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18. The peritoneum. The peritoneal cavity. The development of the
peritoneum.. The histology of tonsils.
Posted in Abdomen by Sahaja on December 18, 2008

Anatomy of the peritoneum & the peritoneal cavity.

Definition of Peritoneum = is a continuous, glistening+ slippery transparent serous membrane, lines the
andominopelvic cavity+ invests the viscera.

The peritoneum consists of two continuous layers, both layers of peritoneum consists of mesothelium, a layer of simple
squamous epithelial cells:
Parietal peritoneum, which lines the internal surface of the abdomino-pelvic wall
has same a/v/n/lymphatics, as the region of wall that it covers
is sensitive to pressure, pain, heat+ cold+ laceration.
Remember = Parietal = Pain* same goes for parietal pleura in thoracic cavity
Pain from FOREGUT = expressed in EPIGASTRIC region, MIDGUT = UMBILICAL region, HINDGUT
= PUBIC region.
nerve supply = phrenic n, lower IC n, subcostal n, Iliohypogastric n, Ilioinguinal n
Visceral peritoneum, which covers visceral organs like the stomach+ intestines.
has same a/v/n/lymphatics, as the organ it covers
Stimulated primarily by stretching + chemical irritation
nerve supply = visceral n, AS pathways

RELATIONSHIP of the VISCERA TO THE PERITONEUM:

Intraperitoneal organs: are almost covered with visceral peritoneum (e.g. the stomach+ spleen)
Extraperitoneal – only organ that is extra- peritoneal is the ovary
Retroperitoneal – 2 types – more on this later
Primary – always has been located behind the peritoneum
Secondary – was originally intraperitoneal, but now is located behind the peritoneal cavity
Infraperitoneal – located below the peritoneal cavity, usually covered superiorly with peritoneum

PERITONEAL REFLECTIONS – support viscera and contain a/v/n

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1 Sup point of peritoneum, 2 inner aspect of the abdominal wall

, 3 superior surface of the urinary bladder, 4 over the uterus in
the female, 5 into the pouch of Douglas, 6 anterior surface of
the rectum onto the posterior abdominal wall, 7 root of the
mesentery of the small intestine. 8 horizontal part of the
duodenum, 9 gastrocolic ligament, GO= greater omentum (11),
12 anterior surface of the stomach, 13 lesser omentum, EF =
epiploic foramen, LPC = lesser peritoneal cavity (lesser sac)

Omentum

Lesser Omentum – double layer peritoneum, from porta hepatis –> lesser curve + sup hor part of duodenum
hepatogastric & hepatoduodenal ligaments
form ant wall of lesser sac
carry L & R gastric a/v b/w 2 layers of peritoneum
free lower margin for = proper hepatic a, bile duct, and portal v
Greater Omentum – hangs down like apron from gr. curve of stomach –> covering transverse colon & other ab
viscera
carry R & L gastroepiploic a/v along greater curve
adheres to areas of inflammation and wraps around inflammed areas
prevents serous diffuse peritonitis = accumulating peritoneal fluid w/ fibrin & leukocytes

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Mesentaries

Mesentary Proper – fan shaped double fold of peritoneum, suspends jejunum & ileum from post ab wall
forms a root (duod-jej flexure –> R iliac fossa)
free border encloses SI
contains sup mesenteric & SI a/v/n/lymph vessels
Transverse Mesocolon - connect post surfac of transv. colon –> post ab wall
fuses w/ gr. omentum to form gastrocolic lig
contains middle colic a/v/n/lymphatics
Sigmoid Mesocolon – inverted V shaped peritoneal fold
connects sigmoid colong to pelvic wall
contains sigmoid a/v
Mesoappendix – connects appendix to mesentery of ileum
contains appendicular a/v

Peritoneal Folds - reflections w/ free edges

Umbilical folds – 5 folds of peritoneum below umbilicus

Lat umbilical folds = contain inf epigastric a/v
Medial umbilical folds = contain umbilical a
Median umbilical folds = contain remnant of urachus = connects urinary bladder of the fetus with the allantois,
a structure that contributes to the formation of the umbilical cord
Retrouterine folds – extension from cervix of uterus, along side of rectum to pelvic wall (post) and form Rectouterine
pouch of Douglas
Ileocecal fold – terminal ileum –> cecum

Peritoneal Ligaments

Gastrosplenic lig – from L greater curve –> hilus of spleen, has short gastric a/v, L gastroepiploic a/v
Splenorenal lig – Hilus of spleen –> L Kidney, has splenic a/v, has tail of pancreas

