Seryous sheath of the abdominal cavity. Floors peritoneum scheme

Physician, peritoneum, is called a thin serous shell, which wipes the inner surface of the walls abdominal cavity And the internal organs that are in it. Its total area is an average of 2 m2.
If you trace the further stroke of the peritoneum on the front and upper abdominal walls, it turns out that it turns into a diaphragmal surface, forming a gray-shaped bundle, Lig.Falciforme Hepatis, in the free edge of which is a round bunch of liver, Lig. Teres Hepatis. From the bottom surface of the diaphragm behind the crescent ligament, the peritonea worst on the diaphragm surface of the liver, forming a crown ligament of the liver, Lig. Coronarium Hepatis, which, along the edges, has the shape of triangular plates, or triangular ligaments, Lig. Triangulare Dextrum Et Sinistrum.
From the diaphragmal surface of the liver of the peritoneum through its lower edge goes to the visceral surface, where does a number of bundles give to the internal organs: to the kidney - Lig. Hepatorenal, low stomach curvature - lig. Hepatogastricum, in the duodenum - Lig. Hepatoduodenal. Lig. Hepatoduodenale, Lig. Hepatogastricum and Lig. Phrenicogastricum together form a small gland, Omentum Minus. Hepter and duodenal bunch, Lig. Hepatoduodenale connecting the liver gate with the initial department duodenal gut. In this bundle, there are right left - Ductus Choledochus, v. portae, a. Hepatica Propria (by anatomical cipher (two) - Ductus, Vena, Arterna), as well as lymphatic vessels and nerves. It is important to consider when operational interventions on extrahepatic bile ducts.
At the small curvature of the stomach, the sheets of small gland diverge and cover the front and rear surfaces of the stomach. At the big curvature of the stomach, these sheets converge and descend down in front of the transverse colon and small intestines, forming the front plate of the large gland, Omentum Majus. The leaves of the large gland are descended down, after which they wrap up, forming his backlamp. Thus, a large gland is formed by four lynks of peritoneum. The rear plate of the large seal, reaching the cross-binding and her mesenter, grows with them, and then they are heading together for the pancreas, where the sheets are diverted. One sheet covers and goes up on a diaphragm, and the second - covers the lower surface of the gland and goes into the mesentery, Colon Transversum.
The organs that lie in the abdominal cavity have a different attitude towards the peritoneum.
If the body is covered with peritoneum from all sides, its attitude towards the peritoneum is called intraperitoneal; If the organ is covered with peritoneum from three sides, such an attitude is called mesoperitoneal; If the organ is covered with peritoneum on one side, then such an attitude is called the EcSteperitoneal.
When moving visceral peritoneum from one body to another or in an interface or vice versa, the peritonea forms bundles, folds, chepts, as well as furrows, recesses, pits, sinuses, bags. Abdominal cavity, Cavum Abdominis, is conditionally divided into three levels: upper, middle and lower.
1. Upper level Bounted on top of a diaphragm, from the bottom - the transverse colon and her mesentery. It contains stomach, liver and spleen.
2. Middle level It takes a plot from the mesentery of the transverse colon, Mesocolon Transversum to the entrance to the small pelvis. It contains an empty and ileum, ascending, descending and blind intestine with a heart-shaped process.
3. Lower level Extends from the entrance to a small pelvis to the pelvic diaphragm, deepening its cavity. It contains a straight intestine, bladder, ureters, prostate, seed bubbles in men, and in women - uterus and ovaries.
1. For the upper level organs, the peritonea forms three bags, Bursae (D. N. Zernov): liver, bursa hepatica; Potion, Bursa Pregastrica; and salon, bursa omeentalis.
Hepatic bag, Bursa Hepatica, - located under the diaphragm and separates from the front-line bag with a sickle bunch, it is limited to a coronary bundle, Lig. Coronarium Hepatis. In the hepatic bag contains right share Liver, and in the depths of the bag under the biscuits, the upper pole of the right kidney and adrenal glands is palp.
Badge, Bursa Pregastrica, is located in front of the liver and spleen under the diaphragm. It contains left share Liver, spleen and front surface of the stomach, it has a deep breath-space.
Suite Bag, Bursa Omentalis, is located behind the stomach and small gland, Omentum Minus formed by three peritonean ligaments: liver and gastric, Lig. Hepatogastricum, which is directed from the gate of the liver to the small curvature of the stomach and the hepatic duodenal, Lig. Hepatoduodenale connecting the gate of the liver with Pars Superior Duodeni. The sunel bag is limited to the anterior wall, which is formed by a small gland, the rear wall of the stomach and gastrointestinal bundle, Lig. Gastrocolicum.
The rear wall is formed by an on-sleep leaflet of the peritoneum; the upper surface of the tail of the liver and the diaphragm; Lower - Mesocolon Transversum et Colon Transversum. The left wall of the gland bag is formed by the spleen ligaments: Lig. Gastrolienal et Colon Transverrsum and Lig. phrenicosplenicum.
The sushi bag is reported to the peritoneal cavity through the glands, Foramen Omentale (Winslowi), which is limited: in front - Lig. Hepatoduodenal; Rear - Lig. Hepatorenale; bottom - Lig. Duodenorenale and from above - a taper of the liver. In the gland bag, the tensile, upper and lower spleen deepets are distilled. In operational interventions, the surgeon can enter the gland hole in the gland bag for the purpose of its revision.
Large seal, Omentum Majus, - in the form of apron covers the loop of the small intestine in front. It is formed by four leaflets of peritoneum, which have grown in the form of plates. The front plate is formed by two pure sheets, which go down from the large curvature of the stomach and, passing in front of the transverse colon, they grow up with it, forming a gastrointestinal ligament, Lig. Gastrocolicum. The front plate is lowered to the level of pubic bones, and then worst, forming the rear plate of the large gland. Between the leaflets of the front and rear plate plates is a slick-like cavity, it is reported to the cavity of the gland bag, but in adult the cavity of the gland is partially committed.
