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PERITONEUM  BY AGAGWU, ONYINYECHUKWU M. MATRIC NUMBER: 224913 COURSE: ADVANCED HUMAN GROSS ANATOMY  (I)   COURSE CODE: ANA 701 LECTURER IN CHARGE: DR R.S. AJANI

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INTRODUCTION FUNCTIONS OF PERITONEUM TYPES OF PERITONEUM ARRANGEMENT OF PERITONEAL ORGANS MODIFICATIONS OF THE PERITONEAL CAVITY INTRAPERITONEAL SPACES FUNCTIONS OF PERITONEUM CLINICAL CORRELATES CONCLUSION REFERNCES

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The peritoneum is a continuous, glistening, and slippery transparent serous membrane that  lines the  abdominopelvic  cavity and invests the viscera .  It also supports the viscera, and provides a pathway for blood vessels and lymph.

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Two types: Parietal peritoneum Visceral peritoneum

Diagram showing the parietal and visceral peritoneum. Source: Moore  et al ., 2014

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It is the part of the peritoneum that is in direct contact with the  abdomonopelvic  wall. It is served by the same blood and lymphatic vasculature and the same somatic nerve supply as the region of the wall which it lines.  Pain is usually localised.

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Invests the viscera (such as the stomach and intestines) It is served by the same blood and lymphatic vasculature and visceral nerve supply It is insensitive to touch, temperature or laceration but usually stimulated primarily by stretching and chemical irritation. Pain is poorly localized &  referred to the dermatomes of the spinal ganglia.

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The arrangement of peritoneum is dependent on how abdominal organs are related to it. That also affects the classification of visceral organs INTRAPERITONEAL  ORGANS EXTRAPERITONEAL  ORGANS

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These are organs which are  almost completely covered with visceral peritoneum . They  invaginate  into the peritoneum, like pressing the fist into an inflated balloon. They include the stomach, spleen, appendix, pancreas (tail), duodenum (first part), liver, transverse colon etc.

Diagram showing the parietal and visceral peritoneum. Source:  Agur  & Dalley , 2009

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(lesser E)

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These are organs that are partially covered with peritoneum (just on one surface). They are further classified into the following: Retroperitoneal organs  Subperitoneal  organs

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These are organs that have parietal peritoneum  only on their anterior surfaces . They are  situated between the parietal peritoneum and the posterior abdominal wall.  They include , pancreas (head, neck and body),  ureters , ascending and descending colon, oesophagus, and rectum.

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These are organs that have parietal peritoneum only on their  superior surfaces .  They include the urinary bladder, cervix of the uterus and last part of the rectum.

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It is a potential space of capillary thinness between the parietal and visceral layers of peritoneum.  It is situated within the abdominal cavity and continues inferiorly into the pelvic cavity. It contains a thin film of peritoneal fluid, which is secreted by the  mesothelium .

Diagram showing the peritoneal cavity. Source: Moore  et al ., 2014

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The peritoneal  ﬂuid  contains leukocytes and antibodies that resist infection In males, the peritoneal cavity is completely closed. However, there is a communication pathway in females to the exterior of the body through the uterine tubes, uterine cavity, and vagina which constitutes a potential pathway of infection from the exterior.

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The peritoneum covers nearly all viscera within the gut and conveys neurovascular structures from the body wall to the  intraperitoneal  viscera. In order to carry out its functions, the peritoneum develops into a highly folded, complex structure and various terms are used to describe the parts of the peritoneum that connect organs with other organs or to the abdominal wall, and the compartments and recesses that are formed as a consequence.  They include: the mesentery,  omentum , peritoneal ligament, peritoneal folds, and peritoneal recesses.

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This is a double layer of peritoneum that occurs as a result of the  invagination  of the peritoneum by an organ It constitutes a continuity of the visceral  and  parietal peritoneum. Connects  intraperitoneal  organs  (stomach, pancreas, spleen, small intestine)  to the posterior body wall

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Lesser
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Small
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Diagram showing the mesentery. Source: Moore  et al ., 2014

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Intraperitoneal Organ
Jejunum
Mesentary
Double layer of visceral
peritoneum
Retroperitoneal Organ
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Diagram showing the mesentery. Source: https://www.teachmeanatomy.com

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It is a double-layered extension or fold of peritoneum that passes from the  stomach  and  proximal part of the duodenum  to adjacent organs in the abdominal cavity.  It is of two types:  Greater  omentum Lesser  omentum

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It is a prominent, four-layered peritoneal fold that hangs down like an apron   from the  greater curvature of the stomach and the proximal part of the duodenum .  After descending, it folds back and attaches to the  anterior surface of the transverse colon .

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Diagram showing the greater  omentum Source: Moore  et al ., 2014

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It is a much smaller, double-layered peritoneal fold that connects the  lesser curvature of the stomach and the proximal part of the duodenum to the liver .  It also connects the stomach to a triad of structures that run between the duodenum and liver in the free edge of the lesser  omentum .