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Gastrophrenic lig – Upper greater curve –> diaphragm

Gastrocolic lig – Greater curve –> transverse colon, absorbed into greater omentum, usually
Phrenicocolic lig – Colic flexure –> diaphragm
Falciform lig – sickle shaped peritoneal fold, connects liver –> diaphragm & ant ab wall
border b/w R & L Lobe (ant)
contains ligamentum teres hepatis, and paraumbilical v, which cxts L portal v w/ subcut v in umbilical regions
Ligamentum Teres Hepatis – aka round ligament of liver, lies in lower free marginof falciform ligament, is L border
of quadrate lobe on visceral surface of liver, remnant of umbilical v
Coronary Lig – peritoneal reflection from diaphragmatic surface of liver onto diaphragm, encloses bare area of liver
has R & L extensions that form R & L triangular ligaments
Ligamentum Venosum – fibrous remnant of ductus venosus, lies in fissure on inf surface of liver, forms L border of
caudate lobon visceral surface of liver

Start @ 1 and follow around the peritoneal cavity. 2. Back of

the abdomen, anterior surface of the right kidney, pass through
the epiploic foramen, along the posterior wall of the lesser
peritoneal cavity, 3 then up along the renal lienal ligament 4
onto the posterior surface of the stomach 5. Your finger will
continue through the epiploic foramen again to turn around the
free margin of the lesser omentum 6, then over the anterior
surface of the stomach again 7. Continue to follow around the
greater curvature of the stomach 8 until you reflect again along
the gastrolienal ligament 9. Your finger will now pass around
the spleen, onto the left kidney to the parietal peritoneum and
back to the falciform ligament fl.

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THE PERITONEAL CAVITY

located within the abdominal cavity & continous inf. to the pelvic cavity.
= a potenial space between the parietal+ visceral layers of peritoneum
contain no organs
contains a thin film of peritoneal fliud = which is composed of water, electrolytes+ other substances derived from
interstitial fliud in adjacent tissues.
peritoneal fluid lubricates the peritoneal surfaces, enabling the viscera to move over each other without friction and
allowing the movements of digestion
Contains leukocytes+ antibodies that resists infection.
Lymphatic vessels, particularly on the inf.surface of the unceasingly active diaphragm, absorb the peritoneal fluid.

In Males: the peritoneal cavity is completely closed

In Females: connected to extra-peritoneal cavity through the uterine tubes, uterine cavity, & vagina

split into Lesser Sac & Greater Sac

Lesser Sac = Omental Bursa

irregular space that lies behind liver, lesser omentum, stomach, upper ant part of greater omentum
closed sac, except for cxn w/ greater sac via epiploic foramen
3 recesses:
Sup. recess – being liver, stomach, lesser omentum
Inf recess – behind stomach, extends into layers of greater omentum
Splenic recess – extends to the L to the hilus of spleen

Greater Sac

extends across entire area of abdomen and from diaphragm –> pelvic floor
5 recesses:
Subphrenic recess – peritoneal pocket b/w diaphram & ant/sup part of liver
separates into R & L recesses by falciform lig
Subhepatic recess – peritoneal pocket b/w liver & transverse colon

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Hepatorenal recess – deep peritoneal pocket b/w liver (ant) & kidney (post)
Morison’s pouch = formed by R subhepatic & hepatorenal recess
comminucates w/ subphrenic recess, lesser sac via epoploic foramen, and R paracolic gutter(to pelvic
cavity)
Paracolic recess – (aka gutters) – lies lat to asc/desc colon

Epiploic foramen (of Winslow) - natural opening b/w lesser and greater sacs

Sup = peritoneum of caudate lobe of liver

Inf = peritoneum of 1st part of duodenum
Ant = free edge of lesser omentum
Post = peritoneum covering IVC

Retroperitoneal Space

The retro peritoneal space is seperated into the 3 compartments by the renal fasica. This fascial covering is like a tent that is
closed susuperiorly and open inferiorly.

Ant Chamber = b/w peritoneum and renal fascia, has all secondary retroperitoneal organs

asc colon
desc colon
duodenum (except sup hor part)
pancreas (except tail, sometimes)
Br. of sup mesenteric a, celiac trunk, sup/inf mesenteric v, portal v, common bile duct

Middle Chamber = w/in renal fasica, has primary retroperitoneal organs.

