Lecture № 5

Serous Sacs, Features and Functions

There are three serous sacs in the living man. There are: Pericardial, Pleural, and Peritoneal.
They all are developed from intra embrionic coelome.
Development of the Serous Sacs.
At the stage of the 3-4 week of embrionic development each of mesoderms are divided into
two layers and the space appered between them. This space is called coelome. Right and left
parts of the body have their own coelome.
There are two layers of coelome:
1. Somato-pleurae layer – layer which lines the amniotic cavity (outer aspect). Parietal
layer of Serous sac is developed from this layer.
2. Splanchno-pleurae layer – Layer which lines the yorc sac and developing primitive
digestive tube. Visceral layer is developed from this layer.
Two visceral layers connect each other in saggital plane. Thus dorsal and ventral
mesenterium are perfomed. At the period of 7-8 embrionic week diaphragma begins to
develop. Diaphragma devides each coelom into three absolutely isolated cavities: unpaired
thoracic cavity situated cranially and paired abdominal cavity situated caudally. From
thoracic cavity three serous sacs are developed: two pleural sacs and one pericardial sac.
Caudal part of the coelom became unpaired, because ventral mesenterium disappeared and
digestive tube is connected with the body wall only by dorsal mesenterium.
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Three absolutely isolated serous sacs are present in the thorasic cavity, one for each lung
and one, middle, sac for the heart. The serous covering of the lung is called pleura. It has
two layers: the visceral pleura (pleura visceralis) and the parietal pleura (pleura
parietalis).
The visceral, or pulmonary pleura, covers the lungs and fused with the pulmonary
substunce so closely that it cannot be removed without injury to the tissue. The visceral
pleura invests the lung completely and is continuous with the patietal pleura at the root of
the lung.
The potential space between two layers is called pleural cavity. In a healthy subject
the pleural cavity is not visible macroscopically. Under normal conditions it contains 1 or 2
ml of fluid. This cavity becomes patent when air (Pneumothorax), fluid (Pleurisy with
effusion), blood (Haemothorax) or pus (empyema) are in it. Parietal pleura is subdivided
according to regions it lines into three parts: the costal pleura, the diaphragmatic pleura and
mediastinal pleura.
The costal pleura (pleura costalis), the most extensive part of the parietal pleura,
lines the inner surfaces of the ribs and intercostal spaces.
The diaphragmetic pleura (pleura diaphragmatica) covers the superior surface of
the diaphragm except for the middle part where the pericardium is in direct contact with the
diaphragm.
The mediastinal pleura (p. mediastinalis) lines the medial surface of lung. In front it
is continuous with the costal pleura at costomediastinal line of pleural reflection below it is
continuous with diaphragmatic pleura at costodiaphragmetic line of pleural reflection and
posteriorly with the costal pleura at costovertebral line of pleural reflection. The
mediastinal pleura bounds laterally the mediastinal organs. The complex of organs
occupying the space between the mediastinal pleura is called mediastinum. This complex
forms as if a septum between the two pleural sacs. An anterior and posterior part are
distinguished in the mediastinum. It is bounded by frontal plane drawn through the posterior
part of both pulmonary roots.
The anterior mediastinum (mediastinum anterius) contains the heat with the
pericardium, the thymus, the vena cava superior, the ascending aorta and the aortic arch with
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its branches, the pulmonary viens, the trachea and bronchi, the phrenic nerves, the bronchial
arteries and veins, and the lymph nodes. The posterior mediastinum (mediastinum
posterius) is ocuppies by the oesophagus the thoracic aorta, the thoracic duct, the lymph
node, the vena cava inferior, the azygos and hemiazygos veins, the splanchnic nerves and
the vagus nerves streching on the oesophageal walls.
The boundaries of the lungs coincide not in all places with those of the pleural sacs.
Reserve spaces are formed by two parietal layers of the pleura where the pulmonary borders
do not coincide with the pleural bounderies; these are the pleural recesses, or sinuses
(recessus pleuralis).The lung enters them only during very deep inspiration. The largest
sinus the costodiapfragmatic recess (recessus costodiaphragmaticus) is situated on the
right and left sides along the inferior boundary of the pleura, between the diaphragm and the
thoracic cage; the inferior pulmonary borders do not reach the pleural boundaries here.