2. The average peritonean cavity can be viewed by lifting the large gland and the transverse rimp. In the middle level, four departments are allocated: the right and left side channels, Canalis Lateralis Dexter Et Sinister, which pass between the side walls of the abdomen and ascending and downstairs, as well as two mesenteric sinuses, Sinus Mesenttericus Dexter Et Sinister, formed as a result of the division of the middle floor mesentery The small intestine that passes sideways downwards from left to right. The left and right sines are separated from each other with the root of the mesentery of the small intestine and are combined with a small pelvis.
Mesentery, Mesenterium, is a fold formed by two pure sheets, by which the small intestine is attached to the rear wall of the abdominal cavity. The rear edge of the mesentery is its root, Radix Mesenterii, which originates on the left side of the II of the lumbar vertebra and passes in the oblique direction to the right iliac yam. The root of the mesentery during movement crosses the final portion of the duodenum, the aorta, the lower venu, the right ureter and the large lumbar muscle.
Between the serous leaflets of the mesentery contains adipose tissue, the lymph nodesBlood and lymphatic vessels and nerves pass. There are a number of pits on the back cluster leaflet of the peritoneum, since internal abdominal hernias of a retroperitoneal type can sometimes be formed in them. At the place of the duodenum transition to the empty, small recesses are formed, the Recessus Duodenalis Superior Et Inferior. In the field of transition of the small intestine in the thick higher and below the ileal-sluggled fold, Plica Ileoceacalis, there are two recesses: Recessus IleoCeacalis Superior et Inferior. At the location of the blind intestine, an on-line leaf of peritoneum forms a deepening - a smell of a blind intestine, or a sluggled recess, the RECESSUSUS RETROCAAACALIS. In the hole behind the blind intestine sometimes there is a hole leading to a sluggish recess.
3. The punch of the lower level covers its walls and organs that are in it, depending on the floor. And the initial rectum department is covered with trousers from all sides (intraperitoneally) and have their mesenter. Medium department, rectum, covered in front and sides, the rear surface remains not covered with peritoneum, and even lower, at a distance of 7.5-8 cm from the rear pass, the peritoneum, moving from the front surface of the rectum to the back surface bladderForms a straight-turn-to-publish recess, Excavatio Rectovescal. The penette feature of the men is that part of the serous bag is isolated in the scrotum, covering each egg separately. In the process of development through the inguinal channel in the scrotum, a fingellular bag is made - a vaginal process, Processus Vaginalis, which in 99% of cases, in addition to the distal department. Thus, two serous bag remains in the scrotum, in which the serous fluid accumulates with inflammation (orchit).
In women between bladder And the rectum is the uterus. It is covered with trousers from all sides, so in the cavity of women's pelvic cavity there are two recesses: straightforward-uterine, excavatio recto-uterina (between the rectum and the uterus), and bubble and uterine, Excavatio Vesicouterina (between the urine and bladder). Excavatio RECTOUTERINA, or Douglasi's deepening (Douglasi) is practical: it accumulates blood, pus or serous fluid under inflammatory states and bleeding in the abdominal cavity, therefore, in clinical (gynecological) practice, it is carried out by puncture of this deepening with a diagnostic purpose. On the sides of the bruncher's uterus goes on the walls of a small pelvic, forming a wide uterine bunch, Lig. Latum Uteri, located transversely in the cavity of the small pelvis and separates it to the front and rear departments.
In both floors in the umbilical area, Regio Pubica, there is a prostate cellular space, Spatium PreveSicale (Cavum Retzii), limited in front - transverse fascia, Fascia Transversalis, rear - bladder and peritoneum. The space is filled with fatty tissue, venous plexus of the bladder and prostate and arteries, blood supply bubble. Through the prostate space, access to the bladder during the operation of a supraid high opening of the bladder is carried out. The prostate space is a place where the blood accumulates (during fractures of pubic bones) and urine (when the bladder is injected). All this is essential in clinical (urological) practice. Therefore, with a bladder filled with a bladder, the peritoneum rises up, and the bladder adjacent to the front abdominal wall, which allows in a clinical (surgical) practice to carry out the bladder puncture (needle of the beer or trocar) over the symphysome.
Within the lower level of the abdominal cavity, the peritonea forms pits and folds. On the back surface of the front abdominal wall From the navel to the bladder stretches five navel folds: median, Plaica Umbilicalis Mediana, two media, Placae Umbilicales Mediates, two lateral, Plicae Umbilicales Laterals. In the middle umbilical fold there is a rosy urinary duct, Urachus; in medial - navel artery, and in lateral - aa. Epigastricae Inferiores (Branches a. Iliaca Externa). On the sides of the median umbilical fold are behind-eye-bubble pits, Fossae Suppravesicales. Because of the medial and lateral folds on each side are medial inguinal pits, Fossae Inguinales Mediates, and outside the lateral folds - lateral pits, Fossae Inguinales Laterales. The lateral pakhovo jams coincides with a deep inguinal ring, and the medial - with superficial; through these pits can go inguinal herrozhiWhat matters in clinical (surgical) practice.
Blood supply peritoneum is carried out by branches (arteries) abdominal aorta: lower diaphragmal, upper and lower mesenter, front and rear sluggish, adrenal, renal and lumbar arteries. Viennic blood flows into the system of the upper and lower hollow vein and in a portal vein.
Lymphotok From the peritoneum passes through the lymphatic capillaries of the surface and deep lymphatic net (L. V. Chernyshenko, A. M. Sinitskaya, 1982) after which Lymph through the hatches penetrates the lymphatic vessels of the peritoneum.
Innervation The peritoneum is carried out by surface nervous plexus, which is located in the peritoneum over elastic grids, and deep nervous plexus, which is located in the deep lattice of the collagen-elastic layer.

