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The relation of the peritoneum to the gut

Course video 35 of 74

You have already learned that the bowels are not arranged symmetrically left and right. The rotation processes of the gut and its suppliers have important consequences for the peritoneal coverings of the gut and the abdominal wall. It determines why some structures lie easily accessible in the abdomen and others are more hidden away. In this week you will get a grip on difficult concepts as 'intraperitoneal' and 'retroperitoneal'. It is also a starter week about abdominal surgery. You will also learn a secret: The best way to mobilize the abdominal and pelvic organs is to separate what got adhered when the patient was just an embryo! Please feel free to dive into these embryonic matters and enjoy all the twists and turns!

In this anatomy course you will explore the organs involved in our food digestion and discover the common causes of abdominal and pelvic pain. The latest graphics and animations will help you to find new insights and understanding of this part of the body, that has been the focus of anatomical research for centuries and presently arouses renewed scientific interest. You will explore the 3D anatomy of the organs from a basic level, providing thorough anatomical understanding, to its advanced application in surgical procedures. This course will challenge you to discover and help you to understand the anatomy of the abdomen and pelvis in all its aspects, ranging from its embryological underpinnings, via digital microscopy to gross topography and its clinical applications. The course is unique in that it continuously connects basic anatomical knowledge from the lab with its medical applications and current diagnostic techniques. You’ll get the chance to discuss anatomical and clinical problems with peers and experts in forum discussions and you will receive guidance in exploring the wealth of anatomical information that has been gathered over the centuries. Follow us on an exciting journey through the abdomen and pelvis where you digest your food but also where new life starts!

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教學方

Marco De Ruiter, PhD
Professor of Clinical and Experimental Anatomy
Paul Gobée, MD
Assistent professor of Anatomy
Beerend P. Hierck, PHD.
Associate professor of developmental biology
Daniël Jansma, MSc
E-Learning developer
Bas Boekestijn, MD
Trainee Radiology
Friso Jansen
Drs.

腳本

Welcome.

In the early embryo, there is a cavity, the intraembryonic coelomic cavity.

This cavity develops into cavities around the heart, the lungs, and the intestines.

Respectively the pericardial, pleural, and peritoneal cavities.

These cavities, in turn, are lined by membranes,

respectively the pericardium, the pleura, and the peritoneum.

Collectively they are known as serous membranes.

Serous membranes are slippery membranes that line the inside of the body cavities,

and cover the organs that are embedded in these cavities.

Hence the heart, the lungs, and

the intestines are all lined by these serous membranes.

The serous membranes allow the ensheathed organs to move in relation to their

surroundings while they also partially fix the position of the organs.

The serous membrane of the gut is the peritoneum.

In this video we'll explain the general relation between the serous membranes and

the organs that they surround,

especially the relation between the peritoneum and the gut.

The relation of the serous membranes to the ensheathed organs

Is traditionally explained via a balloon model.

Even though it's probably not 100% correct from a biological development point of

view, it provides a conceptually easy to understand model which

is why we'll demonstrate this balloon model here.

Imagine we originally have a completely empty abdominal cavity.

The spleen is still in place in this model,

because we can't remove it here, but you should imagine it's also gone.

Now I'm going to introduce the peritoneum.

This balloon stands for the peritoneum.

Inside the balloon stands for the peritoneal cavity.

Imagine that the balloon, that's the peritoneum, is completely blown up, and

I'll place it in the abdomen, and thus it fills the complete abdomen from inside,

and thus the peritoneum lines the inside of the body wall.

Now I'll introduce the gut.

This white tube stands for the gut,

the gut is in fact behind the peritoneum in the abdomen.

Now I'm going to take both the gut and

the peritoneum out to demonstrate to you what happens.

And I'm going to turn it a little bit.

The gut gets, over time, embryologically,

gets pushed into the peritoneum, and

in that way there is a layer of peritoneum that comes to lay adjacent to the gut.

This layer, if you might be able to see here, that's the so

called visceral layer, named after the word viscus, that means intestine.

Now remember that this peritoneum was also in the abdomen.

So we also had a layer on the outside, adjacent to the body wall.

That's called the parietal layer,

called from the Latin word paries which means wall.

Now, in fact, these two layers were lying adjacent to each other

because there is no air in the peritoneum, in fact, like there is in this balloon.

But there's only a slightly bit of slippery fluid and

the balloon is completely filled with convoluted and long intestines.

These intestines have pushed into the balloon like this and because, it's

completely filled with these intestines, the layer that lies on the intestine,

the visceral layer, lies directly adjacent to the layer that's on the outside,

the parietal layer, and with only this little bit of slippery fluid in between,

these layers can move in relation to each other.

And that means that this organ,

in this case the gut, can move in relation to its surroundings.

And that's the great thing of this configuration,

that it allows organs to move in relation to its surroundings.

And that's so far about this model.

So far in this model,

we can schematically draw the balloon model with this cross section.

Once again we see the gut, the visceral and the parietal peritoneum.

And the gut was pushed into balloon in this direction.

Imagine the gut now being pushed even deeper into the balloon

such that the sides of the balloon collided again behind the gut.

Thus forming a double layer, such a double layer is called a mesentery.

By definition, a mesentery is double layer of peritoneum that arouse by invagination

of an organ, and that connects the organ with the body wall, and that

gives pathway for neurovascular structures from the body wall to the organ.

The great thing about this construction is that the gut can move freely, but

at the same time there are limits to it's freedom because it's fixed to

the back wall, so the chances of getting entangled are slim.

The second great thing is that the blood vessels, the lymphatic vessels, and

the nerves can reach the gut, as they have a pathway through the mesentery.

Summarizing, we discussed that the heart, the lungs, and the intestines

are surrounded by the pericardial, pleural, and peritoneal cavities, and

these cavities may be viewed as a balloon, into which the heart, the lungs,

and the intestine have been pushed from the outside, and the balloon material

representing respectively the pericardium, the pleura, and the peritoneum, those get

adhered on one side to the organs and on the other side to the body wall.

And the sides can slide over each other,

this enabling movement of the embedded organs.

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