anatomy of stomach,functions of stomach, location, shape position and parts of stomach,orifices of stomach, curvature of stomach, relations of stomach, blood supply, innervation, lymphatic drainage, clinical relation , GERD, peptic ulcer,
3. INTRODUCTION
It is the muscular bag. It is the widdest and the most
dilated portion of alimentary canal.
It has many functions:
1. Storage of food (stomach capacity of adult is1500ml).
2. Mixes food with gastric secretions to form a semifluid
chyme.
3. Protein digestion
4. Kills micro organism via HCl
5. Instrinsic factor is release that help in absorption of
Vit B12
6. Secrets mucous
4. 2 Orifices:
Cardiac orifice
Pyloric orifice
2 Borders:
Greater curvature
Lesser curvature
2 Surfaces:
Anterior surface
Posterior surface
3 Parts:
Fundus
Body
Pylorus:
The pylorus is formed of 3 parts
Pyloric antrum
Pyloric canal
Pyloric sphincter
PARTS OF STOMACH
5.
6. OPENINGS/ ORIFICES
GASTROESOPHAGEAL JUNCTION/ OPENING:
It is a physiological rather than an anatomical, sphincter. Lying at
level of T10&T11.
Consists of a circular layer of smooth muscle (under vagal and
hormonal control).
It helps to Prevents regurgitation (reflux) of food.
NB. Notice the abrupt mucosal transition from esophagus to
stomach (Z- line)
GASTRODUODENAL JUNCTION:
The pyloric antrum extends from Incisura angularis to the pylorus
The pylorus is a tubular part of the stomach
It lies in the transpyloric plane at L1-2
It has a thick muscular end called pyloric sphincter.
The cavity of the pylorus is the pyloric canal.
7.
8. CURVATURES/ BORDERS
Lesser curvature:
It extends from right border of stomach and cardiac orifice to
the pylorus. It is composed of;
Hepato gastric ligament
Hepato duodenal ligament
Also known as lesser omentum.
Greater curvature:
Is longer than the lesser curvature.
It extends from the left of the cardiac, over the dome of
fundus, and along the left border of stomach to pylorus.
It is connected to spleen via gastrosplenic omentum .
it extends from upper part of greater curvature ,and to the
transverse colon via greater omentum.
It attaches to diaphragm through Gastro phrenic ligament
9.
10. FUNDUS AND BODY OF STOMACH
FUNDUS:
Dome-shaped
Located to the left of the cardiac orifice
Usually full of gas.
In X-Ray film it appears black
BODY:
Extends from fundus to The level of Incisura Angularis:
A constant notch on the lesser curvature
11. Muscular Layers of Stomach
It has 3
muscular
layers:
1. Longitudinal
layer: outer
most layer
2. Circular layer:
inner layer
3. Oblique layer:
inner most
layer
It’s mucous membrane is thrown into folds and called rugae.
12.
13.
14. PERITONEAL RELATIONS
Anterior and posterior surface is covered by
peritoneum.
BARE AREA OF STOMACH:
Posterior surface of stomach just cranial to
gastrophrenic ligament
Greater and lesser curvature along peritoneal
reflection.
15. RELATIONS
Anterior Relations of
stomach
Anterior abdominal
wall
Left costal margin
Diaphragm
Left lobe of the liver
Posterior Relations of
stomach
Diaphragm
Spleen
Left suprarenal gland
Upper part of left kidney
Splenic artery
Pancreas
Transverse mesocolon
Transverse colon
19. ARTERIAL SUPPLY OF STOMACH
As it is derived from the foregut (celiac trunk)
1- Left gastric artery: It is a branch of celiac artery.
Runs along the lesser curvature.
2- Right gastric artery: branch of cieliac trunk.
Runs to the left along the lesser curvature.
3-Short gastric arteries – arise from the splenic artery.
Pass in the gastrosplenic ligament.
4- Left gastroepiploic artery: from splenic artery
Pass in the gastrosplenic ligament, along the greater
curvature
5- Right gastroepiploic artery: from the gastroduodenal artery of
hepatic .
Passes to the left along the greater curvature.
21. VENOUS DRAINAGE OF STOMACH
Left and right gastric veins portal vein
Short gastric vein and left gastroepiploic veins
splenic vein
Right gastroepiploic vein superior
mesenteric vein
22.
23. LYMPHATIC DRAINAGE
Is into four zones:
Pancreatico-spleenic nodes
R- gastric epiploic nodes
Pyloric nodes
L- gastric nodes
They all drain into cieliac nodes and to supra clavicular
nodes, one of the first area to detect in case of gastric
carcinoma.
24.
25.
26. INNERVATION
Sympathetic fibers are vasoconstrictors, antiperistaltic and
carry pain sensation. It is derived from the celiac plexus.
From segments T6-T10
Parasympathetic fibers from both vagi are for motility &
secretory
Anterior vagal trunk/ anterior gastric nerve:
Formed from the left vagus
Supply the anterior surface of the stomach
Gives off a hepatic branchalso to pylorus.
Posterior vagal trunk/ posterior vagus nerve:
Formed from the right vagus
Supply the posterior surface of the stomach
Gives off a large branch to the celiac and the superior
mesenteric plexuses.