GENERAL FEATURES OF STOMACH
INTRODUCTION AND SITUATION OF STOMACH
•Most dialated part-digestive system.
•b/w oesophagus and duodenum.
•Reservoir of food
•Converts food into chyme
•Digestion of proteins
•Prevents bacterial invasion
•Most dialated part-digestive system.
•b/w oesophagus and duodenum.
•Reservoir of food
•Converts food into chyme
•Digestion of proteins
•Prevents bacterial invasion
•Epigastric, left hypochondriac and umbilical regions.
Mention the two surfaces.
describe in the features and relations of it.
Anteriorsuperior and posterioinferior surface.
Anteriosuperior
•Covered with peritoneum.
•Relations
Rt-gastric impression of the left lobe and quadrate lobe of liver.
Upper left –diaphragm,spleen.
Out side – left pleura ,base of left lung,6th to 9th cc.
Intermediate-anterior abdominal wall.
features
traubes
gastric triangle
posterio inferior surface
•Covered with peritoneum-lesser sac.
•Stomach bed structures.
Left crus of diaphragm
Left supra renal gland
Anterior surface of left kidney
Tortuous splenic artery
Anterior surface of pancreas
Anterior layer of transverse meso colon
Gastric impression of spleen
mention the arteries supplying the stomach with its area of supply
•Coeliac trunk
•Left gastric artery-
principal artery supplies upper 2/3rd of stomach.
•Right gastric-
common hepatic-anastomose .
•Short gastric-3-4
in no-splenic artery-fundus
•Left gastroepiploic –
splenic- greater curvature.
•Right gastro epiploic-
gastroduodenal artery-left gastroepiploic.
•Posterior gastric artery-
sometimes-splenic artery-supplies posterior wall of fundus.
types of lymphatic plexus.
intrinsic and extrinsic
components of nerve supply
•Sympathetic-coeliac plexus
•Parasympathetic-vagus
CAPACITY AND SHAPE OF THE STOMACH.
NAME THE DIFFERENT TYPES OF STOMACH.
•New born-30-50ml
•Adult 1000-1500ml
•Cadaver –sickle shape
•Living –J shaped
•Clinically 3 types
•Sthenic type/normal type –long limb of j is slightly oblique.
•Hypersthenic type-j is very oblique-steer horn stomach-prone duodenal ulcer.
•Hyposthenic or asthenic-j is vertical-gastric ulcer.
boundaries of traubes
• Traubes
Area over lying the fundus of the stomach.
•Tympanic on percussion
•Boundaries
Above – lower border left lung.
Below-left costal margin
Right side-lower border of left lobe of liver.
Left side – lateral end of spleen.
Aa: obliterated-enlarged spleen ,pleural effusion
describe the mode of supply
mention its importance
•Arteries form arterial arcades along lesser and greater curvature.
•Subserous,intramuscular and submucous plexuses.
•Long mucosal arteries –muscularis mucosa –communicate with each other –break in to capillaries.
•Submucosal –fair sized-associated-network of veins.
Absent along lesser curvature-long slender mucosal arteries arise from large feeders.
Ischemia –ulceration.
Arterio venous anastomosis exist in the submucous coat-blood shunted from arteries to veins.
describe the intrinsic plexus
pecularities
•3 sets of inter communicating plexus.
•Submucous ,intramuscular,subserous.
•
•Begin as subepithelial lymphatic radicles-periglandular plexus-efferents pierce the muscularis mucosa-submucous plexus.
•
•Intramuscular –sub serous plexus-accompany the blood vessels and drain into particular group-lymph nodes.
•Lymph vessels anastomose freely in the stomach wall.
•There are valves in the vessels.
•They direct the lymph in two directions.
•Watershed line –curved line parallel to the greater curvature and 2/3rd of the way of the lesser curvature-on the anterior surface.
•2/3rd-right .
•1/3rd –left.
Sympathetic
•Preganglionic fibres-lateral cells of T6-T9 of spinal cord.
•Coeliac plexus –via greater splanchnic nerves
•Post ganglionic fibres-coeliac plexus –stomach.
•Vasomotor
•Stimulate the pyloric spincter and inhibit rest of the gastric musculature.
•Sensory sympathetic-painful sensations from the stomach.
PARTS OF STOMACH
•2 orifices
Cardiac
Pyloric
•2 curvatures
Lesser
Greater
•2 surfaces
Anterio superior
Postero inferior
•3 subdivisions
Fundus
Body
Pyloric part
Subdivisions of stomach
•Fundus
Above the horizontal plane b/w cardiac notch
Filled with air
Extends beneath the left cupola –left 5th intercostal space.
