Greater omentum

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Greater omentum
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The greater omentum and corresponding vasculature is visible covering the intestines (dissection image with liver held out of the way).
Label at bottom.
Details
Precursor Dorsal mesentery
Identifiers
Latin omentum majus
MeSH D009852
TA A10.1.02.201
FMA 9580
Anatomical terminology

The greater omentum (also the great omentum, omentum majus, gastrocolic omentum, epiploon, or, especially in animals, caul) is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature of the stomach, passing in front of the small intestines and doubles back to ascend to the transverse colon before reaching to the posterior abdominal wall. The greater omentum is larger than the lesser omentum, which hangs down from the liver to the lesser curvature. The common anatomical term "epiploic" derives from "epiploon", from the Greek epipleein, meaning to float or sail on, since the greater omentum appears to float on the surface of the intestines. It is the first structure observed when the abdominal cavity is opened anteriorly. [1]

Peritoneum serous membrane that forms the lining of the abdominal cavity or the coelom—it covers most of the intra-abdominal (or coelomic) organs—in amniotes and some invertebrates

The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves.

Curvatures of the stomach

The curvatures of the stomach refer to the greater and lesser curvatures. The greater curvature of the stomach is four or five times as long as the lesser curvature.

Stomach digestive organ

The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital digestive organ. In the digestive system the stomach is involved in the second phase of digestion, following mastication (chewing).

Contents

Structure

Greater and lesser omentum Lesser omentum EN.svg
Greater and lesser omentum

The greater omentum is the larger of the two peritoneal folds. It consists of a double sheet of peritoneum, folded on itself so that it has four layers.

The two layers of the greater omentum descend from the greater curvature of the stomach and the beginning of the duodenum. They pass in front of the small intestines, sometimes as low as the pelvis, before turning on themselves, and ascending as far as the transverse colon, where they separate and enclose that part of the intestine.

Duodenum first section of the small intestine

The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine may be used instead of duodenum. In mammals the duodenum may be the principal site for iron absorption.

Small intestine part of the digestive tract, following the stomach and followed by the large intestine

The small intestine or small bowel is the part of the gastrointestinal tract between the stomach and the large intestine, and is where most of the end absorption of food takes place. The small intestine has three distinct regions – the duodenum, jejunum, and ileum. The duodenum is the shortest part of the small intestine and is where preparation for absorption begins. It also receives bile and pancreatic juice through the pancreatic duct, controlled by the sphincter of Oddi. The primary function of the small intestine is the absorption of nutrients and minerals from food, using small finger-like protrusions called villi.

Pelvis lower part of the trunk of the human body between the abdomen and the thighs (sometimes also called pelvic region of the trunk

The pelvis is either the lower part of the trunk of the human body between the abdomen and the thighs or the skeleton embedded in it.

These individual layers are easily seen in the young, but in the adult they are more or less inseparably blended.

The left border of the greater omentum is continuous with the gastrosplenic ligament; its right border extends as far as the beginning of the duodenum.

Gastrosplenic ligament

The gastrosplenic ligament is part of the greater omentum.

The greater omentum is usually thin, and has a perforated appearance. It contains some adipose tissue, which can accumulate considerably in obese people.

In biology, adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular endothelial cells and a variety of immune cells such as adipose tissue macrophages. Adipose tissue is derived from preadipocytes. Its main role is to store energy in the form of lipids, although it also cushions and insulates the body. Far from being hormonally inert, adipose tissue has, in recent years, been recognized as a major endocrine organ, as it produces hormones such as leptin, estrogen, resistin, and the cytokine TNFα. The two types of adipose tissue are white adipose tissue (WAT), which stores energy, and brown adipose tissue (BAT), which generates body heat. The formation of adipose tissue appears to be controlled in part by the adipose gene. Adipose tissue – more specifically brown adipose tissue – was first identified by the Swiss naturalist Conrad Gessner in 1551.