The peritoneum, covering the abdominal organs, the pelvic cavities, differently refers to the organs: one of these organs (DPK, pancreas, kidneys) are covered with trousers only from the front surface, other organs (ascending, descending parts of the thick bowel) are covered with peritoneum on three sides, finally , stomach, small intestine, surrounded by peritoneum completely, excluding their chilus. The peritoneum adjacent to the abdominal walls is called the trimmed (parietal); The covering organs - visceral.

The anatomy of the peritoneum forms a number of protruding, folds, ligaments and mesensek, which is formed in the cavity of the peritoneum a number of slots. These gaps are only part of a common cavity, they are more or less widely communicated. Among the bags of the abdominal cavity is a large surgical interest in the sushi bag.

The hepatic bag is a gap around the right liver lobe. The left side of the hepatic bag from the bargaining bag separates the sickle bunch.

The middle department of peritoneum becomes visible, if you pull the large gland to the top. Here at the location of the DPK in skinny gut A twelve-dimensional fold is formed. Below the folds and the left is the deepening, differently expressed in various people. This is the so-called twelve-dimensional turnout. In order to see the root of the mesentery, for example, for anesthesia, it is necessary to pull the thin bowel down and left. The root of the mesentery distinguishes two peculiar form of the department, the right top is called the "right-hand mesenteric sinus", and the lower and left - "left mesenteric sinus".

The right sinus of mesenter is isolated from neighboring anatomical departments, only ahead of the intestines This sinus is reported to them. Left mesenteric sinus is wider and it is reported with a small pelvis. At an anatomical transition site fine intestine There are two small pocket pockets in thick, the top is called the upper messenger-blind pocket pocket and the same lower pocket.

