Download MBBS Anatomy PPT 80 Stomach Notes

Location

l Upper and left part of abdomen

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l Epigastric, umbilical and left

hypochondrial region

Stomach

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l In adult life, stomach located T10 and

L3 vertebral segment

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l Can be divided into anatomic regions

based on external landmarks

l 4 regions

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l Cardia
l Fundus
l Corpus (body)
l Antrum

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Anatomy

l Cardia- region

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just distal to the

GE junction

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l Fundus- portion

above and to the

left of the GE

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junction
Anatomy

l Corpus- region

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between fundus and

antrum

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l Margin not distinctly

external, has arbitrary

borders

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l Antrum- bounded

distally by the

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pylorus

l Which can be

appreciated by

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palpation of a

thickened ring of

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smooth muscle

shape

l Depends on degree of distension and

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surrounding viscera

l Empty - J shape
l Partly distended - piriform

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l Obese - horizontal - steer horn

stomach
size

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l Distensible
l 10 in. long

Capacity

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l 30 ml - birth
l 1 l - puberty
l 1 ? l ? 2 l or more - adult

External features

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l Cardiac orfice -7th costal cartilage, T 11

vertebra

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l Pyloric orifice - lowerborder of L 1
Pyloric constriction - circular groove
Pylorus = gate guard
PrePyloric vein in front of constriction
l Lesser curvature, lesser omentum, incisura

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angularis
External features...

l Greater curvature, GO,GS,GP.

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l cardiac notch

Anterior surface - forward upward
Posterior surface -backward downward

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Sub divisions

l Cardiac ,Pyloric parts

Cardiac ? fundus , body

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Pyloric ? pyloric antrum ( 3 in.), pyloric

canal(1 in.)
Relations

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Peritoneal
l Lesser omentum
l Greater omentum
l Gastrosplenic ligament
l Gastrophrenic ligament

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l Bare area

Relations.....

Visceral

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l Anterior surface
Liver, diaphragm, ant. Abd.wall
l Posterior surface
Diaphragm, Lt. kidney, Lt. supra renal

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gland, pancreas, transverse mesocolon,

splEnic flexure of colon, splenic artery -

stomach bed

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Sromach Bed

Interior of stomach

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l Gastric rugae
Longitudinal along lesser curvature ?

gastric canal, irregular elsewhere.

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l Gastric pits
Gastric glands opens
Vasculature

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l Well vascularized organ
l Arterial flow mainly derived from

Celiac Artery

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l 3 Branches

lLeft Gastric Artery

lSupplies the cardia of the

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stomach and distal esophagus

lSplenic Artery

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lGives rise to 2 branches which

help supply the greater

curvature of the stomach

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lLeft Gastroepiploic
lShort Gastric Arteries
lCommon Hepatic or Proper Hepatic

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Artery

l2 major branches

lRight Gastric- supples a

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portion of the lesser curvature

lGastroduodenal artery

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-Gives rise to Right

Gastroepiploic artery

-helps supply greater

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curvature in conjunction

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with Left Gastroepiploic Artery

Blood supply

l Left gastric artery- br of coeliac trunk

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l Right gastric artery- br of common

hepatic artery

l Right gastro epiploic artery- br of

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gastrodoudinal artery

l Left gastro epiploic artery- br of

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splenic artey

l 5-7 short gastric arteries -br of

splenic artery

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Arterial Supply

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Vasculature
Blood supply

lVeins

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Portal vein
Superior mesenteric vein
Splenic vein

Venous drainage

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? Right & left gastric veins -> hepatic

portal vein.

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l Left gastroepiploic & short gastric

veins -> hepatic portal vein via the

splenic vein.

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l Right gastroepiploic vein join superior

mesenteric vein.

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Venous Drainage

Lymphatic drainage

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l Area A pancreatosplenic
l Area B left gastric
l Area C right gastroepiploic sub pyloric

hepatic

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l Area D diff directions into pyloric,

hepatic, left gastric

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l Coeliac trunk cisterna chyli


Lymphatic Drainage

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Anatomy

l Lymphatic drainage

l Lymph from the proximal portion of the

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stomach drains along the lesser curvature first

drains into superior gastric lymph nodes

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surrounding the Left Gastric Artery

l Distal portion of lesser curvature drains through

the suprapyloric nodes

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l Proximal portion of the greater curvature is

supplied by the lymphatic vessels that traverse

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the pancreaticosplenic nodes

l Antral portion of the greater curvature drains

into the subpyloric and omental nodal groups

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Anatomy

l Nerve Supply

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l Left and Right Vagus Nerves descend

parallel to the esophagus within the

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thorax before forming a peri-esophageal

plexus between the tracheal bifurcation

and the diaphragm

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l From this plexus, two vagal trunks

coalesce before passing through the

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esophageal hiatus of the diaphragm

Anatomy

l Left (anterior)

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l

Vagus Nerve

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l Left of the

esophagus

l Branches

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l Hepatic Branch

l Supplies liver

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and Biliary

Tract

l Anterior gastric

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or Ant. Nerve of

Latarget

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Anatomy

l Right (posterior)

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Vagus Nerve

l Right of the

esophagus

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l Branches

l Celiac
l Posterior

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Latarget

l Innervates

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posterior

gastric wall

Anatomy

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l Parasympathetic innervation of

Stomach- Vagus Nerve

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l 90% of fiber in vagal trunk is afferent

(info transmitting from stomach to CNS)

l Sympathetic innervation of Stomach-

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Splanchnic Nerve

l Derived from spinal segement T5-T10
Nerve supply

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l Sympathetic T5 - T10
Via splanchenic nerves, coeliac and

hepatic pluxes

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? Vasomotor
? Motor to pyloric shincter only
? Pain sensation from stomach

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Nerve supply

l Parasympathetic
From vagi through oesophageal pluxes

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and gastric nerves

? Motor and secretomotor

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Innervation

functions

l Reservoir of food

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l Peristaltic movements
l Gastric glands gastric juice, HCL
l Mucous
l absorption
Applied anatomy

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l Displacement of stomach
l Hiatus hernia
l Congenital diaphramatic hernia
l Pyloro spasm

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l Congenital hypertrophic pyloric stenosis
l Gastrectomy ? ca stomach

Applied anatomy

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l Ulcers, helico bacter pylori and

vagotomy

l Gastric pain felt in epigastium

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l Barium meal x ray, gastroscope