•Body
Imaginary plane extending from incisura angularis to a notch on left side-pyloric antrum.
•Pyloric part
Antrum ,canal,pylorus.
Sulcus intermedius b/w antrum and canal.
10cm-antrum-7.5cm,canal-2.5cm.
Venous drainage
•Corresponds to arteries.
•Drain –portal
•prepyloric –no artery,gastroduodenal-no vein.
•Right and left gastric-trunk of portal vein.
•Short gastric and left gastro epiploic- splenic vein.
•Right gastro epiploic vein in superior mesenteric vein.
•Portocaval anastomosis – around oesphagus—oesophageal tributaries of left gastric and inferior hemiazygos veins.
•Oesophageal varices.
desribe the extrinsic plexus
area of drainage
pecularities
•Part of stomach-left to vertical line drawn-cardiac orifice-accompany short gastric and left gastro epiploic arteries-pass through gastro splenic and lieno renal ligaments-pancreatico splenic lymph nodes. Few to para cardiac group of nodes.
•From upper 2/3rd of right part-lymph pass along lesser curvature-left gastric lymph nodes.
•
•Lower 1/3rd of right part-greater curvature-right gastroepiploic lymph nodes-pyloric group.
•
•Pyloric part –hepatic ,pyloric, left gastric lymph nodes-coeliac group of pre aortic nodes.
•Cardiac orifice gastric and esophageal lymphatic's are continuous.
•Pyloric orifice they do not communicate-with duodenum.
Connective tissue septum present in the submucous coat of pylorus
Circular muscle of stomach is not continous with the duodenum
Longitudinal muscle of stomach turn inward at the pylorus and join with the pyloric spincter.
•Gastric lymphatics are presented with valves-right-lesser curvature,left-greater curvature.
parasympathetic
•Both vagus.
•Anterior and posterior vagal trunks.
NAME THE ORIFICIES
DIFFERENTIATE BOTH THE ORIFICES
Cardiac orifice
Pyloric orifice
Differences
•Situated 2.5cm to left of Median
•Behind left 7th costal cartilage
•Opposite-T 11
•10 cm deep to anterior abdominal wall
•40cm away from incisor teeth.
Pyloric orifice
•Constriction
•Identified –preplyloric vein of mayo
•Thick,movable,
superficial.
•Open in empty stomach
•1.25cm to the right,L1.
gastric triangle
•Gastric triangle
Stomach-contact with anterior abdominal wall.
•Boundaries
Right-inferior border of liver
Left –left costal margin
Below-transverse colon
•Applied anatomy
Oesophageal obstruction-gastrostomy.
why ulcers are more common along lesser curvatures which is the commonest site of ca stomach
lesser curvature
antrum more along lesser curvature
Submucosal –fair sized-associated-network of veins.
Absent along lesser curvature-long slender mucosal arteries arise from large feeders.
Ischemia –ulceration.
Virchows group of lymph nodes-troisiers sign
•Left supraclavicular lymph nodes enlarged-spread –thoracic duct.
anterior vagal trunk
•Anterior vagal trunk
Left vagus-oesophageal wall-hepatic and gastric branches.
Hepatic-pyloric branches –prepyloric stomach,pyloric spincter.
Gastric branches-anterosuperior surface –main branch –nerve of latarjet-lesser curvature-terminal –crows foot.
Name the two curvatures and describe each curvature.
lesser and greater curvature.
lesser curvature
•J shaped
•Fixed
•Right border
•Lies on posterior plane
•Incisura angularis-dependent part.
•2 layers of lesser omentum –contains anastomosis –right and left gastric vessels.
Greater curvature
•Left border
•More superficial
•Movable
•4-5 times longer
•Cardiac orifice-arches upwards-backwards and to left-fundus.
Summit left 5th ics.
Convexity downwards –left –tip of 10th costal cartilage-ends –pyloric orifice.
Pyloric antrum.
ligaments of stomach-describe in brief
•Lesser omentum
•Greater omentum
•Gastrosplenic ligament or third omentum.
•Gastrophrenic ligament
•Left or superior gastro pancreatic fold.
mode of intrinsic venous drainage.
mucosa
submucosa
muscularis externa
adventistia/serosa.
Krukenberg tumour of the ovary
•Secondaries in the ovary-spread-hepatic-subdiaphgramatic-lymph nodes.
posterior vagal trunk
•Right vagus
• Divides into Gastric and coeliac branches.
•Main branch-nerve of latarjet.
Runs through lesser omentum.
•Posteroinferior surface of stomach a separate branch to supply the stomach-nerve of grassi.