17. PERITONEAL FLUID
• Derived from interstitial fluid of adjacent tissues
• Contains water, electrolytes, proteins, macrophages and
lymphocytes
• Peritoneum is a semi-permeable membrane that allows
fluid and cells to move in both directions
• Composition varies according to pathological condition
• Condition when there is excess fluid, usually due to
inflammation or infection is called ascites
18. PERITONEAL STRUCTURES
• Parietal and visceral layers – single layer of
peritoneum
• Mesentery – double layer that suspends gut tube, ie.,
dorsal mesentery and ventral mesentery
• Omentum – special type of mesentery that attaches
stomach to another structure, ie., greater omentum
and lesser omentum
• Peritoneal ligaments – double layer that attaches
more solid viscera to abdominal wall or other organs
• Peritoneal folds – raised, single layer of peritoneum
coursing over blood vessels and ligaments
22. VISCERAL PERITONEUM
• Intraperitoneal
– Organs nearly completely
surrounded by peritoneum
– Organs suspended by
mesentery, omentum or
ligament
• Retroperitoneal
– Organs only partially
covered by peritoneum
– Organs have no
mesentery
37. PERITONEAL FOLDS
• Median umbilical
fold – median
umbilical ligament
• Medial umbilical
folds – median
umbilical ligaments
• Lateral umbilical
folds – inferior
epigastrics
38. PARACOLIC GUTTERS
• Longitudinal channels running along medial and lateral sides of
ascending and descending colon
• Form where parietal peritoneum reflects onto colon as visceral
peritoneum
41. HEPATORENAL RECESS
RIGHT SUBHEPATIC RECESS
(MORRISON’S POUCH)
• One of the lowest
points in the
peritoneal cavity
• Excess fluid/blood will
pool in this area when
patient is supine
Cavity with anterior abdomenal wall removed. Relatively unmolested abdominal cavity.
Liver in blue.
Greater omentum in purple:
fold of parietal peritoneum;
reservoir for fat
rich lymphatic perfusion
secretion of lubricating cleaning fluid
Profused by celiac artery: Spleen in red, pancreas in green, stomach in blue
Omentum removed.
Red- superior mesenteric artery
Small and large bowel
Small bowel flipped out of the way. Root of the small bowel in red
Cyphotic bisection; abdominal cavity magnified next slide
Perietal peritoneum (squamous cell membrane) in red
Dorsal root of mesentery in green
Lining of liver will come down, over stomach, creating greater omentum
Lesser omentum in yellow
Greater omentum in blue
Lesser sac in green
9: root of mesentery
3: lesser sac
13: greater sac
