Anatomy of the peritoneum and peritoneal cavity

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Anatomy of the peritoneum and peritoneal cavity

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Anatomy of the coronary circulation
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Anatomy of the abdominal viscera: Liver, biliary ducts and gallbladder
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Heart failure: Pathology review
Anatomy of the coronary circulation
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Anatomy of the cerebral cortex
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Anatomy of the thyroid and parathyroid glands
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Anatomy of the thyroid and parathyroid glands
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Endocrine system anatomy and physiology
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Introduction to the skeletal system
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Anatomy of the abdominal viscera: Pancreas and spleen
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Anatomy of the abdominal viscera: Kidneys, ureters and suprarenal glands
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Abdominal quadrants, regions and planes
Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Anatomy of the abdominal viscera: Esophagus and stomach
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Anatomy of the abdominal viscera: Large intestine
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Anatomy of the peritoneum and peritoneal cavity
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Anatomy clinical correlates: Peritoneum and diaphragm
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Appendicitis: Pathology review
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Acid-base map and compensatory mechanisms
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Anatomy of the abdominal viscera: Esophagus and stomach
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Small intestine
Anatomy of the gastrointestinal organs of the pelvis and perineum
Gastrointestinal system anatomy and physiology
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Diverticular disease: Pathology review
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GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Lung cancer and mesothelioma: Pathology review
Nasal, oral and pharyngeal diseases: Pathology review
Obstructive lung diseases: Pathology review
Pneumonia: Pathology review
Restrictive lung diseases: Pathology review
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Small intestine
Anatomy of the gastrointestinal organs of the pelvis and perineum
Bile secretion and enterohepatic circulation
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Anatomy of the heart
Anatomy of the lungs and tracheobronchial tree
Anatomy of the pleura
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Thoracic wall
Alveolar surface tension and surfactant
Anatomic and physiologic dead space
Breathing cycle and regulation
Diffusion-limited and perfusion-limited gas exchange
Gas exchange in the lungs, blood and tissues
Pulmonary shunts
Regulation of pulmonary blood flow
Respiratory system anatomy and physiology
Ventilation
Ventilation-perfusion ratios and V/Q mismatch
Zones of pulmonary blood flow
Cardiac afterload
Cardiac contractility
Cardiac cycle
Cardiac preload
Cardiac work
Frank-Starling relationship
Measuring cardiac output (Fick principle)
Pressure-volume loops
Stroke volume, ejection fraction, and cardiac output
Acid-base map and compensatory mechanisms
Buffering and Henderson-Hasselbalch equation
Physiologic pH and buffers
The role of the kidney in acid-base balance
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Heart failure: Pathology review
Lung cancer and mesothelioma: Pathology review
Obstructive lung diseases: Pathology review
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
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Introduction to the cardiovascular system
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Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Anatomy of the abdominal viscera: Esophagus and stomach
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Small intestine
Anatomy of the gastrointestinal organs of the pelvis and perineum
Anatomy of the vessels of the posterior abdominal wall
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Gastrointestinal bleeding: Pathology review
Anatomy of the blood supply to the brain
Anatomy of the cranial base
Anatomy of the cranial meninges and dural venous sinuses
Anatomy of the nose and paranasal sinuses
Anatomy of the suboccipital region
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Anatomy clinical correlates: Temporal regions, oral cavity and nose
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck
Headaches: Pathology review
Anatomy of the abdominal viscera: Liver, biliary ducts and gallbladder
Anatomy of the abdominal viscera: Pancreas and spleen
Anatomy clinical correlates: Other abdominal organs
Gallbladder histology
Liver histology
Bile secretion and enterohepatic circulation
Liver anatomy and physiology
Pancreatic secretion
Jaundice: Pathology review
Anatomy of the elbow joint
Anatomy of the glenohumeral joint
Anatomy of the hip joint
Anatomy of the knee joint
Anatomy of the radioulnar joints
Anatomy of the sternoclavicular and acromioclavicular joints
Anatomy of the tibiofibular joints
Joints of the ankle and foot
Joints of the wrist and hand
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Clavicle and shoulder
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Anatomy clinical correlates: Leg and ankle
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Gout and pseudogout: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
Seronegative and septic arthritis: Pathology review
Anatomy of the knee joint
Anatomy clinical correlates: Knee
Rheumatoid arthritis and osteoarthritis: Pathology review
Seronegative and septic arthritis: Pathology review
Candida
Clostridium difficile (Pseudomembranous colitis)
Enterobacter
Enterococcus
Escherichia coli
Proteus mirabilis
Pseudomonas aeruginosa
Staphylococcus aureus
Bacterial and viral skin infections: Pathology review
Skin histology
Skin anatomy and physiology
Acneiform skin disorders: Pathology review
Papulosquamous and inflammatory skin disorders: Pathology review
Pigmentation skin disorders: Pathology review
Skin cancer: Pathology review
Vesiculobullous and desquamating skin disorders: Pathology review
Anatomy of the heart
Anatomy of the vagus nerve (CN X)
Aortic dissections and aneurysms: Pathology review
Cardiomyopathies: Pathology review
Coronary artery disease: Pathology review
Heart blocks: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Ventricular arrhythmias: Pathology review
Hunger and satiety
Anxiety disorders, phobias and stress-related disorders: Pathology Review
Breast cancer: Pathology review
Colorectal polyps and cancer: Pathology review
Dementia: Pathology review
Diabetes mellitus: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Heart failure: Pathology review
HIV and AIDS: Pathology review
Hyperthyroidism: Pathology review
Inflammatory bowel disease: Pathology review
Jaundice: Pathology review
Lung cancer and mesothelioma: Pathology review
Malabsorption syndromes: Pathology review
Mood disorders: Pathology review
Tuberculosis: Pathology review

