Transcription

Okay, so we've talked about a little bit of the basics of the peritoneal cavity and the peritoneum and what the visceral and parietal peritoneum are and the divisions of the actual cavity, so the greater and lesser sacs.   now, we'll just have a guided tour through the peritoneal cavity. We'll start off at the liver and look at some of the peritoneal attachments in a bit more detail.   I'll start at the top and we'll work our way down.

The liver has various ligaments which attach from its surface to the diaphragm and also to the anterior abdominal wall. These ligaments aren't like ligaments in joints which connect bones to bones. These ligaments are folds of peritoneum and they anchor the liver into place.

 

The liver is this organ here in the right upper quadrant of the abdomen. It sits just underneath the diaphragm like this. We'll just take a look at some of the peritoneal attachments of the liver. I'll just isolate it and I'll show you some of the ligaments that we have.

 

We’re looking at the anterior surface of the liver. We've got a ligament which separates the right from the left lobes.   this is called the falciform ligament. I'm drawing this on in yellow. This runs up the middle of the liver.

 

This ligament attaches the liver to the anterior abdominal wall. It attaches it to the inner surface of the rectus sheath.    it attaches behind the rectus sheath as low as the level of the umbilicus. It's a remnant of the umbilical vein of the fetus.

 

In its base, at the base of this ligament, the falciform ligament, in the free margin, you've got a ligament called the round ligament. I'm drawing this little round ligament on in blue. That's contained within the falciform ligament in the free margin at the base of the falciform ligament. The round ligament passes into the groove between the quadrate and left lobe.

 

Remember, above the liver, you've got the diaphragm. I'm drawing the diaphragm on here. This is the diaphragm in red. Reflecting off the diaphragm, you've got folds of peritoneum. These folds of peritoneum reflect off the inferior surface of the diaphragm and attach onto the liver.   You’ve got these reflections from the inferior surface of the diaphragm which reflect onto the liver.

 

This ligament here is called the coronary ligament. You've got upper and lower coronary ligaments. This one here is the upper coronary ligament. You'll be able to see the lower coronary ligament or posterior coronary ligament on the posterior surface of the liver.   Where the anterior and posterior coronary ligaments meet, you get the triangular ligament. You've get this triangular ligament at this side.   this side is the left triangular ligament. And on the other side, you've got the right triangular ligament where the upper and lower coronary ligaments meet.

 

What I'm going to do is show you a diagram to make this a bit clearer than my silly scriblings. If we rotate the liver around, we're going to take a look at the superior surface of the liver.   imagine looking at this view.

 

We’re looking at the same view I just showed you in the model. We're looking superiorly at the liver. We've got the right lobe here, the left lobe on this side, we've got the inferior vena cava posteriorly and you can see the ligament that I drew on before.

 

You’ve got the falciform ligament coming up here separating the right and left lobes. It goes off to attach to the anterior abdominal wall. And then you've got the coronary ligaments which come down from the diaphragm. And then you've got the left triangular ligament and right triangular ligament.

 

Just coming back to this 3D model. We're looking at an anterior view here. What I'm going to do is we're going to rotate it around to the back and we'll look at a diagram of this sort of posterior and inferior surfaces of the liver.

 

We’re looking at the inferior and posterior surface of the liver. You can see the coronary ligament here. This is a reflection of peritoneum which attaches the diaphragm (the inferior surface of the diaphragm) to the liver.

 

You can see the coronary ligament here running round. And then at the bottom, you can see this lower part.   this is the lower part of the coronary ligament which you can see on the posterior surface.

 

This coronary ligament demarcates an area of the liver, which is not peritoneal.   there is a bare area on the liver where there is no peritoneum. This is called the bare area of the liver. This part of the liver is in direct contact with the diaphragm.

 

The right triangular ligament is formed in this lower extremity of the bare area of the liver where these two layers of the coronary ligaments fuse and this right triangular ligament passes to the diaphragm.

 

The peritoneum covers the whole liver except for this area (which I'm showing you) at the back of the liver called the bare area. The majority of the liver is covered in peritoneum, which reflects off the diaphragm.

 

And then you've got this fissure here, which is called the fissure for the ligamentum venosum.   the ligamentum venosum is a fibrous remnant of the ductus venosus. Just below it, just here on the side of the quadrate lobe, you can see where the round ligament comes into the back of the liver.   remember, I showed you the round ligament passing in the margin of the falciform ligament. It passes to the posterior surface and runs along here.

 

From the ligamentum venosum and the porta hepatis, you get the lesser omentum, which connects the liver to the lesser curve of the stomach and to the first part of the duodenum.   the peritoneum which encloses the liver meets to form this double layer of peritoneum at the porta hepatis. And it connects the porta hepatis to the lesser curvature of the stomach and the first part of the duodenum.   this is called the lesser omentum.