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The peritoneum is the
serous membrane The serous membrane (or serosa) is a smooth tissue membrane of mesothelium lining the contents and inner walls of body cavities, which secrete serous fluid to allow lubricated sliding movements between opposing surfaces. The serous membrane ...
forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels,
lymphatic vessel The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph ve ...
s, and nerves. The abdominal cavity (the space bounded by the vertebrae,
abdominal muscles The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...
, diaphragm, and pelvic floor) is different from the intraperitoneal space (located within the abdominal cavity but wrapped in peritoneum). The structures within the intraperitoneal space are called "intraperitoneal" (e.g., the
stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
and intestines), the structures in the abdominal cavity that are located behind the intraperitoneal space are called "
retroperitoneal The retroperitoneal space (retroperitoneum) is the anatomical space (sometimes a potential space) behind (''retro'') the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they have peritoneum on thei ...
" (e.g., the
kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
s), and those structures below the intraperitoneal space are called "subperitoneal" or "infraperitoneal" (e.g., the bladder).


Structure


Layers

The peritoneum is one continuous sheet, forming two layers and a
potential space In anatomy, a potential space is a space between two adjacent structures that are normally pressed together (directly apposed). Many anatomic spaces are potential spaces, which means that they are potential rather than realized (with their realiz ...
between them: the
peritoneal cavity The peritoneal cavity is a potential space between the parietal peritoneum (the peritoneum that surrounds the abdominal wall) and visceral peritoneum (the peritoneum that surrounds the internal organs). The parietal and visceral peritonea are la ...
. The outer layer, the parietal peritoneum, is attached to the
abdominal wall In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls. There is a common set of layers covering and forming all the walls: the deepest being the ...
and the pelvic walls. The
tunica vaginalis The tunica vaginalis is the pouch of serous membrane that covers the testes. It is derived from the vaginal process of the peritoneum, which in the fetus precedes the descent of the testes from the abdomen into the scrotum. After its descent, ...
, the serous membrane covering the male
testis A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testostero ...
, is derived from the vaginal process, an outpouching of the parietal peritoneum. The inner layer, the visceral peritoneum, is wrapped around the visceral organs, located inside the intraperitoneal space for protection. It is thinner than the parietal peritoneum. The mesentery is a double layer of visceral peritoneum that attaches to the gastrointestinal tract. There are often blood vessels, nerves, and other structures between these layers. The space between these two layers is technically outside of the peritoneal sac, and thus not in the peritoneal cavity. The potential space between these two layers is the
peritoneal cavity The peritoneal cavity is a potential space between the parietal peritoneum (the peritoneum that surrounds the abdominal wall) and visceral peritoneum (the peritoneum that surrounds the internal organs). The parietal and visceral peritonea are la ...
, filled with a small amount (about 50 mL) of slippery
serous fluid In physiology, serous fluid or serosal fluid (originating from the Medieval Latin word ''serosus'', from Latin ''serum'') is any of various body fluids resembling serum, that are typically pale yellow or transparent and of a benign nature. The fl ...
that allows the two layers to slide freely over each other. The right
paracolic gutter The paracolic gutters (paracolic sulci, paracolic recesses) are peritoneal recesses – spaces between the colon and the abdominal wall. Structure There are two paracolic gutters: * The right lateral paracolic gutter. * The left medial paracolic ...
is continuous with the right and left subhepatic spaces. The epiploic foramen allows communication between the greater sac and the lesser sac. The peritoneal space in males is closed, while the peritoneal space in females is continuous with the extraperitoneal pelvis through openings of the
fallopian tubes The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ot ...
, the
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
, and the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
.


Subdivisions

Peritoneal folds are omenta, mesenteries and ligaments; they connect organs to each other or to the abdominal wall. There are two main regions of the peritoneal cavity, connected by the omental foramen. * The greater sac, represented in red in the diagrams above. * The lesser sac, represented in blue. The lesser sac is divided into two "omenta": ** The
lesser omentum The lesser omentum (small omentum or gastrohepatic omentum) is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach, and to the first part of the duodenum. The lesser omentum is usually divided into th ...
(or ''gastrohepatic'') is attached to the lesser curvature of the stomach and the
liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...
. ** The
greater omentum The greater omentum (also the great omentum, omentum majus, gastrocolic omentum, epiploon, or, especially in animals, caul) is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature ...
(or ''gastrocolic'') hangs from the
greater curvature of the stomach The curvatures of the stomach refer to the greater and lesser curvatures. The greater curvature of the stomach is four or five times as long as the lesser curvature. Greater curvature The greater curvature of the stomach forms the lower lef ...
and loops down in front of the
intestines The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...
before curving back upwards to attach to the transverse colon. In effect it is draped in front of the intestines like an apron and may serve as an insulating or protective layer. The mesentery is the part of the peritoneum through which most abdominal organs are attached to the abdominal wall and supplied with
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
and lymph vessels and nerves.


Omenta


Mesenteries In zoology, a mesentery is a membrane inside the body cavity of an animal. The term identifies different structures in different phyla: in vertebrates it is a double fold of the peritoneum enclosing the intestines; in other organisms it forms com ...


