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Flashcards in this deck (48)

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  • What is Toldt's (retrocolic) fascia and where is it located?

    • Toldt's (retrocolic) fascia: a remnant of peritoneum
    • Location: behind the ascending and descending colon
    fascia retrocolic

  • Where is the retroperitoneal space located relative to fascia layers?

    • Located between the endoabdominal fascia and the retrorenal fascia
    retroperitoneal fascia

  • What is the paranephron space and where is it found?

    • Paranephron: space between the prerenal and retrorenal fascia, around the kidney
    paranephron kidney

  • Where is the paracolon space located?

    • Paracolon: between the prerenal/Toldt's fascia and the peritoneum
    paracolon fascia

  • What are the superior and inferior boundaries noted for the described fascial spaces?

    • Superior boundary: diaphragm
    • Inferior boundary: pelvis
    boundaries anatomy

  • Name the three pelvic floors (levels).

    • Peritoneal floor (cavum pelvis peritoneale)
    • Subperitoneal floor (cavum pelvis subperitoneale)
    • Subcutaneous floor (cavum pelvis subcutaneae)
    pelvis floors

  • What are the contents and pouches of the peritoneal pelvic floor?

    • Contents: part of bladder, part of rectum, uterus (females)
    • Pouches: male - rectovesical; female - vesicouterine and rectouterine (Douglas)
    peritoneal pelvis

  • What structures are contained in the subperitoneal pelvic floor?

    • Extraperitoneal bladder and rectum
    • Ureters
    • Internal iliac vessels
    • Sacral plexus
    • Prostate and seminal vesicles (male)
    • Cervix and vagina (female)
    subperitoneal pelvis

  • What is included in the subcutaneous pelvic floor?

    • Subcutaneous floor (cavum pelvis subcutaneae): ischiorectal fossa
    subcutaneous ischiorectal

  • What structure forms the medial boundary of the ischiorectal/ischiorectal fossa?

    • Levator ani
    pelvis anatomy boundaries

  • What structure forms the lateral boundary of the ischiorectal/ischiorectal fossa?

    • Obturator internus
    pelvis anatomy boundaries

  • What forms the inferior boundary of the ischiorectal/ischiorectal fossa?

    • Perineal skin
    pelvis anatomy boundaries

  • Where is Alcock's (pudendal) canal located?

    • In the fascia of obturator internus
    pudendal canal anatomy

  • What structures does Alcock's (pudendal) canal contain?

    • Internal pudendal vessels
    • Pudendal nerve
    pudendal neurovascular anatomy

  • Name the main pelvic fascial spaces listed.

    • Prevesical
    • Retrorectal
    • Lateral
    • Paravesical
    • Pararectal
    • Paraprostatic/Parametrial
    pelvis spaces anatomy

  • What is the location of the prevesical space?

    • Between pubis and bladder
    pelvis spaces prevesical

  • What is the location of the retrorectal space?

    • Between rectum and sacrum
    pelvis spaces retrorectal

  • What is the location of the lateral pelvic space?

    • Between parietal fascia and sagittal septum
    pelvis spaces lateral

  • Where is the paravesical space located?

    • Around bladder (visceral)
    pelvis spaces paravesical

  • Where is the pararectal space located?

    • Around rectum (visceral)
    pelvis spaces pararectal

  • What is the paraprostatic/parametrial space located around?

    • Around prostate/uterus
    pelvis spaces paraprostatic

  • In the esophageal porto-caval anastomosis, which portal tributary is involved?

    • Left gastric vein
    venous anastomosis esophageal

  • In the esophageal porto-caval anastomosis, which caval tributary is involved?

    • Esophageal veins (to azygos)
    venous anastomosis esophageal

  • What clinical consequence is associated with the esophageal porto-caval anastomosis?

    • Esophageal varices
    clinical anastomosis esophageal

  • Which three anatomical sites are listed as portal-systemic anastomosis locations?

