Peritoneal MembranePeritoneal Membrane- Features -- Features -

•• ReflectionsReflections

•• Omentum (apron or drape)Omentum (apron or drape)

•• MesenteryMesentery

•• ““LigamentsLigaments””

•• Extent of organ coveringExtent of organ covering

•• IntraperitonealIntraperitoneal

•• RetroperitonealRetroperitoneal

Retroperitoneal

Intraperitoneal

Greater and Lesser SacsGreater and Lesser Sacs

•• Lesser omentum (sac)Lesser omentum (sac)•• AKA AKA ““Omental bursaOmental bursa””

Unit II, p 10Unit II, p 10

Mesenteries of the Embryologic GutMesenteries of the Embryologic Gut

Unit II, p 10Unit II, p 10

Rotation of the GutRotation of the Gut- Axis for rotation -- Axis for rotation -

Unit II, p 11Unit II, p 11

LateralityLaterality

•• Normal (situs solitus)Normal (situs solitus)

•• Alteration (situs inversus totalis)Alteration (situs inversus totalis)

•• Abnormal (heterotaxy, situsAbnormal (heterotaxy, situs

ambiguus; or mirror-image,ambiguus; or mirror-image,

isometry)isometry)

•• Dysregulation of the embryonicDysregulation of the embryonic

organizer (organizer (““nodenode””))

•• Genes: nodal, lefty, ptx2Genes: nodal, lefty, ptx2

Bisgrove, Morelli, Yost. Bisgrove, Morelli, Yost. Annu. Rev. Genomics Hum. Genet. 2003. 4:1Annu. Rev. Genomics Hum. Genet. 2003. 4:1––3232

Gastrointestinal (GI) SystemGastrointestinal (GI) System- Overview -- Overview -

Unit II, p 11Unit II, p 11

Foregut, Midgut, HindgutForegut, Midgut, HindgutDistinction is based on embryologic arterialDistinction is based on embryologic arterial

supplysupply

Unit II, p 12Unit II, p 12

Foregut, Midgut, HindgutForegut, Midgut, HindgutUnique venous drainageUnique venous drainage

Unit II, p 12Unit II, p 12

Esophageal Barium StudiesEsophageal Barium Studies

Foregut - OverviewForegut - Overview

•• Parts: Stomach, duodenum (half),Parts: Stomach, duodenum (half),

liver, gall bladder, pancreas, spleenliver, gall bladder, pancreas, spleen

•• Arterial supply: celiac artery (trunk)Arterial supply: celiac artery (trunk)

•• 3 branches: splenic, left gastric,3 branches: splenic, left gastric,

common hepaticcommon hepatic

•• Venous drainage: gastric andVenous drainage: gastric and

splenic veins to portal veinsplenic veins to portal vein

•• Innervation: autonomicsInnervation: autonomics

•• Lymphatic drainage: organ nodesLymphatic drainage: organ nodes

StomachStomach

Unit II, p 13Unit II, p 13

StomachStomach

Upper GI Barium StudiesUpper GI Barium Studies

DuodenumDuodenum

Unit II, p 13Unit II, p 13

Spleen and PancreasSpleen and Pancreas

Unit II, p 13Unit II, p 13

Anterior View of the LiverAnterior View of the Liver

Unit II, p 14

Superior View of the LiverSuperior View of the Liver

Inferior View of the Liver

Unit II, p 14

GallbladderGallbladder

Unit II, p 14

DuodenumDuodenum- Internal Anatomy -- Internal Anatomy -

Review of the ForegutReview of the Foregut

Unit II, p 14

Stones in the Gall BladderStones in the Gall Bladder

• What consent means is the patient will

drink 1.5 liters of barium!

• Consent is obtained to perform an

upper GI barium study to rule in or out

gallbladder disease (do you recall

why?)

Case

•• SymptomsSymptoms

•• Dull pain in the upper right quadrantDull pain in the upper right quadrant

of the abdomenof the abdomen

•• Vomiting and diarrhea for 3-4 hoursVomiting and diarrhea for 3-4 hours

•• Spiral CT, with contrastSpiral CT, with contrast

•• High-resolution (512 x 512 pixels),High-resolution (512 x 512 pixels),

serial thin-section (0.5 cm sliceserial thin-section (0.5 cm slice

thickness) imagingthickness) imaging

CaseCase

•• CT (barium and iodine) revealed normalCT (barium and iodine) revealed normal

biliary and vascular anatomy,biliary and vascular anatomy,

respectivelyrespectively

CaseCase

•• Differential diagnosis?Differential diagnosis?