By: Ameer Ali Abbas Hassan
First Stage (A4)
.
The peritoneum is the serous membrane that lines the abdominal cavity. It is
composed of mesothelial cells that are supported by a thin layer of fibrous tissue
The peritoneum is derived from mesoderm
The peritoneum layers
The outer layer is the parietal peritoneum,
which attaches to the abdominal and pelvic
walls.
The inner visceral layer wraps around the
internal organs located inside the
intraperitoneal space.
The peritoneum cavity
The potential space between the 2 layers contains about 50 to 100 ml of serous
fluid that prevents friction and allows the layers and organs to glide freely.
In the male – closed sac, but in the female – open due to uterine tubes, the
uterus, and the vagina
The peritoneum cavity divided into:
Lesser sac, is the cavity in the abdomen that is formed by the lesser and
greater omentum.
Greater sac is the cavity in the abdomen that is inside the peritoneum but
outside the lesser sac
The epiploic foramen, also known as the foramen of
Winslow. This foramen allows communication
between the greater and lesser sacs. It is bordered by
the hepatoduodenal ligament anteriorly, the inferior
vena cava (IVC) posteriorly, duodenum inferiorly,
and the caudate lobe of the liver superiorly.
Boundaries of the peritoneal cavity include:
Anterior abdominal muscles
Vertebrae
Pelvic floor
Diaphragm
Intraperitoneal organs: include the stomach,
spleen, liver, first and fourth parts of the
duodenum, jejunum, ileum, transverse, and
sigmoid colon.
Retroperitoneal organs: lie behind the posterior
sheath of the peritoneum and include the aorta,
esophagus, second and third parts of the duodenum, ascending and descending
colon, pancreas, kidneys, ureters, and adrenal glands.
"Infraperitoneal" or "subperitoneal" those structures below the
intraperitoneal space (e.g., the bladder)
Structures that are intraperitoneal are generally mobile, while those that
are retroperitoneal are relatively fixed in their location.
Blood supply
Total effective blood flow to the human peritoneum is estimated between 60
and 100 mL/min, representing 1–2 % of the cardiac outflow
The parietal peritoneum receives blood from the abdominal wall vasculature,
including the iliac, lumbar, epigastric, and intercostal arteries.
The visceral peritoneum receives supply from the superior and inferior
mesenteric arteries and celiac artery
The parietal peritoneum drains into the inferior vena cava while the visceral
peritoneum drains through the inferior mesenteric vein, the superior mesenteric
vein and the splenic vein into the portal vein.
Nerve supply
The peritoneum has both somatic and autonomic innervations
The parietal peritoneum receives its innervation from spinal nerves T10 through
L1. This innervation is somatic and allows for the sensation of pain and
temperature that can be localized.
The visceral peritoneum receives autonomic innervation from the Vagus nerve
and sympathetic innervation that result in the difficult to localize abdominal
sensations triggered by organ distension
Peritoneal Subdivision
Names of Folds Mes / Meso
Small Intestine / Enteron…… Mesentery
Large Intestine / Colon……Mesocolon
Stomach…… Omentum / Omenta
Organs – organ / Abdominal wall……Ligaments
Ligaments they connect organs to each other
Mesentery is the part of the peritoneum through which most abdominal organs
are attached to the abdominal wall and supplied with blood and lymph vessels
and nerves.
Content:
1. Superior mesenteric a. & v.
2. Jujunal and lleal a. & v.
3. Autonomic nerve plexus
4. Lymphatics & lymph nodes
5. Fat
Omenta fold of peritoneum that connect the stomach with another viscera
Lessor omentum Greater omentum
The lesser omentum (or gastrohepatic) double layered fold of
peritoneum which extends from lesser curvature of stomach &1st 2cm
of duodenum to liver
Contains
1. Common bile duct,
2. Proper hepatic a.
3. Hepatic portal v.
The greater omentum (or gastrocolic) hangs from the greater curve of the
stomach and loops down in front of the intestines before curving back
upwards to attach to the transverse colon
Contents
1. Left Gastroepiploic vessels
2. Right Gastroepiploic vessels
Greater omentum – Functions
Storage of fat
Protect against infections – Macrophage – small dens white patches –
Milky spot
Limits spread of infection – Sealing –
Policeman of Abdomen
Functions of Peritoneum
1. Movement of Viscera: – Provide slippery surface – permit free
movements like? – Peristalsis, movements during respiration & Filling &
evacuation of hollow viscera
2. Protection of Viscera: – Phagocytic cells & lymphocytes – Greater
omentum – move towards infection site & seal it – Policeman of
Abdomen
3. Absorption and Dialysis: – Mesothelium – semipermeable membrane –
Both secretive & absorptive – Fluid injection – Peritoneal dialysis
4. Healing power and Adhesions: – Mesothelial cells – Fibroblast –
Abnormal adhesion - obstruction
5. Storage of Fat
References
1. Tank, P. (2013) Grants Dissector 15th ed., ch.4 The abdomen, p.99
2. Drake et al. (2009) Gray’s Anatomy for Students, 2nd Edition, Abdominal
Viscera, p.406
3. Tortora, Gerard J., Anagnostakos, Reginald Merryweather, Nicholas P.
(1984) Principles of Anatomy and Physiology, Harper & Row Publishers,
New York
4. "Healthoracle.org Is For Sale" (PDF). Retrieved 14 April 2018.
5. Longo, D; Fauci, A; Kasper, D; Hauser, S; Jameson, J; Loscalzo, J
(2012). Harrison's Principles of Internal Medicine (18th Ed.). New York
6. "Peritoneum - Origin and meaning of peritoneum by Online Etymology
Dictionary". Www.etymonline.com. Retrieved 14 April 2018.