Subdivisions

Horizontal disposition of the peritoneum in the upper part of the abdomen (phrenicolienal ligament labeled at bottom left) Gray1039.png
Horizontal disposition of the peritoneum in the upper part of the abdomen (phrenicolienal ligament labeled at bottom left)
Diagram to show the lines along which the peritoneum leaves the wall of the abdomen to invest the viscera (phrenicosplenic ligament labeled at center right) Gray1040.png
Diagram to show the lines along which the peritoneum leaves the wall of the abdomen to invest the viscera (phrenicosplenic ligament labeled at center right)

The greater omentum is often defined to encompass a variety of structures. Most sources include the following three: [2] [3]

The splenorenal ligament (or lienorenal ligament) (from the left kidney to the spleen) is occasionally considered part of the greater omentum. [4] [5] It is derived from the peritoneum, where the wall of the general peritoneal cavity comes into contact with the lesser sac between the left kidney and the spleen; the splenic artery and vein pass between its two layers. It contains the tail of the pancreas, the only intraperitoneal portion of the pancreas, and splenic vessels.One or more of the preceding sentences incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

Phrenicosplenic ligament

The phrenosplenic ligament (lienophrenic ligament or phrenicolienal ligament) is a double fold of peritoneum that connects the thoracic diaphragm and spleen. [6]

The phrenicosplenic ligament is part of the greater omentum. Distinctions between the phrenicosplenic ligament and adjacent ligaments, such as the gastrophrenic, gastrosplenic and splenorenal ligaments, which are all part of the same mesenteric sheet, are often nebulous. [6]

Blood supply

The right and left gastroepiploic arteries provide the sole blood supply to the greater omentum. Both are branches of the celiac trunk. The right gastroepiploic artery is a branch of the gastroduodenal artery, which is a branch of the common hepatic artery, which is a branch of the celiac trunk. The left gastroepiploic artery is the largest branch of the splenic artery, which is a branch of the celiac trunk. The right and left gastroepiploic arteries anastomose within the two layers of the anterior greater omentum along the greater curvature of the stomach.

Development

Two of the stages in the development of the digestive tube and its mesentery. The arrow indicates the entrance to the bursa omentalis Gray987.png
Two of the stages in the development of the digestive tube and its mesentery. The arrow indicates the entrance to the bursa omentalis

The greater omentum develops from the dorsal mesentery that connects the stomach to the posterior abdominal wall. During its development, the stomach undergoes its first 90° rotation along the axis of the embryo, so that posterior structures are moved to the left and structures anterior to the stomach are shifted to the right. As a result, the dorsal mesentery folds over on itself, forming a pouch with its blind end on the left side of the embryo. A second approximately 90° rotation of the stomach, this time in the frontal plane, moves structures inferior if they were originally to the left of the stomach, and superior if they were originally to the stomach's right. Consequently, the blind-ended sac (also called the lesser sac) formed by the dorsal mesentery is brought inferiorly, where it assumes its final position as the greater omentum. It grows to the point that it covers the majority of the small and large intestine.

Functions

The functions of the greater omentum are:

Clinical significance

Surgical removal

Omentectomy refers to the surgical removal of the omentum, a relatively simple procedure with no major side effects, that is performed in cases where there is concern that there may be spread of cancerous tissue into the omentum. Examples for this are ovarian cancer and advanced or aggressive endometrial cancer as well as intestinal cancer and also appendix cancer. The procedure is generally done as an add-on when the primary lesion is removed.

Additional images

See also

Notes and references

  1. Drake, Richard L., et al., Gray's anatomy for students, Philadelphia, PA: Churchill Livingstone/Elsevier, 2010. Print.
  2. 1 2 Dalley, Arthur F.; Moore, Keith L. (2006). Clinically oriented anatomy. Hagerstown, MD: Lippincott Williams & Wilkins. p. 237. ISBN   0-7817-3639-0.
  3. Anatomy Tables - Stomach & Spleen Archived 2006-12-06 at the Wayback Machine .
  4. Kyung Won Chung (2005). Gross Anatomy (Board Review). Hagerstown, MD: Lippincott Williams & Wilkins. p. 205. ISBN   0-7817-5309-0.
  5. "Module - Peritoneal Cavity Development" . Retrieved 2007-12-01.
  6. 1 2 "Phrenicosplenic ligament". Farlex Partner Medical Dictionary. Retrieved May 18, 2013.
  7. 1 2 3 The omentum: A unique organ of exceptional versatility Indian Journal of Surgery, May 1, 2006, Alagumuthu, M; Das, Bhupati; Pattanayak, Siba; Rasananda, Mangual

Related Research Articles

Abdominal cavity

The abdominal cavity is a large body cavity in humans and many other animals that contains many organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the thoracic diaphragm, a thin sheet of muscle under the lungs, and its floor is the pelvic inlet, opening into the pelvis.

