Peritoneum

The peritoneum (Greek: peritonaion = the stretched-out peritoneum) serves to seal off the abdominal cavity and the organs located within it in an airtight manner. It is divided into a parietal and a visceral leaf and covers all organs of the abdominal cavity below the diaphragm up to the pelvis (the deepest point is the Douglas space). It also produces peritoneal fluid and is part of the immune system.

Structure of the peritoneum

The total area of the peritoneum in humans is 1.6 to 2.0 m2. On the front wall of the abdominal cavity below the navel there are five longitudinal folds, which are used as guiding structures in surgery. The three structures in the middle date from the embryonic period and show here the three large vessels for blood exchange between mother and child.

The structures running laterally from them contain the arteria and the inferior epigastric vein, which serve to supply blood to the abdominal wall. The peritoneum is divided into a visceral and a parietal leaf according to its covering structures. These organs are also attached to a suspension band, the meso.

The leaves of the peritoneum are supplied by various nerves. The visceral leaf is mainly innervated by the autonomic nervous system. Parts of the peritoneum above the gall bladder and liver are innervated by the phrenic nerve.

The parietal leaf is sensitively innervated by the spinal nerves and the phrenic nerve and is therefore very sensitive to pain. are located in the so-called subperitoneal space and invade the parietal leaf of the peritoneum from below. At this point the peritoneum is called the peritoneum urogenital.

  • The peritoneal cavity itself is lined by the parietal leaf of the peritoneum. – The visceral leaf covers the liver, spleen, gallbladder, stomach and most of the large and small intestine. – The urinary bladder and in women
  • The uterus,
  • Ovaries and
  • Fallopian tubes

Function

The peritoneum secretes and absorbs peritoneal fluid. This is a clear fluid which serves as a “lubricant” and allows the organs to move against each other. This movability is particularly important in the case of: The amount of fluid normally does not exceed 50 ml.

Larger amounts of peritoneal fluid are pathological and are called ascites. This is a common symptom when insufficient production of this fluid prevents smooth movement of the organs against each other and can lead to pain or even adhesions of the peritoneum. Inflammation of the peritoneum (peritonitis) is a life-threatening complication that can occur after surgery or organ perforation.

Furthermore, the peritoneum serves as an airtight seal for the abdominal organs and for immune defence. – stomach filling and the

  • Digestion, and a
  • Pregnancy necessary. – Liver failure,
  • Inflammation or
  • Tumour diseases of the abdominal cavity or peritoneum.

Inflammation of the peritoneum, medically called peritonitis, is an inflammatory process that can have various causes. Depending on the cause, peritonitis can be divided into primary and secondary peritonitis. Primary peritonitis accounts for only a very small proportion of the peritonitis that occurs.

Inflammation is called peritonitis if it occurs without being preceded by disease of other organs of the abdominal cavity. Basically, any inflammation of the organs of the abdominal cavity that come into contact with the peritoneum can cause peritonitis. If this is the case, it is called secondary peritonitis.

Most frequently, peritonitis occurs in conjunction with appendicitis. However, inflammation of other organs can also be accompanied by peritonitis, for example, inflammation of the female reproductive organs. A so-called diverticulitis is another reason why the peritoneum can become inflamed.

In this disease a protrusion of a part of the large intestine occurs and becomes inflamed, as does the adjacent peritoneum. If bacteria enter the peritoneal cavity due to an intestinal injury, the peritoneum will almost certainly become inflamed. The symptoms of peritonitis are differentiated according to the status of the disease.

If peritonitis occurs locally, the general condition of the person affected is hardly affected. A fever may also occur, but is rarely the main symptom. Painful pressure in the affected region is a typical symptom of local peritonitis.

Also typical is a so-called defence tension of the abdominal muscles, which can be assessed by palpation of the abdomen. However, if a so-called generalised peritonitis is present, the general condition of the affected person is very severely impaired. Shock symptoms are associated with low blood pressure, rapid pulse and high fever.

The abdomen shows defensive tension and a pronounced sensitivity to pressure when touched. Acute peritonitis should be diagnosed as soon as possible by a treating physician so that specific treatment can be initiated. The therapy of peritonitis is always carried out surgically.

During the operation, the inflammation should be localised and, if possible, removed, for example by removing an inflamed appendix. Ideally, all bacteria responsible for the inflammation of the peritoneum should also be removed. Usually an accompanying therapy is carried out, which includes the administration of broad-spectrum antibiotics to prevent the bacteria from multiplying.