Other ligaments and folds

In addition, in the
pelvic cavity The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet (the superior opening of the pelvis). Its lower boundary is the pelvic floor. The pelvic cavity primarily contains the reproduc ...
there are several structures that are usually named not for the peritoneum, but for the areas defined by the peritoneal folds:


Classification of abdominal structures

The structures in the abdomen are classified as intraperitoneal, mesoperitoneal,
retroperitoneal The retroperitoneal space (retroperitoneum) is the anatomical space (sometimes a potential space) behind (''retro'') the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they have peritoneum on thei ...
or infraperitoneal depending on whether they are covered with visceral peritoneum and whether they are attached by mesenteries (mensentery, mesocolon). Structures that are ''intraperitoneal'' are generally mobile, while those that are ''retroperitoneal'' are relatively fixed in their location. Some structures, such as the kidneys, are "primarily retroperitoneal", while others such as the majority of the duodenum, are "secondarily retroperitoneal", meaning that structure developed intraperitoneally but lost its mesentery and thus became retroperitoneal.


Development

The peritoneum develops ultimately from the mesoderm of the trilaminar embryo. As the mesoderm differentiates, one region known as the lateral plate mesoderm splits to form two layers separated by an
intraembryonic coelom In the development of the human embryo the intraembryonic coelom (or somatic coelom) is a portion of the conceptus forming in the mesoderm during the third week of development. During the third week of development, the lateral plate mesoderm split ...
. These two layers develop later into the visceral and parietal layers found in all serous cavities, including the peritoneum. As an embryo develops, the various abdominal organs grow into the abdominal cavity from structures in the abdominal wall. In this process they become enveloped in a layer of peritoneum. The growing organs "take their blood vessels with them" from the abdominal wall, and these blood vessels become covered by peritoneum, forming a mesentery. Peritoneal folds develop from the
ventral Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
and dorsal mesentery of the embryo.


Clinical significance


Imaging assessment

CT scan is a fast (15 seconds) and efficient way in visualising the peritoneal spaces. Although ultrasound is good at visualizing peritoneal collections and ascites, without ionising radiation, it does not provide a good overall assessment of all the peritoneal cavities. MRI scan is also increasingly used to visualise peritoneal diseases, but requires long scan time (30 to 45 minutes) and prone to motion artifacts due to respiration and peristalsis and chemical shift artifacts at the bowel-mesentery interface. Those with peritoneal carcinomatosis, acute pancreatitis, and intraabdominal sepsis may not tolerate prolonged MRI scan.


Peritoneal dialysis

In one form of dialysis, called
peritoneal dialysis Peritoneal dialysis (PD) is a type of dialysis which uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte pro ...
, a glucose solution is sent through a tube into the peritoneal cavity. The fluid is left there for a prescribed amount of time to absorb waste products, and then removed through the tube. The reason for this effect is the high number of arteries and veins in the peritoneal cavity. Through the mechanism of
diffusion Diffusion is the net movement of anything (for example, atoms, ions, molecules, energy) generally from a region of higher concentration to a region of lower concentration. Diffusion is driven by a gradient in Gibbs free energy or chemica ...
, waste products are removed from the blood.


Peritonitis

Peritonitis is the
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
of the peritoneum. It is more commonly associated to infection from a punctured organ of the abdominal cavity. It can also be provoked by the presence of fluids that produce chemical irritation, such as gastric acid or pancreatic juice. Peritonitis causes fever, tenderness, and pain in the abdominal area, which can be localized or diffuse. The treatment involves rehydration, administration of antibiotics, and surgical correction of the underlying cause. Mortality is higher in the elderly and if present for a prolonged time.


Primary peritoneal carcinoma

Primary peritoneal cancer is a cancer of the cells lining the peritoneum.


Etymology

"Peritoneum" is derived from
Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...
περιτόναιον ''peritonaion'' "peritoneum, abdominal membrane" via
Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
. In Greek, περί ''peri'' means "around," while τείνω ''teino'' means "to stretch"; thus, "peritoneum" means "stretched over."


Additional images

Image:Gray403.png, Median sagittal section of pelvis, showing the arrangement of fasciæ Image:Gray1038.png, Horizontal disposition of the peritoneum in the lower part of the abdomen Image:Gray1125.png, Sagittal section through posterior abdominal wall, showing the relations of the capsule of the kidney Image:Gray1224.png, Topography of thoracic and abdominal viscera Image:Gray1039.png, Horizontal disposition of the peritoneum in the upper part of the
abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...
Image:Cytology of normal mesothelium.jpg,
Cytology Cell biology (also cellular biology or cytology) is a branch of biology that studies the structure, function, and behavior of cells. All living organisms are made of cells. A cell is the basic unit of life that is responsible for the living an ...
of the normal
mesothelial cell The mesothelium is a membrane composed of simple squamous epithelial cells of mesodermal origin, which forms the lining of several body cavities: the pleura (pleural cavity around the lungs), peritoneum (abdominopelvic cavity including the mesent ...
s that line the peritoneum, with typical features.Image by Mikael Häggström, MD. Sources for mentioned features:
-
-
Wright's stain


See also

*
Duodenorenal ligament The duodenorenal ligament is a fold of peritoneum that occasionally crosses from the duodenum at the termination of the hepatoduodenal ligament to the right kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. ...


References


External links

*
Overview and diagrams at colostate.edu
{{Authority control Abdomen