    • Rectal
    • Paraumbilical
    • Retroperitoneal
    portal-systemic anatomy

  • Name three veins listed as tributaries to the portal vein.

    • Superior rectal v.
    • Paraumbilical vv.
    • Colic vv.
    portal veins

  • Name three veins listed as tributaries to the caval system.

    • Middle/inferior rectal v.
    • Superficial epigastric v.
    • Lumbar vv.
    caval veins

  • What clinical condition is associated with portal hypertension at the rectal site?

    Hemorrhoids

    clinical portal-hypertension

  • What clinical sign is associated with portal hypertension at the paraumbilical site?

    Caput medusae

    clinical portal-hypertension

  • What clinical consequence is noted for the retroperitoneal portal-systemic site?

    Retroperitoneal bleeding

    clinical retroperitoneal

  • Which veins form the caval-caval anastomosis described?

    Lumbar veins ↔ Ascending lumbar veins (to azygos/hemiazygos → SVC)

    anastomosis caval

  • At which vertebral level does the superior mesenteric artery (SMA) originate?

    L1

    vertebral-levels sma

  • What is the vertebral level of the posterior aspect of the cardia of the stomach?

    T11

    vertebral-levels stomach

  • What vertebral level corresponds to the posterior pylorus?

    L1

    vertebral-levels pylorus

  • At what vertebral level is the duodenojejunal flexure located?

    L2

    vertebral-levels duodenum

  • Which vertebral levels correspond to the kidney hilum?

    L1-L2

    vertebral-levels kidney

  • What vertebral levels are given for the pancreas in the quick reference?

    L1-L2

    vertebral-levels pancreas

  • At which vertebral level does the aorta bifurcate?

    L4

    vertebral-levels aorta

  • What is the peritoneal covering of the liver?

    • Mesoperitoneal (except bare area)
    liver peritoneum

  • What is the peritoneal covering of the gallbladder?

    • Mesoperitoneal
    gallbladder peritoneum

  • What is the peritoneal covering of the stomach?

    • Intraperitoneal
    stomach peritoneum

  • What is the peritoneal covering of the duodenum (bulb + flexure)?

    • Intraperitoneal
    duodenum peritoneum

  • What is the peritoneal covering of the rest of the duodenum?

    • Retroperitoneal
    duodenum peritoneum

  • What is the peritoneal covering of the jejunum and ileum?

    • Intraperitoneal
    smallintestine peritoneum

  • What is the peritoneal covering of the cecum?

    • Intraperitoneal
    cecum peritoneum

  • What is the peritoneal covering of the appendix?

    • Intraperitoneal (with mesoappendix)
    appendix peritoneum

  • What is the peritoneal covering of the ascending colon?

    • Mesoperitoneal
    colon peritoneum

  • What is the peritoneal covering of the transverse colon?

    • Intraperitoneal
    colon peritoneum
Studieaantekeningen

Fascia and cellular spaces

  • Toldt's (retrocolic) fascia: a remnant of peritoneum lying posterior to the ascending and descending colon; important surgical plane for mobilization of colon.
  • Cellular spaces / fat planes: include paranephric, paracolon, and spaces between layers of retroperitoneal fascia; these spaces permit spread of infection/bleeding and contain fat that continues into adjacent regions.
  • Typical locations:
  • Between endoabdominal (transversalis) fascia and retrorenal fascia.
  • Between prerenal and retrorenal fascia (around kidney).
  • Between prerenal/Toldt's fascia and the peritoneum (behind ascending/descending colon).
  • Boundaries & continuity:
  • Superior limit often reaches the diaphragm; inferiorly continues into the pelvis.
  • Paraureteric fat is a continuation of these retroperitoneal spaces.