The boundary between the lower and the upper - iliac-blind pockets serves the terminal department of the iliac. There are blind pockets of the peritoneum, which go to the stop of the blind intestine - the abnormal intestine in the back of the blind intestine (Recessus Retrocaecalis Sinistra - Fossae Caecalis).

On the sides of the middle department is located on the right ascending and on the left - a descending thick intestine. The brush of the peritoneum of the duck from the rising intestine, the rear-side suspension of the abdominal wall - the right side canal. Book this channel goes into the right iliac region, and below in a small pelvis. The duck from the descending colon is similar to the right left side channel. The book he continues into a small pelvis, expanding, goes into the peritoneum S-shaped curvature. The bottom department of the peritoneum, falling into the pelvis cavity, covers the organs of the urogenital system.

In men, the peritonean, going on the back of the pelvis, goes to the rectum, forming her mesenter, and, passing about 8 cm, the brush from the rectum covers the rear wall of the bladder. Then the brush leaf goes to the top of the bladder and, enters the front wall, goes to the inner surface of the front wall of the abdomen. Localization of the transition of the anatomy of the peritoneum from the bubble on the stomach wall changes depending on its filling. The deepening between the bladder, the rectum is called a bubble and rejection. On the sides, his peritonea covers ureters and seven-way ducts.

In women, the anatomy of the peritoneum from the rectum goes to the vagina arch, heads upward, shelters the overall part of the uterine neck and the body of the uterus, goes to the bottom of it, then descends on the front of the uterus body. It does not reach the cervix, but goes to the bladder.

The uterus with a wide ligament forms two deepening of the peritoneum: the front - bubble-uterine recess is minor than the rearmost-intestinal depression (rear douglas). The rear deepening opens the holes of phallopy pipes.

Thus, the peritonean cavity represents a completely closed education in men, and in women it is through Fallopiev pipes, the uterus, the vagina has a message with foreign worldthat can serve as a gate to penetrate inflammation pathogens.

The anatomical features of the abdominal cavity and the lining serous shell contribute to the development of severe complications, as soon as the peritonean is involved in the process. These complications depend on the following reasons:

In the abdominal cavity there is plenty of folds and pockets. When inspection of these pockets is extremely difficult, and the systematic survey of all organs is usually not possible due to the severe state of the patient. Therefore, it is easy to view any damage or illness as the peritoneum itself and the organ in it, and in perforations and injuries, complete cleaning of the peritoneum from inserts in it, food and hiding masses.

The organs that are inside the abdominal cavity, especially thin, thick intestine, are constantly moving depending on the breathing, bowel filling and peristaltics. Therefore, fell into the abdominal cavity foreign bodies, Pump, dietary masses are easily spread throughout the peritoneum.

Since the peritonean is richly equipped with a receptor apparatus and reflexes from it continuously go to the central nervous system, then reflex disorders of activity of not only intestines, but also organs of respiration and blood circulation may occur.

Especially dangerous irritation, even only mechanical, in the field of mesentery, pancreas and solar plexus (reflexogenic zones). It is completely unacceptable any rude mechanical irritation even with complete anesthesia of nervous trunks and plexuses in the area of \u200b\u200bthe listed zones.

The cavity of the belly divided by peritoneal cavity And the retroperitoneal space. Peritoneal cavity Limits a parietal leaflet of peritoneum. The retroperitoneal space is part of the cavity of the abdomen, lying between the parietal fascism of the belly at its back wall and parietal peritoneum.

Both of these parts abdominal cavity It is closely related to each other because it is from the retroperitoneal space to the organs of the peritoneal cavity, vessels and nerves are suitable. Most of Belly organs is located in the peritoneal cavity. At the same time, there are organs arranged in peritoneal cavity, and in the retroperitoneal space.

Peritoneal cavity. Peritoneum. Parietal peritonean. Visceral peritonean. Pushy's move

Peritoneum - Serous shell covering from the inside of the cavity wall of the abdomen ( parietal peritonean) or surface internal organs (visceral Perjun).

Both peritoness leaves, passing one to another, form a closed space, which is peritoneal cavity.

Normally, this cavity is a narrow slot filled with a small amount of serous fluid playing the role of lubricant to facilitate organ movements abdominal cavity relative to the walls or each other.

The amount of serous fluid usually does not exceed 25-30 ml, the pressure is approximately equal to the atmospheric. In men, the cavity of the peritoneum is closed, in women through the fallopian tubes Reported with the uterus of the uterus. When clustering fluid, blood or pus volume peritoneal cavity Increases, sometimes significantly.

