The histophysiology and pathophysiology of the peritoneum

Baal, Juliette O.A.M. van; Vijver, Koen K. Van de; Nieuwland, Rienk; Noorden, C. J. F. van; Driel, Willemien J. van; Sturk, Auguste; Kenter, Gemma G.; Rikkert, Linda Gerritdina; Lok, Christianne

doi:10.1016/j.tice.2016.11.004

Cited by 159 publications

(173 citation statements)

References 105 publications

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“…This difference in density parameters (TVD, PVD) is most likely due to a different anatomy. The submesothelial stroma contains the peritoneal vasculature, of which vessels with a diameter of < 100 µm (i.e., arterioles, capillaries, and venules) form the peritoneal microcirculation [1]. The vasculature is organized in a single layer and the microvessels are arranged relatively spaciously, resulting in a low vessel density.…”

Section: Discussionmentioning

confidence: 99%

“…The peritoneum lines the abdominopelvic cavity and covers the majority of visceral organs [1]. It is essential for the regulation of the intra-abdominal inflammatory response [2], exchange of peritoneal fluid [3], and prevention of fibrosis [4].…”

Section: Introductionmentioning

confidence: 99%

“…When peritoneal structure and function are compromised in response to pathological processes, this is expected to result in changes to the vasculature [1, 6, 10]. Generally, the peritoneum is expected to have a relatively low blood vessel density; this can however be altered in response to disease [1, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…Generally, the peritoneum is expected to have a relatively low blood vessel density; this can however be altered in response to disease [1, 11, 12]. Therefore, improved understanding of peritoneal vascularization patterns can facilitate insight into associated pathology, detection of disease, and development of new treatment strategies [13].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Incident Dark Field Imaging of the Human Peritoneal Microcirculation

Kastelein

Milstein

et al. 2018

J Vasc Res

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Background/Aims: This study describes the peritoneal microcirculation, compares quantitative parameters and angioarchitecture to the standard of sublingual microcirculatory assessment, and determines the practical feasibility of this method. Methods: Incident dark field imaging was performed of the peritoneum and sublingually to determine angioarchitecture, total and perfused vessel density (TVD and PVD), the proportion of perfused vessels (PPV), the microvascular flow index (MFI) and image acquisition time. Results: Peritoneal angioarchitecture was characterized by a quadrangular network of longitudinally oriented capillaries, often flanked by fat cells. Differences between peritoneal and sublingual microcirculation were observed with regard to TVD (peritoneum 12 mm/mm² [95% CI 10–14] vs. sublingual 23 mm/mm² [95% CI 21–25]; p < 0.0001), PVD (peritoneum 11 mm/mm² [95% CI 9–13] vs. sublingual 23 mm/mm² [95% CI 21–25]; p < 0.0001), PPV (peritoneum 88% [95% CI 79–97] vs. sublingual 99% [95% CI 99–100]; p = 0.014), and MFI (peritoneum 3 [IQR 2.3–3.0] vs. sublingual 3 [IQR 3.0–3.0]; p = 0.012). There was no difference in image acquisition time (peritoneum 2: 34 min [95% CI 1: 49–3: 19] vs. sublingual 2: 38 [95% CI 1: 37–3: 32]; p = 0.916). Conclusion: The peritoneal microcirculation was characterized by a low capillary density and a distinctive angioarchitecture. The possibility of peritoneal microcirculatory assessment offers promise for the study of peritoneal (patho-)physiology and (monitoring or detection of) associated diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative Incident Dark Field Imaging of the Human Peritoneal Microcirculation

Kastelein

Milstein

et al. 2018

J Vasc Res

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“…This monolayer, with its basal lamina and submesothelial stroma, creates a semipermeable barrier through which water and solutes are passively exchanged 213. Larger particles and bacteria are cleared through stomata, lymphatic channels between mesothelial cells, which are concentrated on the diaphragmatic surface (fig 2).…”

Section: Pathophysiologymentioning

confidence: 99%

Secondary peritonitis: principles of diagnosis and intervention

Ross

Matthay

Harris

2018

BMJ

112

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Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.

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