Pelvic region — pelvic floors (3 levels)

  1. Peritoneal floor (cavum pelvis peritoneale)
  2. Contents: part of bladder, part of rectum, uterus in females.

  3. Peritoneal pouches: male: rectovesical; female: vesicouterine and rectouterine (Douglas pouch).

  4. Subperitoneal floor (cavum pelvis subperitoneale)

  5. Contents: extraperitoneal portions of bladder and rectum, ureters, internal iliac vessels, sacral plexus, prostate and seminal vesicles (male), cervix and upper vagina (female).

  6. Subcutaneous floor (cavum pelvis subcutaneae)

  7. Main feature: ischiorectal (ischioanal) fossa — a fat-filled space that allows expansion of the rectum and anal canal.
  8. Boundaries of ischiorectal fossa:
    • Medial: levator ani
    • Lateral: obturator internus
    • Inferior: perineal skin

Alcock's (pudendal) canal

  • Location: within the fascia of the obturator internus running along the lateral wall of the ischioanal fossa.
  • Contents: internal pudendal vessels and the pudendal nerve (neurovascular bundle to perineum).
  • Clinical note: site for pudendal nerve block and vulnerable in pelvic trauma.

Pelvic fascial spaces (key surgical/anatomical spaces)

  • Prevesical: between the pubic symphysis and bladder; important in extraperitoneal bladder injuries.
  • Retrorectal (presacral): between rectum and sacrum; potential site for abscesses or tumors.
  • Lateral: between parietal pelvic fascia and sagittal septum; lateral spread of disease.
  • Paravesical: visceral space around the bladder.
  • Pararectal: visceral space around the rectum.
  • Paraprostatic / Parametrial: surrounding prostate in males or uterus in females; relevant in radical pelvic surgery.

Key anastomoses (high yield)

  • Porto-caval anastomoses (4 clinically important sites):
  • Esophageal: left gastric (portal) ↔ esophageal veins → azygos (caval).
    • Clinical: esophageal varices with portal hypertension.
  • Rectal: superior rectal (portal) ↔ middle/inferior rectal (caval).
    • Clinical: internal hemorrhoids from portal hypertension.
  • Paraumbilical: paraumbilical veins (portal) ↔ superficial epigastric (caval).
    • Clinical: caput medusae around the umbilicus.

  • Retroperitoneal (colic): colic veins (portal) ↔ lumbar veins (caval).

    • Clinical: possible retroperitoneal bleeding manifestations.

  • Caval–caval (systemic) anastomosis:

  • Lumbar veins ↔ ascending lumbar veins → azygos/hemiazygos → superior vena cava; provides collateral flow when IVC is obstructed.

Quick reference — vertebral levels (common landmarks)

  • SMA origin: L1.
  • Cardia of stomach (posterior surface): ~T11.
  • Pylorus (posterior surface): ~L1.
  • Duodenojejunal flexure: ~L2.
  • Kidney hilum: ~L1–L2.
  • Pancreas (neck/body region): ~L1–L2.
  • Aortic bifurcation: L4.

Quick reference — peritoneal coverings (common abdominal organs)

  • Intraperitoneal (mobile, with mesentery): stomach, jejunum, ileum, transverse colon, appendix (with mesoappendix), cecum (usually intraperitoneal).
  • Mesoperitoneal (partially covered / attached): liver (except the bare area), gallbladder, ascending colon (mesoperitoneal), sigmoid often intraperitoneal.

  • Retroperitoneal (secondarily retroperitoneal / fixed): most of the duodenum (except bulb and flexure), ascending and descending colon (posteriorly fixed by Toldt's fascia), pancreas (mostly retroperitoneal except tail).

  • Clinical tip: organs that are intraperitoneal are more mobile and have mesenteries; retroperitoneal organs have posterior attachments and less mobility.

Practical mnemonics & surgical relevance

  • Toldt's fascia is a useful plane for colon mobilization during colectomy.
  • Remember the four porto-caval sites for complications of portal hypertension: esophageal, rectal, paraumbilical, retroperitoneal.
  • Alcock's canal = location of pudendal neurovascular bundle; important for regional anesthesia and pudendal nerve entrapment.