Depending on the degree of coverage of the internal organ viscenary peritonean There are bodies covered with peritoneum from all sides (intraperitoneal), from three sides (mesoperitoneal) and on the one hand (extraperitoneal).

It should, however, remember that intraperitoneally located organs are actually covered physician Not absolutely from all sides. Each such organ has at least a narrow strip, not covered with peritoneum. It is to this place that the approach of the vessels and nerves through the special formations of peritoneum - mesenter or bundles. These formations are a duplication of peritoneum (two sheets), which, as a rule, combines the visceral peritoneum organ with parietal peritoneum. In the gap between these sheets and includes vessels and nerves from the retroperitoneal space. In some cases, the peritoneal ligaments combine the visceral peritoneum of two neighboring organs.

It is clear that the meso and extraperitoneally located organs of the vessels and nerves are suitable from the side not covered physician.

This is an extremely important position: it should be firmly remember that no vessel or nerve will try the peritoneum and does not pass simply in peritoneal cavity - All of them are located first in the retroperitoneal space, and then the approach to the organ through one or another mesentery or bond.

1. Mambriogenesis of peritoneum.

2. Functional value peritoneum.

3. Features of the structure of peritoneum.

4. Topography of peritinas:

4.1 Upper floor.

4.2 Middle floor.

4.3 Lower floor.

Embrygenesis peritoneum

As a result of embryonic development, the secondary cavity of the body - in general it is divided into a number of isolated closed serous cavities: so in the chest cavity - 2 pleural cavities and 1 pericardial cavity; In the abdominal cavity - the cavity of the peritoneum.

Men has another serous cavity between the egg shells.

All these cavities are hermetically closed, with the exception of women - with the help of uterine pipes during ovulation and menstruation, the abdominal cavity is communicated with the environment.

In this lecture, we will touch the structure of such a serous shell as peritoneum.

Peritoneum is a serous shell, which is divided into parietal and visceral sheets, which cover the walls and internal organs of the abdominal cavity.

The visceral leaflet of the peritoneum covers the internal organs located in the abdominal cavity. There are several species of the relationship of the organ to the peritoneum or the coverings of the peritoneum organ.

If the body is covered with peritoneum from all sides, they speak about the intraitoneal position (for example, a small intestine, stomach, spleen, etc.). If the organ is covered with peritoneum from three sides, they mean the mesoperitoneal position (for example, the liver, ascending and downward colon). If the organ is covered with peritoneum on the one hand, it is an extraperitoneal or retroperitoneal position (for example, kidneys, lower third of the rectum, etc.).

Parietary leaflet lins the walls of the abdominal cavity. In this case, it is necessary to define the abdominal cavity.

The abdominal cavity is the body of the torso located below the diaphragm and filled with internal organs, mainly digestive and urogenital systems.

The abdominal cavity has a wall:

top is a diaphragm

lower - pelvic diaphragm

rear - vertebral pillar and rear abdominal wall.

the front-point is the abdominal muscles: straight, outdoor and inner oblique and transverse.

The parietal leaves wretches these walls of the abdominal cavity, and visceral - covers the internal organs located in it, and a narrow gap is formed between visceral and parietal leaves of the peritoneum - the cavity of the peritoneum.

Thus, summarizing the one said, note that a person has several separate serous cavities, including the cavity of the peritoneum lined with serous shells.

Speaking of serous shells, it is impossible not to touch their functional significance.

The functional value of the peritoneum

1. Serous shells reduce friction on each other internal organs, since the liquid, lubricating the surface of contacting.

2. The serous shell has a transduce and existent function. The peritonese allocates to 70 liters of liquid per day, and all this liquid is absorbed by the peritoneal itself during the day. Different plots of peritoneum can perform one of the above functions. Thus, a diaphragmal peritonean is possessed mainly by the suction function, the serous cover of the small intestine has a transcompical ability, the serous cover of the abdominal velocity can be used to neutral areas, serous stomach cover.

3. For serous shells, the protective function is characterized, because They are a kind of barriers in the body: a serous hemolymphatic barrier (for example, Peritonea, Pleverra, Pericardi), a serous hematic barrier (for example, a large gland). In serous shells localized a large number of phagocytes.

4 The peritonean has large regenerator abilities: the damaged section of the serous shell is first covered with a thin layer of fibrin, and then simultaneously all over the damaged area - mesothelium.