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It consists of a double layer of peritoneum that connects an organ with another organ or to the abdominal wall It is named for the particular structures it connects.

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Falciform  ligament connects the liver to the anterior abdominal wall. Hepatogastric  ligament, connects the liver to the stomach.  Hepatoduodenal  ligament, connects the liver to the duodenum and conducts the portal triad: portal vein, hepatic artery, and bile duct.

Diagram showing the peritoneal ligament. Source: Moore  et al ., 2014

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Gastrophrenic  ligament connects the stomach to the inferior surface of the diaphragm. Gastrosplenic  ligament which reflects to the  hilum  of the spleen connects the stomach to the spleen. Gastrocolic  ligament connects the stomach to the transverse colon.

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The  peritoneum,  because of its complexity in investing the viscera forms folds which allow the passage of neurovascular structures.  The peritoneal folds also connect the visceral organs to the abdominal wall or to each other.  They include the  omenta , mesentery and peritoneal ligaments.

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These are pouches formed as the peritoneum drapes over viscera, that is, they are formed by a peritoneal folds.  An example is  the inferior recess of the  omental  bursa  between the layers of the greater  omentum  and the  superior recess of the  omental  bursa  between the caudate lobe of the liver and the diaphragm.

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Supracdic
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Infracdic
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Duodenum
Transvere colon
Inferior recess of
omental
Mesentery of
intestine
Greater omentum
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Visceral *ritoneum
PMietal peritoneum
Rectovesical
Urinary bladder

Diagram showing the peritoneal recess. Source:  Agur  & Dalley , 2009

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These are areas of visceral organs, especially the  intraperitoneal  organs that are not covered and hence allow the entrance or exit of neurovascular structures. Example: the bare area of the liver

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Diagram showing the bare area of the liver. Source:  https://www.earthslab.com/anatomy/liver

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These are subdivisions of the peritoneal cavity. After the rotation and development of the greater curvature of the stomach, the peritoneal cavity is divided into peritoneal sacs: Greater sac Lesser sac

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It is the main and larger part of the peritoneal cavity. The transverse  mesocolon  (mesentery of the transverse colon) divides the abdominal cavity into two compartments: Supracolic  compartment Infracolic  compartment

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Supracolic  Compartment: containing the stomach, liver and spleen. Infracolic  Compartment: containing the small intestine, ascending and descending colon. This compartment lies posterior to the greater  omentum  and is further divided into the right and left  infracolic  spaces by the mesentery of the small intestine.

Diagram showing the greater sac. Source:  Agur  & Dalley , 2009

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There is a free communication between the  supracolic  and  infracolic  compartments through the  paracolic  gutters (the grooves between the lateral aspect of descending or ascending colon and the  posterolateral  abdominal wall).

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Diagram showing the subdivisions of the greater sac. Source: Moore  et al ., 2014

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It   is an extensive sac-like cavity that lies posterior to the stomach, lesser  omentum , and adjacent structures.  It has a superior recess which is limited superiorly by the diaphragm and posterior layers of the coronary ligaments of the liver and an inferior recess between the superior parts of the layers of the greater  omentum .

Diagram showing the subdivisions of the lesser sac. Source:  Agur  & Dalley , 2009

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The  omental  bursa communicates with the greater sac through the  omental   ( epiploic ) foramen , which is an opening situated posterior to the free edge of the lesser  omentum  ( hepatoduodenal  ligament).

Diagram showing the  omental  foramen. Source:  Agur  & Dalley , 2009

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The  omental  foramen is bounded: Anteriorly: by the  hepatoduodenal  ligament, containing the hepatic portal vein, hepatic artery, and common bile duct. Posteriorly : by the inferior vena cava (IVC) and the right  crus  of the diaphragm. Superiorly: by the liver, covered with visceral peritoneum. Inferiorly: by the superior or first part of the duodenum.

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It forms a supporting (peritoneal) fold which suspends various abdominal organs.  Peritoneal fluid allows free movement and gliding between the viscera which often changes size and shape.  The peritoneum limits and prevents the spread of  intraperitoneal  infections between the peritoneal cavities.  It serves as a means of conveying blood vessels,  lymphatics , and nerves to abdominal organs.  Storage of large amounts of fat.  Peritoneal fluid contains leukocytes and antibodies that resist infection.

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PERITONITIS  This is the inflammation of the peritoneum. It occurs either as a result of bacterial infection during  laproscopy   or traumatic perforation and rupture of an abdominal organ, as in duodenal ulcer or appendicitis.  It also occurs when an ulcer perforates the wall of the stomach or duodenum, spilling acid content into the peritoneal cavity.  It is highly dangerous because of the high rate with which it can spread over large areas causing rigidity of the affected parts of the abdominal wall. It results in accumulation of serum, fibrin, cells, and pus in the peritoneal cavity.

