19. Anatomy, Histology, &, Embryology of the Stomach « DOTE Anatomy... http://anatomytopics.wordpress.com/2008/12/19/19-anatomy-histology-e...

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19. Anatomy, Histology, &, Embryology of the Stomach
Posted in Abdomen by newwrldyankee on December 19, 2008

. Anatomy, Histology, & Embryology of the Stomach

*Intraperitoneal, and part of foregut

Anatomy of the Stomach

Location: in the left hypochondrium, and epigastric regions

Surface Projection: “J” shape, size and position very variable, but two main points are fixed to the ab wall and are constant in their surface
projection.

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Esophageal-Gastric Jxn (Cardia) – L side, 2-4 cm lat to midline, @ 7 costal cart anteriorly, @ T10-11 posteriorly

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Gastro-duodenal Jxn (Pylorus) – L1-2 at slight R, 9 costal cart, 1-2 cm lat to midline, can shift down to L3-4 when stomach is full

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Fundus - sup edge of 5 rib @ mid-inguinal line

Stomach cross midline about 5 fingers above the umbilicus

Topography: Sits in the Gastric bed, made up of the pancreas, spleen, left kidney, left suprarenal gland, transverse colon (L flexure),
mesocolon, and diaphragm

Ant = Diaphragm, left lobe of liver, anterior ab wall,spleen, transverse colon

Post = the Gastric Bed as mentioned above, along with the Omental Bursa (Lesser Sac), and the splenic a.

Function: Stores and digest food, using Gastric juice (chyme), made up of Gastrin, HCL, Pepsin,etc.

Parts:

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19. Anatomy, Histology, &, Embryology of the Stomach « DOTE Anatomy... http://anatomytopics.wordpress.com/2008/12/19/19-anatomy-histology-e...

1. 1. Cardia – part of the stomach that receives the esophagus

2. Fundus – area of the stomach above the level of the cardia, located w/in left dome of diaphragm. Cardiac notch -angle between
esophagus and fundus
3. Body (Corpus) – main part of stomach between cardia and pyloric antrum
4. Pyloric Antrum – funnel shaped region of stomach that leads to pyloru
5. Pylorus – last part of the stomach, contains the pyloric sphincter, the muscle that allows the emission of gastric juice into duodenum.
6. Lesser Curve – the shorter, concave side from the cardia to the pylorus. Attachment site for lesser omentum. Angular notch – angle
between pyloric antrum and pylorus
7. Greater Curve – long convex line leading from cardia to pylorus, next to spleen. Attachment site for greater omentum.

Blood Supply:

Because stomach is part of FOREGUT, it is supplied by branches of SUP MESE0TERIC A.

Lesser curve – L gastric a (celiac trunk), R gastric a (hepatic a proper, from common hepatic a from celiac
trunk). Both gastric a anastomose with each other.

Greater curve – L gastroepiploic (same as gastro-omental) (splenic a), R gastro-epiploic a (from gastroduodenal
a) The 2 gastroepiploic anastomose with each other.

Fundus - Short gastric a (splenic a)

Veins pretty much follow the arteries.

L&R Gastric v → portal v.

Short gastric v and left gastroepiploic v → splenic v → portal v.

R gastro omental v → sup mesenteric a

Lymph Drainage – divide stomach into quadrants

Upper Right → L gastric nodes → can go to 3 places:

Sup/ant → parasternal nodes, sup/post → post mediastinal nodes. Both drain into supraclavicular nodes.
(→ thoracic duct)

Can also drain into → cardiac nodes → celiac nodes

Clinical 0ote – The fact that gastric nodes can drain eventually into supraclavicular lymph nodes is
clinically significant. In the case of gastric carcinoma or inflammation, one of the first areas where it can
be detected is if one of the supraclavicular nodes, the Virchow, is enlarged.

NOTE – a “sentinal” lymph node, is usually superficially placed and one of the first to be felt in case of
inflammation or carcinoma. It is not the specific name of one lymph node, but a general term for any
lymph node that fits the above description.

Upper Left → Splenic nodes → run w/ splenic a to go to celiac nodes

Lower Right → Pyloric nodes → celiac nodes

Lower Left → gastroepiploic nodes → pyloric nodes

All drain eventually to cysterna chyli, unless mentioned otherwise

Innervation

P0S – (+) digestion, secretion, vasodilation.

Foregut = CNX sends branches to submucosal/myenteric plexus w/in wall of organs → short post ggl
fibers

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S0S - (-) digestion, secretion, vasoconstriction

from T6-T9 → send branches to celiac plexus through grtr. Splanchnic n. → aortic hiatus → celiac ggl
plexus around celiac trunk → post ggl fibers run with arteries that branch off celiac trunk.

Special Areas:

Labbe’s Triangle – where stomach is in direct contact with ab wall. Loc between inf border of liver, L costal
arch, and transverse colon.

Space of Traube – location of fundus. Located between inf border of liver, spleen, L costal arch, transverse
colon

Clinical 0OTE – From Wikipedia = There are 2 possibilities to evaluate splenomegaly in the clinical
examination: percussion and palpation.[1] Percussion can be done in this space.Underneath Traube’s
space lies the stomach, which produces a tympanic sound on percussion. If percussion over Traube’s
space produces a dull tone, this might indicate splenomegaly (but can also occur after a meal). Assessing
this may be more difficult in obese patients.