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kidneys
suprarenal glands
ureters
Ab aorta + branches
IVC + branches
Thoracic duct
Cisterna Chyli

Post Chamber = b/w renal fascia and transverse fascia(post ab wall)

asc lumbar v (becomes azygos v, once crosses diaphragm into thoracic cavity)
Greater/Lesser splanchnic n
SNS trunk
Subcostal n.
Lumbar plexus + branches
Ilioinguinal n.
Inohypogastric n
Obturator n
Genitofemoral n
Gonadal a/v

Histology – Tonsils

Slide #25 Palatine Tonsils *H&E

Structures to Identify:

tonsillar crypts
str. sq. non keratinizing epith
lymph nodules (primary and secondary)
muscle bundles
germinal centers
CT capsule

With naked eye: dark, blue, partially encapsulated specimen w/ deep crypts

General Info:

The palatine tonsilles(faucial tonsils)are paired, ovoid structures that consits of dense accumulation of lymphatic tissue

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located in the mucous membrane of the fauces(the junction of the oropharynx + oral cavity).
The epithelium that forms the surface of the tonsil dips into the underlying CT in numerous places, forming crypts
known as tonsillar crypts.
Numerous lymphatic nodules are evident in the walls of the crypts.
Tonsils guard the opening of the pharynx, the common entry to the respiratory+ digestive tracts.
CLI7CAL 7OTE: can become inflamed because of repeated infection in the oropharynx+ nasopharynx+ can even
harbour,
bacteria can cause repeated infections if they are overwhelmed.
debris and abcteria that collects in tonsilar crypts are hard to clean, as not enough saliva to clean them
When this occurs, the inflamed palatine tonsils+ pharyngeal tonsils ( also called adenoids) are removed
surgically.

Important Histological Features

C.T. capsule on one side, oral mucosa on other side

Stratified squamous nonkeratinizing epithelium, lymphocytes invade epithelium within the crypt
this epith is present in both palatine and lingual tonsils

Mucous membrane, lamina propria enlarged contains lymphatic nodules

7OTE = W/in nodule s= B lymphocytes, b/w them = T lymphocytes

Stroma, each lobules has a cortex+ medulla, the cutting plane of the section determines whether you can see both or
not

surrounded by a dense fibroelastic CT capsule (red)

Extends trabeculae to the margin of the cortex and medulla, which can contain fat, a/v
Below CT capsule = skeletal m fibers, but not as much as in lingual tonsil

CORTEX- darker stained(blue)

Blood vessels with epithelioreticular cell sheath, cytoreticulum

Different than CT
has no reticular fibers

Contains epithelioreticular cells as the stroma. Ovoid nucleus, larger cell, lighter colour = lymphoreticular
mesrk
large # of High Endothelial Venules (HEVs)

Embryo

Develops form endoderm instead of mesoderm, unlike regular ct, mostly small lymphocytes
epithelial lining of 2nd pharyngeal pouch – forms buds that penetrate surrounding mesenchyme
mesenchyme => becomes palatine tonsil primordium
in 3rd – 5th, invaginated by lymph tissue, forming tonsil

Slide #26 Lingual Tonsils *H&E

Structures to Identify:

tonsilar crypts
CT
salivary glands
Str. Sq. non-keratinizing epith
lymph nodules
skeletal m

With Nake Eye: A solid specimen with a darker region on one side

General Info:

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aggregation of lymph tissue located at root of tongue, posterior to sulcus terminalis

not usually inflammed, as very accessible to saliva, and tonsilar crypts are not that deep for debris to collec

Histological Characteristics:

has a str. squamous non-keratinized epith – very characteristic of oral mucosa, lines surface, and dips down in very
shallow tonsillar crypts
tonsillar crypts form deep invaginations on surface of tongue, ext. deep into LP
Many lymph nodules, some secondary.
nodules = B lymphocytes, b/w nodules = T lymphocytes
LP = adipose tissue, mucus acini of lingual glands, ducts of glands, lymphoreticular tissue
Below LP, is the skeletal musc. coming from the tongue – bright red color

To be sure it is lingual tonsil = look for the str sq non kerat epith, large amts of skeletal m, lingual mucus glands, NO CT
capsule

Embryology – The development of the peritoneum

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. 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

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Tagged with: greater sac, infraperitoneal, Intraperitoneal, lesser sac, lingual tonsil, mesentary, omental bursa, palatine tonsil,
peritoneum, retroperitoneal, Secondary retroperitoneal, tonsillar crypts

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