Another, smaller, reserve space is at the anterior border of the left lung. It extends for the
distance of the cardiac notch between the costal and mediastinal pleurae and is called the
costomediastinal recess (recessus costomediastinalis).Fluid (inflammatory exudate)
produced in inflammation of the pleura accumulates first of all in the pleural sinuses. The
pleural sinuses are the part of the pleural cavity, but they are nevertheless differ from it. The
pleural cavity is the space between the visceral and parietal pleurae; pleural sinuses
are reserve spaces of the pleural cavity between two layers of the parietal pleura.
The pericardial sac (pericardium) is a closed serous sac, in which two layers are
distinguished: an outer fibrous layer, the pericardium fibrosum, and an inner serous
layer ,the pericardium serosum. The serous pericardium is divided into two layers: a
visceral layer or the epicardium mentioned above, and a parietal layer, which fuses with the
inner surface of the fibrous pericardium and lines it. The space between parietal and visceral
layers is called serous cavity (cavum pericardii). It contains a small amount of serous fluid
(liquor pericardii). On the trunks of large vessels close to the heart, the visceral and parietal
layers are continuous. The pericardium is directly attached to the mediastinal pleura on both
sides. The posterior surface of the pericardial sac adjoins the oesophagus and the descending
aorta. The passage behind the aorta and pulmonary trunk is called the transverse sinus of
the pericardium (sinus transversus pericardii). The space bounded below and to the right by
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the inferior vena cava and above and to the left by the left pulmonary veins is the oblique
sinus of the pericardium (sinus obliquus pericardii).
The peritoneum is a serous membrane which is located into abdominal cavity. It
consists of two layers, parietal (peritoneum parietale) and visceral (peritoneum viscerale).
The parietal layer lines the abdominal wall, while the visceral layer invests the internal
organs. The space between parietal and visceral layers is called peritoneal cavity (cavum
peritonei).This space contains a small amount of serous fluid; this fluid moistens the surface
of the organs and so makes easier their movement against one another. In male the
peritoneal cavity is closed serous sac, but in female it is an open cavity because the
fimbriated end of uterine tube opens into the peritoneal cavity. So the peritoneal cavity
through uterine tube, uterus and vaginal canal communicates with the outside. When air
enters the cavity during operation or postmortem examination or when pathological fluids
accumulate in it, this cavity is become large.
The parietal peritoneum forms а continuous lining on the anterior and lateral walls of
the abdomen. Then it passes on to the diaphragm and the posterior abdominal wall. Неrе it
is reflected on the viscera and is directly continuous with the visceral peritoneum investing
them.
In the lower part of the anterior abdominal wall the peritoneum forms five folds
converging on the umbilicus: one unpaired medial umbilical fold (plica umbilicalis mediana)
and two paired medial and lateral umbilical folds (plicae umbilicales mediales and plicae
umbilicales laterales). These folds bound on each side two inguinal fossae (fossae
inguinales) above the inguinal ligament, which аrе related to the inguinal canal.
It is very difficult to have clear conception of the disposition of peritoneum. So we
shall study peritoneum in two ways or dispositions.
1.Vertical disposition.
For easier understanding of the complex relations, the whole peritoneal cavity can be
separated into three regions, or storeys: (1) an upper storey bounded superiorly by the
diaphragm, and inferiorly by the mesocolon transversum; (2) а middle storey extending
downward from the mesocolon transversum to the entry into the true pelvis; 3) the lower
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storey begins at the line of entry into the true pelvis and corresponds to the cavity of the true
pelvis which is the lowest part of the abdominal cavity.
1. From the inferior surface of diaphragm the peritoneum will be reflected to upper surface of
the liver. It is form ligaments of liver: the coronary ligament of the liver (lig. coronarium
hepatis), This ligament then perfom the right and left triangular ligaments of the liver (lig.
triangulare dextrum and sinistrum); the falciform ligament of the liver.(lig. falciforum).