Peritoneal Ligaments

Dorsally (Behind, part of dorsal mesogastrium) – phrenicogastric, phrenico lienal, lienorenal, gastrocolic lig,
Greater omentum

Ventrally (ant, part of ventral mesogastrium) – hepatogastric lig

Histology – Stomach # 47 * H&E

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Structures to Identify:

simple columnar epithelium

gastric pits (foveal)

simple tubular glands

mucus, chief, parietal, resting cells

APUD (stained by heavy metals, like Ag)

Meissner’s/Myenteric plexus

Rugae

surface mucus cells

General Information

under diaphragm on left side, our slide is taken from the body region of stomach

Cardia, Fundus, Pylorus – all have diff glands and diff secretions.

Stomach mixes and partially digests food, creating chyme to send to duodenum

Layers: Mucosa, Submucosa, Muscularis Externa, Serosa (visceral peritoneum)

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19. Anatomy, Histology, &, Embryology of the Stomach « DOTE Anatomy... http://anatomytopics.wordpress.com/2008/12/19/19-anatomy-histology-e...

Mucosa

Simple columnar epithelium, that invaginates into stomach parenchyme to make gastic pits, where gastric glands
open into. Gastic glands have glandular epithelium

mucus surface cells secrete mucus onto surface of stomach to protect it from the acidiity of gastric juice (pH=1-2)

Lamina Propria – lymphoreticular connective tissue, loads of reticular fibers and collagen fibers, as well as diffuse
lymph tissue referred to collectively as GALT (Gut assoc. lymph tissue)

Muscularis mucosae – Inner circular layer and outer longitudinal layer. Smooth m. strands from the inner layer split
each gastric pit from each other.

Gastric Glands:

*Secretions from glands listed in picture on right.

Mucus neck glands – secrete soluble mucus, very pale cytoplasm, lots of rough ER, located in neck of gastric glands,
in b/w parietal cells. Cuboidal with basal nucleus,

Parietal cells – triangular cells with very very eosinophillic (red) cytoplasm, narrow apical part that points towards pit,
large cell with large nucleus. Located in neck and partially the isthmus of gastric pit.

Chief cell – small, cuboidal, basophillic cell, highest in # at base of gland so look for them there.

Enteroendocrine cell – v. faint cell with LARGE nucleus, (unlike parietal, which is v. red normally), smaller than
parietal cell, has paracrine secretion, secrete not into pit, but into lamina propria.

Originate from endoderm but become endocrine, part of GEP cells system (Gastro-Entero-Pancreatic), but can also
say is part of APUD (neural crest origin)

Submucosa

contains Meissner’s plexus (aka Submucosal plexus)

In empty stomach, can protrude into rugae

dense irregular CT, with more collagen fibers than LP

lymph vessels, capillaries, larger arterioles, venules, fibroblasts, adipose

Muscularis Externa

NOTE Has three layers of musc = Inner oblique, middle circular, outer longitudinal

has Myenteric plexus – PNS ggl and n fibers – loc. b/w middle and outer layers

Serosa

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comes with sub serosa

equivalent to visceral peritoneum – only present in intraperitoneal organs, or organs covered partially with peritoneum

considered simple squamous mesothelium, so if asked to find mesothelium, you know what it is.

Stomach # 48 * PAS

PAS shows CARBS = mucus producing cells

surface epithelium is dark, as well due to surface mucus cells → easy to identify by looking for bright pink line on top of epithelium

parietal cells stain less darkly (as compared to H&E)

w/in LP can see purple fibers due to PAS positive staining of reticular fibers

reticulare basement membrane around gland also PAS positive

Secondary lymph nodules also visible

PAS rxn : used to visualize carbohydrates like substances. Periodic acid oxidizes the vicinal hydroxyl and amino groups, breaks the chain to form an
aldehyde. Basic fuchsin bleached by sulfuric acid reacts with these aldehyde groups, giving characteritic magenta color.

Structures to Identify in particular:

mucus neck cells and surface mucus cells

Parietal cells

LP

reticular fibers

lymph nodules

Embryology of Stomach

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Appears as enlargement of forgut @ 14 week, changes from tube shape due to different rates of growth of the future lesser and greater curves,
and because of movements of surrounding organs

Longitudinally: rotates L (ant) and R (post). Posterior side grows faster → creates lesser and greater curvature

Ant-Post axis: Pylorus moves R & up, cardia moves L and down

Stomach connects to dorsal body by dorsal mesogastrium, which thru the clockwise rotation, is carried left to form greater omentum

L vagus = ventral surface of stomach, R vagus = dorsal surface (which makes sense as the L vagus rests on the ant side of esoph, and R vagus is
on posterior side, and it just carries on down that way.

Longit. Rotation causes creation of lesser sac behind stomach

Ant/Post Rotation causes creation of greater sac,

Lesser Omentum (hepatoduodenal and hepatogastic ligaments) formed by ventral mesogastrium with falciform lig.

Anim = http://www.indiana.edu/~anat550/gianim/sdo/sdo.html

Anim2 = http://www.rvc.ac.uk/Review/abdomen/HTML/stomach.htm

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Tagged with: cardia, chief, enteroendocrine, gastric glands, gastric pits, labbe, parietal, pylorus, Stomach, traube

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