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Notes

Anatomy of the peritoneum and peritoneal cavity

Illustrator: Patricia Nguyen, MScBMC
Editor: Kaitlin Marshall, MSc., BSc.
Editor: Leah Labranche, PhD, MSc, BSc(Hons)
Editor: David Clay, MSc., BSc.
Editor: Andrew Horne, MSc., BSc.
Figure 1: Midsagittal view of the peritoneum and peritoneal cavity. 
Figure 2: Subdivisions of the peritoneal cavity. A. Midsagittal and B. Transverse sections showing the greater and lesser sacs. 
Figure 3: Lesser sac (Omental bursa). A. Midsagittal view. B. Anterior view with stomach reflected. C. Transverse section, inferior view.
Figure 4: Mesenteries of the intestines.
Figure 5: Greater and lesser omenta of the abdomen.
Figure 6: Development of the gut and mesenteries. A. Gut tube migrates from posterior abdominal wall, bringing the dorsal mesentery with it. B. Gut elongates and enlarges. C. Organs grow and rotate, resulting in twists in the mesenteries and peritoneal reflections (ligaments) that connect adjacent organs.

Figure 7: Schematic transverse sections showing the relationships of abdominal organs to the dorsal and ventral mesenteries during development.

A. Organs and mesenteries are in the midline during 5th week of development. B. The organs rotate to the right. C. and D. Fusion of a portion of the dorsal mesentery with the parietal peritoneum of posterior abdominal wall leaves the pancreas in a retroperitoneal position.

Figure 8: Embryological origin of the ventral mesentery. A. Ventral mesentery is derived from the septum transversum (mesoderm). B. Enlarging liver contacts the septum transversum, and portion of ventral mesentery covering the liver splits apart leaving a bare area of the liver, uncovered by visceral peritoneum.
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Questions

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A partial liver resection is performed in a patient with an early stage hepatocellular carcinoma in the left lobe of the liver. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall. Which of the following structures are contained within this ligament?  

Transcript

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At first glance, the peritoneum and peritoneal cavity seem pretty simple, but some aspects, like the peritoneal ligaments, can be a bit confusing. In order to understand them, we need to go way back to their embryological formation. 
 Once upon a time, in an amniotic galaxy far far away, the embryonic body cavity is lined with mesoderm. As the fetus is developing, the embryonic body cavity becomes the primordial abdominal cavity and the mesoderm lining it becomes the parietal peritoneum which is a transparent, serous membrane that helps to form a closed sac, called the peritoneal cavity. 