5. Under the influence of external irritations, not only functions are changed, but also the morphology of serous cover: spikes appear - t. Oh. For serous shells are characterized by degradation abilities; But at the same time, the spikes can lead to a number of pathological conditions requiring repeated operational interventions. And despite high level The development of surgical equipment, intraperitoneal spikes are frequent complications, which forced this disease in the form of a separate nosological unit - adhesive disease.

6. Serous shells are the basis in which the vascular channel, lymphatic vessels and a huge number of nerve elements are locked.

Thus, the serous shell is a powerful receptor field: the maximum concentration of nerve elements, and in particular receptors, is called a reflexogenic zone per unit area of \u200b\u200bserous cover. Such zones include an umbilical area, an ileocecal angle with a heart-shaped process.

7. The total peristine area is about 2 square meters. meters and equal to the area of \u200b\u200bthe skin.

8. The peritoneum performs a fixation function (attaches the organs and fixes them, returns to the initial position after the displacement).

T. about. Serous shells perform several functions:

protective

trophic

fixation

self-gradious, etc.

The peritonean is a serous cover of the inner surface of the abdominal wall (parietal peritonean) and abdominal organs (visceral peritonean). When moving from walls to organs and from the organ on the body, folds, bundles, mesenters, limiting, in turn, space (SPACIUM), sinuses (sinus), pockets are formed.

The abdominal cavity is the cavity limited to the diaphragm at the top, the aperture of the pelvis and the iliac bones at the bottom, the spine and lumbar muscles behind, the right muscles in front, internal oblique and transverse muscles from the sides and in front.

The peritoneum is a semi-permeable, actively functioning membrane that performs a number of functions: exudative-resorbative, barrier (due to migratory and fixed macrophages, circulating immunoglobulins, nonspecific factors), plastic. The gland also has electrostatic properties.

Histologically, the Bunity consists of 6 layers: mesothelium, border membrane, and 4-layers of elastic and collagen fibers. On average, the thickness of the serous shell is about 0.2 mm, the parietal leaflet of the puretter is thicker visceral.

The total area of \u200b\u200bthe permanent cover is about 1.5-2 m 2, which roughly coincides with the surface of the human body.

A small amount of serous liquid contains a small amount of serous fluid (up to 25 ml), which is constantly updated as a result of continuous transduction and resorption processes. It serves as a lubricant, the finest layer covering the surface of the organs.

The exudative portions of the peritoness are mainly serous cover of the small intestine. The greatest exudation intensity reaches in the field of duodenum and decreases towards blind.

The greatest resorbative ability is the periphist of a diaphragm, a large gland, iliac and blind intestine. During the day, the volume of fluid flowing through the peritoneal cavity is about 70-80 liters.

A significant protective role is distinguished by a large seal who is a fold of the peritoneum with an abundance of blood and lymphatic vessels. Due to the potential difference between the gland and inflammatoryly modified organs, the gland always moves to the damage zone, fixing the fibrin to it. The ability of the peritoneum to the formation of adhesions plays an important role in limiting inflammatory processes in the abdominal cavity.

Anatomically allocate: in the upper floor, where there is a liver, stomach and spleen - a liver bag (bursa hepatica), the surrounding right share of the liver, the barsa praegastrica, the gland (Bursa Omentalis). The hepatic bag is divided into adapter and sunbathing departments. The adapter department in the surgical literature is more often called the right subiaphragmal space. At the bottom of the hepatic and bargaining bags continue in the presenter space.

The lower floor of the abdominal cavity can be examined after the large gland and the transverse colon will turn up. This opens the left and right mesenteric sinuses (Sinus Mesenttericus), the side channels (Canalis Lateralis), which communicate with the cavity of the small pelvis.

The blood supply to the peritoneum is carried out from the branches of blood supply vessels the corresponding organ. Ottw venous blood is coming both in the portal (mainly) and in the cavalny system. Lymphootok is most intense from the surface of the large gland and the diaphragm.

Visceral permane has vegetative innervation (parasympathetic and sympathetic) and practically does not have somatic. Therefore, the visceral pains arising in its irritation are not localized. The so-called reflexogenic zones are particularly sensitive: the root of the mesentery, the region of the ventricular barrel, the pancreas, the ileocecal angle, the Douglas of the space. Innervation of parietal peritoneum (with the exception of the pelvic) is carried out by sensitive somatic nerves (branches of intercostal nerves), therefore, with irritation of parietal peritoneum, somatic pain is localized. Parietal pellet cavity pelvis does not have somatic innervation. This explains the absence of protective tension of the muscles of the front abdominal wall when inflammatory processes in a small pelvis.