Teaching slides for session: Peritonium and Oesphagus
Summary
This on-demand teaching session provides an in-depth exploration of the peritoneum and the oesophagus, focusing on their structure, function, and clinical significance. The session begins with an overview of the peritoneum's organisation, including details about its serous membrane, visceral and parietal layers, and the space in between. Attendees will learn about the coronary ligament and how the visceral peritoneum envelops intra-peritoneal organs. We'll delve into the complexities of SADPUCKER - an acronym for a particular grouping of organs within the human body. We will also discuss the importance of mesentery, ligaments, and the portal triad.
The latter part of the class focuses on the anatomy of the oesophagus, a vital component of the digestive system, with coverage of its anterior, posterior, and lateral relations, as well as its arterial supply. We'll also touch on its placement and function within the body.
Get ready for a comprehensive understanding of these vital components of the body and their clinical implications. Ideal for medical professionals looking to deepen their knowledge or refresh their understanding, join us to learn, ask questions, and engage in an informative and interactive session.
Learning objectives
- Understand the structure and functions of the peritoneum including its mesothelial layer and its parietal and visceral layers.
- Recognize the importance of the peritoneum in relation to various organs, using the SADPUCKER acronym as a reference.
- Understand the clinical significance and organization of the oesophagus, including its location, dimensions, and functional roles.
- Know the different relations of the esophagus in the abdomen, how it connects to other organs and its blood supply.
- Identify the various ligaments related to the peritoneum and their association with different organs and their clinical importance.
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The PERITONEUM AND THE Oesophagus Temiand JagPERITONEUM ORGANISATION • Mesotheliallayer (serousmembrane)lubricating the abdominal cavity • Parietal(abdominal cavity),visceral (organs) layerswitha potential space inbetween, mesentery (doubleperitoneal layer),omenta (four layers) • Coronary ligament = bare area of the liver • Visceral peritoneum (serosa) envelopesintraperitonealorgans • SADPUCKER - Suprarenal gland, Aorta, Duodenum, Pancreas,Ureter, Colon (transverse, sigmoid), Kidneys,Esophagus,RectumCLINICAL SIGNIFICANCE • Greater andLesser omentaandsac attachtothegreater andlesserstomachcurvature –allows expansion • Mesenteryimportantforbloodvessels,nerves,and lymphatics • Ligaments–hepatogastric, hepatoduodenal,gastrosplenic • PORTAL TRIAD–hepatic artery proper, common bileduct, hepatic portalveinin the hepatoduodenalligament C6-T11 The oesophagus EnterstheabdomenatT10 • The oesophagus is a fibromuscular tube, approximately 25cm in length,that transports food from thepharynxtothestomach • It begins intheneck,at thelevelof C6 • It descends downwardintothe superior mediastinum of thethorax,positioned between thetracheaand the vertebralbodies of T1 to T4. It thenenters theabdomen via theoesophageal hiatus (an opening intheright crusof thediaphragm) at T10. • Theabdominalportion of the oesophagus is approximately 1.25cm long – it terminates by joining thecardiac orificeof the stomach at levelof T1justleftofthemidline.The abdominal oesophagus The abdominal oesophagus representsthe short distalpart of the oesophagus locatedin the abdominal cavity.Major relations of the oesophagusin the abdomen Anterior relations Peritoneum:Theesophagus is coveredby peritoneum on its anterior surfaceafterit passesthroughthe diaphragm. Left lobe of theliver:Theleft lobeof the liver lies immediately anterior to theabdominalesophagusasit enters the stomach. Theesophagusispartially coveredby theliver at the gastroesophageal junction. Anterior vagaltrunk: Consistsof severalsmallertrunkswhose fibersmostlycome fromthe leftvagusnerve.Major relations ofthe oesophagus inthe abdomen Posteriorrelations Leftcrusofthe diaphragm:The left diaphragmaticcrus surroundsthe esophageal hiatusandis located posterior tothe esophagusasitentersthe abdomen. Posteriorvagaltrunk:Consistsofasingle trunk whose fibersmostly come fromthe right vagus nerve.Major relations of the oesophagus in the abdomen Lateral relations Leftside:The fundus ofthe stomachlies onthe leftsideoftheabdominal esophagus,as theesophaguscurvesto jointhe stomach atthe gastroesophageal junction (betweenthestomachandoesophagus). The lower oesophagealsphincter islocatedatthe gastro-oesophagealjunction. Thegastro-oesophagealjunctionis situatedtotheleftofthe T11 vertebra, and is marked by thechange from oesophagealtogastric mucosa. The sphincterisclassifiedas aphysiological(orfunctional) sphincter,as it does nothave anyspecificsphinctericmuscle and isinstead maintainedbyarange offactorsArterial supply of the abdominal esophagus Thearterial supply to the abdominal oesophagus includes: • Oesophagealbranchesfrom theleft gastric artery (from theceliac trunk) • Oesophageal branches from the left inferior phrenic artery (from theabdominalaorta)Thank you for listening Anyquestions?