Mesentery human organ

The mesentery is a contiguous set of tissues that attaches the intestines to the posterior abdominal wall in humans and is formed by the double fold of peritoneum. It helps in storing fat and allowing blood vessels, lymphatics, and nerves to supply the intestines, among other functions.

Abdominal aorta

The abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

Splenic artery

The splenic artery is the blood vessel that supplies oxygenated blood to the spleen. It branches from the celiac artery, and follows a course superior to the pancreas.

Lesser omentum

The lesser omentum is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the first part of the duodenum.

The lesser sac, also known as the omental bursa, is the cavity in the abdomen that is formed by the lesser and greater omentum. Usually found in mammals, it is connected with the greater sac via the omental foramen. In mammals, it is not uncommon for the lesser sac to contain considerable amounts of fat.

Greater sac

In human anatomy, the greater sac, also known as the general cavity or peritoneum of the peritoneal cavity proper, is the cavity in the abdomen that is inside the peritoneum but outside the lesser sac.

Right gastroepiploic artery portal vein

The right gastroepiploic artery is one of the two terminal branches of the gastroduodenal artery. It runs from right to left along the greater curvature of the stomach, between the layers of the greater omentum, anastomosing with the left gastroepiploic artery, a branch of the splenic artery.

Left gastroepiploic artery

The left gastroepiploic artery, the largest branch of the splenic artery, runs from left to right about a finger’s breadth or more from the greater curvature of the stomach, between the layers of the greater omentum, and anastomoses with the right gastroepiploic.

Right gastric artery Blood vessel of the human digestive system

The right gastric artery arises, in most cases, from the proper hepatic artery, descends to the pyloric end of the stomach, and passes from right to left along its lesser curvature, supplying it with branches, and anastomosing with the left gastric artery. It can also arise from the region of division of the common hepatic artery, the left branch of the hepatic artery, the gastroduodenal artery, and most rarely, the common hepatic artery itself.

Transverse colon

The transverse colon is the longest and most movable part of the colon. It crosses the abdomen from the ascending colon at the hepatic or right colic flexure with a downward convexity to the descending colon where it curves sharply on itself beneath the lower end of the spleen forming the splenic or left colic flexure. In its course, it describes an arch, the concavity of which is directed backward and a little upward. Toward its splenic end there is often an abrupt U-shaped curve which may descend lower than the main curve.

Foregut

The foregut is the anterior part of the alimentary canal, from the mouth to the duodenum at the entrance of the bile duct. Beyond the stomach, the foregut is attached to the abdominal walls by mesentery. The foregut arises from the endoderm, developing from the folding primitive gut, and is developmentally distinct from the midgut and hindgut. Although the term “foregut” is typically used in reference to the anterior section of the primitive gut, components of the adult gut can also be described with this designation. Pain in the epigastric region, just below the intersection of the ribs, typically refers to structures in the adult foregut.

Gastrocolic ligament

The gastrocolic ligament is a portion of the greater omentum that stretches from the greater curvature of the stomach to the transverse colon. It forms part of the anterior wall of the lesser sac.

Hepatogastric ligament

The hepatogastric ligament or gastrohepatic ligament connects the liver to the lesser curvature of the stomach. It contains the right and the left gastric arteries. In the abdominal cavity it separates the greater and lesser sacs on the right. It is sometimes cut during surgery in order to access the lesser sac. The hepatogastric ligament consists of a dense cranial portion and the caudal portion termed the pars flaccida.

Gastric lymph nodes

The gastric lymph nodes consist of two sets, superior and inferior.

Omental foramen

In human anatomy, the omental foramen, is the passage of communication, or foramen, between the greater sac, and the lesser sac.

The development of the digestive system concerns the epithelium of the digestive system and the parenchyma of its derivatives, which originate from the endoderm. Connective tissue, muscular components, and peritoneal components originate in the mesoderm. Different regions of the gut tube such as the esophagus, stomach, duodenum, etc. are specified by a retinoic acid gradient that causes transcription factors unique to each region to be expressed. Differentiation of the gut and its derivatives depends upon reciprocal interactions between the gut endoderm and its surrounding mesoderm. Hox genes in the mesoderm are induced by a Hedgehog signaling pathway secreted by gut endoderm and regulate the craniocaudal organization of the gut and its derivatives. The gut system extends from the oropharyngeal membrane to the cloacal membrane and is divided into the foregut, midgut, and hindgut.