What makes understanding the peritoneum so difficult

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來自 Universiteit Leiden 的課程

Anatomy of the Abdomen and Pelvis; a journey from basis to clinic.

327 個評分

Universiteit Leiden

Anatomy of the Abdomen and Pelvis; a journey from basis to clinic.

327 個評分

In this anatomy course you will explore the organs involved in our food digestion and discover the common causes of abdominal and pelvic pain. The latest graphics and animations will help you to find new insights and understanding of this part of the body, that has been the focus of anatomical research for centuries and presently arouses renewed scientific interest. You will explore the 3D anatomy of the organs from a basic level, providing thorough anatomical understanding, to its advanced application in surgical procedures. This course will challenge you to discover and help you to understand the anatomy of the abdomen and pelvis in all its aspects, ranging from its embryological underpinnings, via digital microscopy to gross topography and its clinical applications. The course is unique in that it continuously connects basic anatomical knowledge from the lab with its medical applications and current diagnostic techniques. You’ll get the chance to discuss anatomical and clinical problems with peers and experts in forum discussions and you will receive guidance in exploring the wealth of anatomical information that has been gathered over the centuries. Follow us on an exciting journey through the abdomen and pelvis where you digest your food but also where new life starts!

從本節課中

Knowing your peritoneal relationships

You have already learned that the bowels are not arranged symmetrically left and right. The rotation processes of the gut and its suppliers have important consequences for the peritoneal coverings of the gut and the abdominal wall. It determines why some structures lie easily accessible in the abdomen and others are more hidden away. In this week you will get a grip on difficult concepts as 'intraperitoneal' and 'retroperitoneal'. It is also a starter week about abdominal surgery. You will also learn a secret: The best way to mobilize the abdominal and pelvic organs is to separate what got adhered when the patient was just an embryo! Please feel free to dive into these embryonic matters and enjoy all the twists and turns!

Why bother about the peritoneum4:35

What makes understanding the peritoneum so difficult4:45

The relation of the peritoneum to the gut6:19

Locations of the intestines in relation to the peritoneum7:03

Anatomy on the table - The three locations of organs in relation to the peritoneum4:32

Peritoneal terminology: Introduction1:53

與講師見面

Marco De Ruiter, PhD
Professor of Clinical and Experimental Anatomy
Leiden University Medical Centre
Paul Gobée, MD
Assistent professor of Anatomy
Leiden University Medical Centre
Beerend P. Hierck, PHD.
Associate professor of developmental biology
Leiden University Medical Center
Daniël Jansma, MSc
E-Learning developer
Leiden University Medical Centre
Bas Boekestijn, MD
Trainee Radiology
Leiden University Medical Centre
Friso Jansen
Drs.
Leiden University Medical Centre

Welcome.

We are studying anatomy of the peritoneum.

It is an important subject.

Unfortunately though, also it is a difficult to understand topic.

What makes it so difficult, I will explain that and

also discuss how you can cope with it.

There are three reasons.

First, the intestines make complicated twists and

turns during development of the embryo.

And the peritoneum that surrounds them is growing along with the intestines and

is also twisted in a complicated way.

On this picture you can see it.

You see that the peritoneum is twisted, but

this shows only one of the rotations and relocations that occur.

For many people, the resulting combined three dimensional shape and

position change are difficult to visualize in their minds.

To get a better understanding it can be useful to study different drawings,

models or animations.

And the best even is to try to replay the developments by yourself by drawing it,

folding a piece of paper or even creating your own model.

Second, several areas of peritoneum adhere to each other during development, but

in all kinds of different combinations.

This may lead to place in the abdomen where there are one, two, three, four,

five, or even six layers of peritoneum stuck together.

This picture shows that.

It shows the peritoneal layers as they were in the embryonic periods.

You see three layers here, four layers here, etc.

However, in the postnatal situations, these layers are merged.

Therefore, most anatomical drawings also depict them as merged or

only show two layers.

This picture shows that.

It shows how it is usually drawn.

You see that only two layers are drawn.

Because of this, it is my experience that you will

never get to understand the peritoneum by only studying the gross anatomy books and

trying to imagine in your head how the peritoneum runs.

No matter how hard you try.

Simply because the original layers have gone.

The solution is to be aware that pictures of the adult situation

usually do not show all the original embryological layers.

So instead use the previously mentioned embryological animations or

models to study the peritoneal development.

The third and final reason that makes the peritoneum so difficult is terminology.

There are many different terms for parts of the peritoneum.

Some examples are shown here.

Not only are there many terms, sometimes they also may be used interchangeably

depending on how generic or specific term you use.

Just as you may call a cow either an animal, a cow, a Dutch belted, or

even Bessie.

In the same way we may call the transverse mesocolon either peritoneum, or

mesentery or transverse mesocolon.

To overcome these terminological problems,

be aware that all these terms denote the same tissue, namely peritoneum.

And that are just names for specific parts of it.

In addition, realize that there are a few types of peritoneal formations that have

specific terms.

Namely, mesenteries, peritoneal ligaments, and omenta, as indicated now.

Know how these peritoneal formations are defined and

also be aware of how derivative terms, such as, transverse mediacolon are formed.

Having these basics clear will absolutely help you get a hold on these terms.

Really confusing is, the historically growing usage of the word,

intraperitoneal.

Intra means inside.

But in the anatomy,

intraperitoneal denotes a location that's not inside a peritoneal cavity.

But is only surrounded by peritoneum.

But if a clinician applies an intraperitoneal injection, he or

she does mean he injects inside the peritoneal cavity.

Puzzling?

You bet. The only remedy here is to simply be aware

of this potential confusion, and

to try to determine from the context of the sentence what it actually meant.

To summarize, the challenges in studying the peritoneum are first

difficulty to three dimensionally visualize all it's twists and turns.

Second, the adherence and disappearance of peritoneal layers.

And finally, its terminology complexity.

Be aware of these complicating factors in studying the peritoneum and

follow the provided tips to cope with them.

I hope that will reduce the difficulty For

you in coming to grips with this difficult but important subject matter.

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