This ligament divides the liver into right and left lobes. From the hepatic porta to the lesser
curvature of the stomach peritoneum is fomed the hepatogastric ligament (lig.
hepatogastrica),and to the part of duodenum nearest to the stomach it forms the
hepatoduodenal ligament (lig. hepatoduodenale). The hepatogastric and hepatoduodenal
ligaments are duplications of the peritoneum because two peritoneal layers are encountered in
the region of the porta hepatis. One layer passing tо the porta from the anterior раrt of the
visceral surface of the liver and the other from the posterior раrt. The hepatoduodenal and
hepatogastric ligaments are а continuation of one another and form together the lesser
omentum (omentum minus). Between the layers of the hepatoduodenal ligament pass the
сотптлоп bile duct (on the right), the common hepatic artery (on the left) and the portal
vein (posteriorly and between these structures), as well as lymphatic vessels, nodes and
nerves.
On the lesser curvature of the stomach both layers of the lesser omentum separate, one
to cover the anterior and the other the posterior surface of the stomach. On the greater
curvature they again join and descend in front of the transverse colon and the loops of the
small intestine to form the anterior lamina of the greater omentum (omentum majus). On
some level both layers fold over to ascend and form its posterior lamina. The great omentum
consists therefore of 4 layers.
The upper storey of the peritoneal cavity separates into three sacs: hepatic bursa (bursa
hepatica), pregastric bursa (bursa pregastrica), and omental bursa (bursa omentalis). The
hepatic bursa is related to the right lobe of the liver and is separated from the pregastric bursa
by the falciform 1igament of the liver; it is bounded posteriorly by the coronary ligament of
the liver. The pregastric bursa is related to the left lobe of the liver, anterior surface of the
stomach, and the spleen;
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The omental bursa, lesser sac of the peritoneum (bursa omentalis), is part of the general
peritoneal cavity lying behind the stomach and the lesser omentum.
The cavity of the omental bursa communicates with the general peritoneal cavity only by
means of а relatively narrow epiploic foramen, opening into the lesser sас (foramen
epiploicum). The foramen is bounded above by the caudate lobe of the liver, in front by the
free margin of the hepatoduodenal ligament, below by the superior part of the duodenum, The
parietal peritoneum forming here the posterior wall of the omental bursa covers the
abdominal aorta, vena cava inferior, and the pancreas.
2. The middle storey of the peritoneal cavity can be visualized when the greater omentum and
transverse colon are raised. Using as the boundaries the ascending and descending parts of the
colon on the sides аnd the . mesentery of the small intestine in the middle, this storey can be
subdivided into four compartments; between the lateral abdominal walls and the colon
ascendens and colon descendens are the right and left lateral canals (canales laterales
dexter and sinister); the space bounded by the colon is divided by the mesentery of the small
intestine, descending obliquely from left to right, into the right and left mesenteric sinuses
(sinus mesentericus dexter and sinus mesentericus sinister).
The mesentery (mesenterium) is а fold of two peritoneal layers by means of which the small
intestine is attached tо the posterior abdominal wall. The posterior margin of the mesentery
attached to the abdominal wall is the root of the mesentery (radix mesenterii). It is relatively
short (f5-17 cm), whereas the opposite free end related to the mesenteric part of the small
intestine (jejunum and ileum) is the length of these two segments. The line of attachment of
the root passes obliquely from the left side of the second lumbar Blood vessels, nerves,
lymphatic vessels and lymph nodes pass in the thickness of the mesentery between the two
serous layers containing more or less fatty tissue.
At the junction of the small intestine and the colon are two recesses, the inferior and superior
ileocaecal recesses (recessus ileocecalis inferior and superior), situated below and above the
ileocaecal fold passing from the ileum to the medial surface of the caecum..
А recess in the parietal peritoneum lodging the caecum is called the fossa of caecum
3.The lower storey. Further tracing of peritoneum differs in male and female. On
passing from the anterior surface of the recrum to the posterior surface of the urinary bladder
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in males the peritoneum forms a pouch between its layers behind the bladder this is
retrovesical pouch (excavatio vesicorectalis). In females, therelations of the peritoneum in
pelvis are different because between the urinary bladder and the rectum is the uterus, which is
also covered by the peritoneum. There are two peritoneal pouches in the female pelvis,
namely the recto-uterine pouch (excavatio recto-uterina) between the rectum and uterus and
the uterovesical pouch (excavatio vesico-uterina) between the uterus and the urinary
bladder.
The tunica vaginalis testes is the serous sac too. It has two layers: parietal and visceral
(tunica albuginea).