1150 SPLANCHNOLOGY 



while the remainder is reflected over the contained viscera. In the female the 

 peritoneum is not a closed sac, since the free ends of the uterine tubes open directly 

 into the peritoneal cavity. The part which lines the parietes is named the parietal 

 portion of the peritoneum; that which is reflected over the contained viscera con- 

 stitutes the visceral portion of the peritoneum. The free surface of the membrane 

 is smooth, covered by a layer of flattened mesothelium, and lubricated by a small 

 quantity of serous fluid. Hence the viscera can glide freely against the w r all of the 

 cavity or upon one another with the least possible amount of friction. The attached 

 surface is rough, being connected to the viscera and inner surface of the parietes by 

 means of areolar tissue, termed the subserous areolar tissue. The parietal portion 

 is loosely connected with the fascial lining of the abdomen and pelvis, but is more 

 closely adherent to the under surface of the diaphragm, and also in the middle 

 line of the abdomen. 



The space between the parietal and visceral layers of the peritoneum is named 

 the peritoneal cavity ; but under normal conditions this cavity is merely a potential 

 one, since the parietal and visceral layers are in contact. The peritoneal cavity 

 gives off a large diverticulum, the omental bursa, which is situated behind the 

 stomach and adjoining structures; the neck of communication between the cavity 

 and the bursa is termed the epiploic foramen (foramen of Winslow). Formerly the 

 main portion of the cavity was described as the greater, and the omental bursa 

 as the lesser sac. 



The peritoneum differs from the other serous membranes of the body in pre- 

 senting a much more complex arrangement, and one that can be clearly understood 

 only by following the changes which take place in the digestive tube during its 

 development. 



To trace the membrane from one viscus to another, and from the viscera to the 

 parietes, it is necessary to follow its continuity in the vertical and horizontal 

 directions, and it will be found simpler to describe the main portion of the cavity 

 and the omental bursa separately. 



Vertical Disposition of the Main Peritoneal Cavity (greater sac) (Fig. 1035). It 

 is convenient to trace this from the back of the abdominal wall at the level of the 

 umbilicus. On following the peritoneum upward from this level it is seen to be 

 reflected around a fibrous cord, the ligamentum teres (obliterated umbilical vein), 

 which reaches from the umbilicus to the under surface of the liver. This reflection 

 forms a somewhat triangular fold, the falciform ligament of the liver, attaching the 

 upper and anterior surfaces of the liver to the diaphragm and abdominal wall. 

 With the exception of the line of attachment of this ligament the peritoneum 

 covers the whole of the under surface of the anterior part of the diaphragm, 

 and is continued from it on to the upper surface of the right lobe of the liver as 

 the superior layer of the coronary ligament, and on to the upper surface of the left 

 lobe as the superior layer of the left triangular ligament of the liver. Covering the 

 upper and anterior surfaces of the liver, it is continued around its sharp margin 

 on to the under surface, where it presents the following relations : (a) It covers the 

 under surface of the right lobe and is reflected from tfte back part of this on to the 

 right suprarenal gland and upper extremity of the right kidney, forming in this 

 situation the inferior layer of the coronary ligament; a special fold, the hepatorenal 

 ligament, is frequently present between the inferior surface of the liver and the 

 front of the kidney. From the kidney it is carried downward to the duodenum 

 and right colic flexure and medialward in front of the inferior vena cava, where it 

 is continuous with the posterior wall of the omental bursa. Between the tw r o layers 

 of the coronary ligament there is a large triangular surface of the liver devoid of 

 peritoneal covering; this is named the bare area of the liver, and is attached to the 

 diaphragm by areolar tissue. Toward the right margin of the liver the two 

 layers of the coronary ligament gradually approach each other, and ultimately 