As abdominal organs develop, they protrude into the peritoneum, like pushing your fist into a balloon. Your fist represents the developing abdominal viscera and the balloon represents the parietal peritoneum. As your fist pushes into the balloon it is lined closely by part of the balloon and this represents the visceral peritoneum. So, the visceral peritoneum covers the viscera, while parietal peritoneum lines the internal surface of the abdominopelvic wall; and these two layers are continuous with one another.  
The parietal peritoneum has the same blood and lymphatic supply and the same nerve supply as the region of the wall it lines, meaning it is sensitive to pressure, pain, heat and cold. The visceral peritoneum, on the other hand, has the same blood, lymphatic, and nerve supply as the viscera it covers, meaning it is sensitive to stretch and chemical irritation. 

Depending on their relationship with the peritoneum, abdominal and pelvic organs can be either intraperitoneal, retroperitoneal, or subperitoneal.  
Intraperitoneal organs are almost completely covered with visceral peritoneum, but remember they’re not inside the peritoneal cavity. These organs include the stomach, first part of the duodenum, jejunum, ileum, transverse colon, sigmoid colon, liver and spleen. 
 Now, the retroperitoneal organs, also known as primarily retroperitoneal, develop posterior to the peritoneal cavity, outside of the peritoneum, so they’re only partially covered with peritoneum. The retroperitoneal organs include the kidneys, ureters, suprarenal glands, and rectum. 

There are also secondarily retroperitoneal organs where they begin as intraperitoneal but later on in development become attached to the posterior abdominal wall. The secondarily retroperitoneal organs include the second to fourth parts of the duodenum, pancreas, and the ascending and descending colon. 
 Lastly, the subperitoneal organs, like the urinary bladder, are similar to the retroperitoneal organs, except they are located inferior to the peritoneal cavity, rather than posterior to it.  
The peritoneal cavity is a potential space between the parietal and visceral layers of the peritoneum. Keep in mind that the peritoneal cavity has no abdominal organs, it only contains a thin film of fluid that contains water, electrolytes and other substances derived from the interstitial fluid. The peritoneal fluid helps viscera move without friction, allowing for peristalsis, and it also has white blood cells and antibodies to resist infection.  
Quick quiz. Can you remember which organs are retroperitoneal and which organs are intraperitoneal?  
Now we are going to look at some of the peritoneal structures in adults. Let’s first start by looking at the omentum, which is a fold of peritoneum. There’s actually two of them: the greater omentum and the lesser omentum. 
The greater omentum is a four-layered peritoneal fold that hangs like an apron from the greater curvature of the stomach and the proximal part of the duodenum. After descending, it folds back and it attaches to the anterior surface of the transverse colon and its mesentery. These four layers fuse with one another.  
The lesser omentum is a double-layered peritoneal fold that connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver. Posterior to the lesser omentum, there’s a space known as the lesser sac or omental bursa, and the rest of the peritoneal cavity is known as the greater sac. 

These two spaces communicate through the omental foramen, also called the epiploic foramen.

Anterior to the omental foramen, there’s the hepatoduodenal ligament, which is the free edge of the lesser omentum that contains the portal triad. Posterior to the omental foramen, is the inferior vena cava and the right crus of the diaphragm. Superior to the omental foramen is the liver, and inferior to the omental foramen is the first part of the duodenum. 

The peritoneal cavity as a whole is divided by the transverse mesocolon into a supracolic compartment and an infracolic compartment. 
 The supracolic compartment contains the stomach, liver and spleen. The infracolic compartment is located posterior to the greater omentum and contains the small intestine, as well as the ascending and descending colon. Communication between the supracolic and infracolic compartments happens through the paracolic gutters, which are grooves between the lateral aspect of the ascending or descending colon and the posterolateral abdominal wall. 

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