The part of peritoneal cavity that is most dependent in supine position?
Correct Answer: Right subhepatic space
Description: Ans. d. (Right subhepatic space) (Ref. BDC 3rd/Vol. Ill)Morison's pouch (Right subhepatic space), in a patient lying supine in bed, is the b part of peritoneal cavity. It is the deepest space of the four and the most common site of a subphrenic abscess, which usually arises from appendicitis, cholecystitis, a perforated duodenal ulcer or following upper abdominal surgery.Otherwise, Abscesses are most commonly found in pelvis, right subhepatic space and right subphrenic space.THE PERITONEAL CAVITY# The peritoneal cavity is the largest cavity in the body, the surface area of its lining membrane (2 m2 in an adult) being nearly equal to that of the skin.# It is the space between the parietal and visceral layers (continuous with one another) and is lubricated by serous fluid. It can be divided into the greater sac and smaller lesser sac, which lies behind the stomach.# The greater sac of the peritoneum is divided into- (a) the subphrenic spaces,- (b) the pelvis, and- (c) the peritoneal cavity proper.# The peritoneal cavity proper is redivided by the transverse colon and transverse mesocolon into -- supracolic and- infracolic compartment.# When the supracolic compartment overflows, as is often the case when a peptic ulcer perforates, it does so over the colon into the infracolic compartment, or by way of the right paracolic gutter to the right iliac fossa, and thence to the pelvis.# Whereas the left is open to the pelvis medially, the right is bounded by the ascending mesocolon, which is continuous with the small-bowel mesentery. This boundary means that pathology within this space tends to follow the superior aspect of the small-bowel mesentery as it attempts to reach the pelvis, finally reaching the medial aspect of the caecum. Similarly, pathology within the left infracolic space will involve the superior aspect of the sigmoid mesocolon before being liberated into the pelvis (to reach the lateral paravesical spaces and pouch of Douglas). Negative intrathoracic pressure tends to drive pelvic fluid up the paracolic gutters.# However, although pelvic pathology may freely communicate with the right supracolic spaces (the right subphrenic and subhepatic spaces, and lesser sac) via the right paracolic gutter, the left gutter is partially bounded by the phrenicocolic ligament. This simple concept explains why metastases from ovarian carcinoma frequently involve the liver surface more often than the spleen.# When a visceral perforation occurs the free fluid which spills into the peritoneal cavity runs downwards, largely directed by the normal peritoneal attachments. For e.g., spillage from a perforated duodenal ulcer may run down the right paracolic gutter.
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