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ASCITES This is the accumulation of excess fluid in the peritoneal cavity thereby interfering with movements of viscera, leading to abdominal swelling.  It may occur as a result of mechanical injury, infections, pathological conditions or cancer.  Normally, the highest amount of fluid that should be within the peritoneal cavity is 50mls, but once it exceeds that to say 1500mls it causes  ascite  and the fluid is called ascetic fluid.  The  ascitic  fluid flows along the  paracolic  gutters into the pelvis, especially when the person is upright.

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PERITONEAL ADHESIONS These are scar tissues which arise as a result of damage to the peritoneum, either due to injury (stab wound), infection, or after an abdominal operation.  This makes the peritoneal surfaces become inflamed, making them sticky with fibrin. As healing occurs, the fibrin may be replaced with fibrous tissue, forming abnormal attachments between the visceral peritoneum of adjacent viscera, or between the visceral peritoneum of an organ and the parietal peritoneum of the adjacent abdominal wall.  Adhesiotomy  is the surgical separation of adhesions.

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Others include: Intraperitoneal  injection Peritoneal dialysis

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The peritoneum is a continuous, glistening, slippery transparent serous semi-permeable membrane with two layers that lines the  abdominopelvic  cavities and invests the viscera Modifications occur as double folds (mesenteries and  omenta , and subdivisions called ligaments) that convey neurovascular structures and the ducts of accessory organs to and from the viscera The peritoneal ligaments are named for the particular structures they connect  The main part of the peritoneal cavity (the greater sac) is divided by the transverse  mesocolon  into  supracolic  and  infracolic  compartments.

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Agur  A.M.R. &  Dalley  A.F., 2009. Grant’s atlas of anatomy, 12 th  edition. Philadelphia:  Lippincot  Williams and Wilkins. pp 122 – 125. Arjun  K., Chase J.W.,  Faiz  T. (2020). Anatomy, abdomen, pelvis and peritoneum.  StatPearls  [internet].  statPerals  publishing; Treasure Island; August 10, 2020. Assessed on 14th of August 2021. Brady M., Mahoney E., 2015. Peritoneal cavity. In: Doherty G.M. ed. Current Diagnosis and Treatment: Surgery 14 th  edition. New York, NY: McGraw-Hill; chapter 22. Drake R.I,  Vogl  W. & Mitchell A.M., (2010). Gray’s Anatomy for Students, 2nd Edition. Canada: Churchill Livingstone Elsevier. pp 292 – 297.

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Karcher  D.S., McPherson R.A. (2011). Cerebrospinal, synovial, serous body fluids and alternative specimens. In: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22 nd  edition. Philadelphia: Elsevier/Saunders, Chapter 29. Moore K.L,  Dalley  A.F,  Agur  A.M.R (2014). Clinically Oriented Anatomy, 7 th  edition. Philadelphia:  Lippincot  Williams and Wilkins. pp 217 – 225. https://www.earthslab.com/anatomy/stomach  retrieved on 14th of August 2021. https://www.earthslab.com/anatomy/liver  retrieved on 14th of August 2021. https://wwwlecturio.com/magazine/peritoneum/  retrieved on 14th of August 2021. https://www.teachmeanatomy.com/intraperitoneal-and-retroperitoneal-organs  retrieved on 14th of August 2021.

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PERITONEUM

 BY

AGAGWU, ONYINYECHUKWU M.
MATRIC NUMBER: 224913

COURSE: ADVANCED HUMAN GROSS ANATOMY  (I) 

 COURSE CODE: ANA 701


LECTURER IN CHARGE: DR R.S. AJANI

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 Diagram showing the bare area of the liver. Source:  https://www.earthslab.com/anatomy/liver

slide25-hotlink7

 Karcher  D.S., McPherson R.A. (2011). Cerebrospinal, synovial, serous body fluids and alternative specimens. In: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22 nd  edition. Philadelphia: Elsevier/Saunders, Chapter 29. Moore K.L,  Dalley  A.F,  Agur  A.M.R (2014). Clinically Oriented Anatomy, 7 th  edition. Philadelphia:  Lippincot  Williams and Wilkins. pp 217 – 225. https://www.earthslab.com/anatomy/stomach  retrieved on 14th of August 2021. https://www.earthslab.com/anatomy/liver  retrieved on 14th of August 2021. https://wwwlecturio.com/magazine/peritoneum/  retrieved on 14th of August 2021. https://www.teachmeanatomy.com/intraperitoneal-and-retroperitoneal-organs  retrieved on 14th of August 2021.

PERITONEUM BY AGAGWU, ONYINYECHUKWU M. MATRIC NUMBER: 224913 COURSE: ADVANCED HUMAN GROSS ANATOMY (I) COURSE CODE: ANA 701 LECTURER IN CHARGE: DR R.S. AJANI

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