The peritoneum is a thin, transparent, serous membrane consisting of two layers which are continuous with one another. One of the two layers is referred to as the parietal peritoneum and lines the abdominopelvic cavity. The other layer is called the visceral layer and covers the outer surfaces of most of the abdominal organs. Organs in the abdominopelvic cavity can be referred to as intraperitoneal, extraperitoneal, retroperitoneal, or subperitoneal based on their association with the peritoneum. Organs covered by visceral peritoneum, not actually within the peritoneal cavity, are considered intraperitoneal organs and include the stomach and spleen. On the other hand, the organs outside the peritoneal cavity are extraperitoneal organs. Types of extraperitoneal organs include the retroperitoneal and subperitoneal organs which are typically only covered by parietal peritoneum on one surface. Retroperitoneal organs, such as the kidneys, are located between the parietal peritoneal layer and the posterior abdominal wall with the parietal peritoneum covering their anterior surfaces. Subperitoneal organs have parietal peritoneum covering their superior surfaces and include organs such as the urinary bladder.
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| parietal peritoneum = bright blue; visceral peritoneum = magenta |
The omental foramen, also called the epiploic foramen, connects two areas of peritoneum referred to as the greater sac and the lesser sac. The lesser sac is further divided into the lesser and greater omenta. The omenta are double-layered areas of peritoneum that reach from the stomach and proximal duodenum to other areas of the abdominopelvic cavity. Connecting from the lesser curvature of the stomach to the liver is the lesser omentum while the greater omentum connects from the greater curvature of the stomach to the transverse colon. The lesser omentum includes the hepatogastric ligament and the portal triad within the hepatoduodenal ligament, functioning to link the stomach to the hepatic artery, bile duct, and hepatic portal vein which make up the portal triad. The greater omentum lies over the intestines and folds under upon itself forming a four-layered fold with a peritoneal recess, to ascend and attach to the transverse colon.
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Red = greater sac; Blue = lesser sac |
Mesentery refers to the areas of peritoneum where it is double-layered and invaginates due to an organ. The term “mesentery” is often used more specifically to refer to the peritoneum connecting the jejunum and ileum to the posterior abdominal wall. Mesenteries of other parts of the alimentary tract have their own more descriptive terms. Mesentery surrounding the large intestine is referred to as mesocolon and depending on the portion of the large intestine surrounded, is mesoappendix, transverse mesocolon, or sigmoid mesocolon. These mesentaries contain neurovascular tissue and provides a means of communication between the organs and the body wall. Mesentery also functions to hold organs in place due to its attachment to the posterior abdominal wall, except for the specialized mesenteries which connect an organ to an organ.
Sandwiched between the parietal and visceral layers of the peritoneum is the potential space referred to as the peritoneal cavity. The peritoneal cavity contains peritoneal fluid which functions to lubricate the peritoneal surfaces, reducing friction that would otherwise be associated with the movements of digestion. The peritoneal cavity and the peritoneal fluid also serve an immunological function. Antibodies and leukocytes can be found within the peritoneal fluid and help to resist infection. Sometimes excess peritoneal fluid can collect within the peritoneal cavity, a condition called ascites. If the ascites becomes infected, the condition is referred to as peritonitis.
Peritonitis can develop as the result of another condition, spontaneously, or due to dialysis. Secondary peritonitis typically develops when bacteria, gas, and fecal material enter the peritoneal cavity through a perforation or rupture of the gastrointestinal tract. Spontaneous peritonitis is associated with any disease that causes ascites, but is typically due to liver or kidney failure. Dialysis-associated peritonitis results from bacteria, usually bacteria or fungi of the skin, which is introduced by way of the dialysis procedure. Peritoneal dialysis is different from hemodialysis because waste is filtered using the peritoneal membrane, rather than using an external filter, to filter blood. The catheter used during peritoneal dialysis is what introduces the microorganisms that cause dialysis-associated peritonitis.
Peritoneal dialysis involves filling the peritoneal cavity with a dilute sterile solution and then draining the solution after a specified period of time has passed. Due to the semipermeable nature of the peritoneum and its close association with blood and lymph capillary beds, it is used to filter blood during peritoneal dialysis. During this process, a dilute sterile solution called dialysate, which contains glucose, is introduced into the peritoneal cavity where it is left for an amount of time called the dwell time. During the dwell time, the dialysate absorbs waste products and excess water which move from the patient’s blood and across the peritoneal membrane due to differences in concentration gradients. Following the dwell time, the dialysate is drained through a tube and discarded. This form of dialysis offers the benefit of being performed at home but, it must be done more often than hemodialysis.
A. Robinson
Sources:
Sources:
Moore, Dalley, Agur: Clinically Oriented Anatomy. 6th ed. Baltimore: Lippincott Williams & Wilkins, 2010.
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