig. extends between hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as tail of pancreas. (2) Intersigmoid recess lies behind apex of inv

12、erted V-shaped attachment of sigmoid mesocolon and forms a funnel-shaped recess; its orifice opens downwards. Left ureter passes behind this recess. 5. Pouches In the lesser pelvis, peritoneum dips downwards forming a large fossa, named pouch. In male, rectovesical pouch lies between rectum and urin

13、ary bladder. In the female, rectouterine pouch ( Douglas pouch ) lies between rectum and uterus, and vesicouterine pouch is formed between uterus and urinary bladder. 1.Supracolic compartments (subphrenic space )lies between diaphragm and transverse colon and its mesocolon. It includes some spaces,

14、for example, Suprahepatic and Infrahepatic recess. 2. Infracolic compartments lies below transverse colon and its mesocolon. It has four spaces: right and left paracolic sulci (gutters), right and left mesenterial sinuses (infracolic spaces). (2) Left paracolic sulcus (gutter) lies along lateral sid

15、e of descending colon and opens freely into the pelvis at its lower end. It is separated above from supracolic compartment by phrenicocolic ligament. (3) Right mesenteric sinus (right infracolic space triangular space) lies between root of mesentery, ascending colon, right 2/3 of transverse colon an

16、d its mesocolon. This sinus is almost closed by surrounding structures and loop of small intestine. (4) Left mesenteric sinus (left infracolic space) lies between root of mesentery, descending colon, right 1/3 of transverse colon and its mesocolon. It opens downwards and communicates with pelvis, so

17、 the infection of sinus may directly spread to pelvis cavity. Clinical Notes Clinically the spaces, sulci, sinuses and recesses are important factors in spreading infection in peritonitis. 1. In perforation of posterior wall of stomach, contains from stomach may pass upwards to hepatorenal recess through omental bursa and omental foramen and pass downwards to rectovesical pouch ( male ) or rectouterine pouch ( female ) a