after 24 lecture - it's the enteric nervous system in the peritoneum the enteric nervous system we learned about the very first chapter we covered this semester we talked about the peripheral nervous system in the central nervous system and this was one of the branches of the peripheral this is considered to be the brain of our gut there's about 100 million neurons here that go to from the esophagus to the gut and it's located in two separate processes the my enteric that's found between the longitudinal and circular smooth muscle layers and the submucosal plexus that's in the submucosa in these plexuses there are motor neurons inner neurons connecting neurons and sensory neurons some of the sensory neurons are going to be chemo receptors others are stretch receptors so that you can tell when you if your stomach has a high acid concentration so when you swallow something that's not acidic it's going to raise the pH and that will be detected by the chemo receptors stretch receptors in your stomach are also going to send information that there's food there because you don't want to be secreting enzymes and other things if there's no food there for it to digest the my enteric neurons control gastric motility submucosa 'ls control the secretory cells and as we mentioned before this can function independently of the central nervous system so here we have the enteric nervous system in the blue box we have the my enteric plexus the submucosal plexus and then we have the epithelium of the mucosa and here's the the muscle layers in red or motor neurons in purple or inter neurons and in blue or sensory neurons so we're going to have sensation detected in the mucosa that sensations going to be sent to the submucosal plexus didn't my enteric plexus as well as the autonomic nervous system and the central nervous system inner neurons in the my enteric lexis are going to send information to motor neurons that are in both of my enteric and the submucosal plexus is my enteric then are going to act on that information and cause muscle contractions the submucosa are going to cause secretions vagus a nerve that's that's cranial nerve number 10 supplies parasympathetic fibers and they synapse with neurons in the enteric nervous system to increase their action the sympathetic is going to inhibit the enteric nervous system we have something called the gastrointestinal reflex pathways that we regulate secretions and motility in response to stimuli present in the lumen and they begin within receptors associated with the sensory neurons the peritoneum is the largest serous membrane of body has a visceral and parietal layer and the visceral layer is called the serosa the space between the visceral and parietal layer is called the peritoneal cavity and it's gonna have peritoneal fluid which is just Sarris fluid some things in our body are called retroperitoneal because they're found behind peritoneum the peritoneum is going to interconnect all these different organs as well as blood vessels and lymphatics and nerves and excuse me extensions of the peritoneum include the mesentery the miso colon falciform ligament and the lesser and greater omentum this is a cross-section and it's showing in gray the different parts of the peritoneum as well as here in tan you can see it interconnects it holds everything together it's usually not shown in pictures of the abdominal cavity because it it would obscure the organs so they remove it but it everything is kind of held together by this peritonitis can happen if you have any type of leakage from inside the GI tract into the peritoneal cavity this could be the result of trauma rupture diverticulitis appendicitis a perforated ulcer anything that can cause the contents of the GI tract to leak into the peritoneal cavity can cause peritonitis and peritonitis is a life-threatening problem you can die fairly quickly from peritonitis this shows the greater omentum the greater omentum is kind of like a fat apron that hangs down and covers the whole front of our our abdominal cavity it's important we have this here we have all those layers of the abdominal muscles the external obliques internal obliques the rectus abdominis transverse abdominis but we don't have any bone in here to protect us so it's good that we have this fat apron that hangs down from the transverse colon all the way down towards the urinary bladder if we lift that up you can see behind it the mesentery and the mesentery is like a sheet of tissue that's going to interconnect different parts of the small intestine to the large intestine part of it is also the falciform ligament this is piece of connective tissue that divides the liver into parts the lesser omentum can only be seen if you remove the greater omentum and reflect the liver and gallbladder it connects underneath the liver to the the lesser curvature of the stomach the greater omentum connects to the greater curvature of the stomach the Meisel colin has tissue you can only see it if you're removing small intestines and most of the other organs that connects to the top of the colon and the transverse means a colon there's a sigmoid musical and there's also some music : over in here ascites is a buildup of peritoneal fluid in the peritoneal cavity it can come from a number of different things but you see a huge bloated stomach sticking out that it can come from one of the most common causes is portal hypertension high blood pressure in the blood vessels going to the liver another cause could be congestive heart failure or pancreatitis it is treated with diet and lifestyle change diuretics to decrease the fluid in there as well as paracentesis which would be actually going in and removing the fluid this excess fluid the excess fluid puts pressure on the organs and the GI tract and causes pain as well a type of ascites is seen in a disorder called kwashiorkor kwashiorkor literally means the sickness the baby gets when the new baby comes in the language of the people from Ghana and especially what happens with it is this the kids that have kwashiorkor are starved for protein they're generally getting enough calories but not enough protein if you don't have enough protein in your diet you can't build muscle you can't build a lot of structures enzymes all sorts of things and so what your body will do to make up for the protein you're not getting in the diet is to break down protein and quite often they'll have very thin limbs the reason their bellies get swollen with the sides-- has to do with osmotic imbalance they are getting sufficient calories but they don't have enough protein if you remember back to when we looked at capillary exchange the plasma proteins were important in something called blood colloid osmotic pressure that is directly goes directly against the impression blood moving through the blood vessels the blood hydrostatic pressure blood hydrostatic pressure favors filtration blood colloid pressure favors reabsorption and then the lymphatics return the the difference between the two the colloid and blood colloid osmotic pressure is protein mainly albumin and if you do not get enough protein in your diet you can't produce enough albumin so you're going to accumulate fluid particularly in the midsection this also is going to decrease the abilities lymphatics to return fluid and it's because of hypo albumin or love you mummy Mia that means not enough albumin in the blood this can be treated with diet a change in diet giving them more protein in their diet the reason they say they call kwashiorkor the sickness the baby gets when the new baby comes is because as long as the mother is nursing the new baby its getting plenty of protein from the breast milk but once a new baby comes then the baby that was nursing doesn't nurse anymore and mainly feeds off a diet rich in carbohydrates but very very poor in protein in kwashiorkor is the result the goals for this lecture describe the enteric nervous system listen describe the functions and locations and the two enteric plexuses differentiate between the visceral and parietal peritoneum list the parts of the visceral peritoneum describe what ascites is and what causes kwashiorkor