STOMACH & SMALL

INTESTINE
Dr. Gil L. Apacible
XUSOM
Objectives:
At the end of this lecture, students should be able to:
• Tell the parts of the stomach, their relations and their
location.
• Tell the peculiarities of the pylorus.
• Tell the blood supply of the stomach.
• Describe clinical correlations concerning stomach like
acid peptic disease, pylorospasm and cancer of stomach.
• STOMACH
• Shape resembles letter J,
• Act as a food blender and
reservoir.
• Gastric juice converts food
into semiliquid mixture -
chyme.
• Can hold up to 3 L of food
• Newborn: 30 ml of milk

In supine position, the

transpyloric plane lies along L1
vertebra.
When erect, varies from L2-L4.
• The size, shape and position
of the stomach can vary –
depending on bodily habitus,
movements of diaphragm,
contents and position of
person.
• In supine – lies in R & L
upper quadrants.
• In erect – moves inferiorly.
• PARTS:
• 1. Cardia – surrounds
cardial orifice (superior
opening or inlet).
• 2. Fundus – dilated superior
part.
• 3. Body
• 4. Pylorus - funnel-shaped;
wide part is the pyloric
antrum  canal
sphincter.
• 5. Lesser curvature - has
the angular incisure or notch
• 6. Greater curvature
• Interior of the Stomach
• Gastric mucosa is reddish-
brown during life, except
in pyloric  where it is
pink.
• Thrown into longitudinal
ridges  gastric folds or
rugae.
• A gastric canal (furrow)
forms temporarily during
swallowing along the
lesser curvature  to the
pyloric canal
• Intermittent emptying of
stomach occurs when
intragastric pressure
overcomes the resistance
of the pyloric sphincter.

• Pylorus (gatekeeper) -
wall is thicker, contains
more circular smooth
muscle.
• Forms the pyloric
sphincter, which is
normally in tonic
contraction.
• RELATIONS OF THE
STOMACH
• Anteriorly - diaphragm,
left lobe of liver and
anterior abdominal wall.
• Posteriorly - omental
bursa and pancreas.
• The bed of
stomach:
• Left dome of
diaphragm,
• spleen,
• left kidney and
suprarenal gland,
• splenic artery,
• pancreas,
• transverse
mesocolon and
colon.
• Arterial supply:
• L gastric a (from celiac a.)
 lesser omentum to cardia
• R gastric a (from hepatic a)
 lesser curvature to join L
gastric a.
• R gastro-omental a
(gastroepiploic) from
gastroduodenal a. greater
curvature
• L gastro-omental a (from
splenic a) greater
curvature and join R
gastroomental a.)
• Short gastric arteries (4-5)
from splenic a.  fundus of
stomach
• Gastric Veins
• Left and Right gastric veins  portal vein
• Short gastric vv and L gastro-omental v  splenic v  portal v.
• R gastro-omental v  Superior mesenteric v.  portal v.
• NERVE SUPPLY:
• Parasympathetic: CN 10 that
enter thru the esophageal hiatus
• 1. Anterior vagal trunk (from L
vagus)  lesser curvature 
hepatic and duodenal branches,
anterior gastric branches
• 2. Posterior vagal trunk (from R
vagus)  celiac branches 
celiac plexus, posterior gastric
branches.
Parasympathetic
System
ORGANS Parasympathetic
effects
GIT = longitudinal & Increased motility
circular muscle fibers
= sphincter muscles =relaxation
= glands = increased secretions
SPLEEN - No effect
LIVER - No effect
PANCREAS
= Endocrine - No effect
= Exocrine Increased secretion

Neuron 1: dorsal nucleus of

CN 10
Neuron 2: Meissner’s &
Auerbach’s plexus
Sympathetic - from T6-T9 IML (Intermediolateral column) 
celiac plexus through the greater splanchnic nerve.
 Sympathetic ORGANS Sympathetic effects
Nervous System
GIT = longitudinal & Decreased motility
circular muscle fibers
= sphincter muscles = Contraction
= glands = decreased secretions
Splenic capsule - Contraction
LIVER - Increased
glycogenolysis/gluconeo
genesis
PANCREAS
= Endocrine - Decreased insulin
secretion
= Exocrine Decreased secretion

Primarily vasomotor
 Referred Pain
Visceral referred pain from a gastric ulcer,
is referred to the epigastric region
because the stomach is supplied by pain
afferents that reach the T7 and T8 spinal
sensory ganglia and spinal cord segments
through the greater splanchnic nerve.
• Lymphatic
Drainage
• From superior 2/3 of
stomach gastric
nodes 
pancreaticosplenic
nodes
• From R 1/3 of
inferior third
pyloric nodes
• Left 1/3 of greater
curvature 
pancreaticoduodenal
nodes.
SMALL INTESTINE

DR. GIL L. APACIBLE

Objectives:
At the end of this part of session, students should be able to:
• Tell the parts of duodenum, their relations and their
location.
• Tell the peculiarities of first part of duodenum.
• Tell the blood supply of duodenum.
• Tell the differences of jejunum and ileum/ features of
jejunum and ileum.
SMALL INTESTINE
-made up of
duodenum, jejunum
and ileum.
-primary site for
absorption of
nutrients from
ingested materials.
-extends from pylorus
to the ileocecal
junction.
• DUODENUM
• First and shortest part,
widest and most fixed
part.
• C-shaped course around
the head of pancreas
• Begins at the pylorus on
right side and ends at the
duodenojejunal junction
at left side.
• Considered as partly
retroperitoneal.
• 4 parts;
• 1. Superior (1st part) 5 cm, L1 vertebra
• 2. Descending (2nd part) 7-10 cm
• 3. Horizontal (3rd part) 6-8 cm, crosses L3 vertebra
• 4. Ascending (4th part) 5 cm. Rises up to L2 vertebra.
• First 2 cm - called
AMPULLA(duodenal
cap), provided with
mesentery.
• The rest are fixed and are
retroperitoneal.
• First part: has
hepatoduodenal ligament
• 2nd part: receives the bile
and pancreatic ducts
(hepatopancreatic
ampulla), opens in the
major duodenal papilla.
• Ligament of Treitz -
suspensory muscle of the
duodenum; junction of
duodenum and jejunum
Barium meal
First Part - Duodenal cap
• Blood Supply of
duodenum
• Coeliac a
gastroduodenal A 
superior
pancreaticoduodenal a 
proximal to bile ducts
• Superior Mesenteric A 
inferior
pancreaticoduodenal a
distal to the bile duct,
• The two vessels
anastomosed - superior and
inferior
pancreaticoduodenal
arteries.
• Venous, Lymph and Nerves of
duodenum
• Duodenal veins  portal vein
• Lymphatic vessels follow the
arteries  pancreaticoduodenal
l.n.  pyloric l.n,; also to the
superior mesenteric l.n. and celiac
l.n.
• Nerves: derived from vagus and
sympathetic nerves through the
celiac and superior mesenteric
plexuses.
• DUODENAL ULCERS
• Mostly in the posterior wall of the superior or first part of
duodenum.
• May erode into the gastroduodenal artery or to the liver and
gallbladder, or into the peritoneal cavity  hemorrhage and
peritonitis.
• Jejunum and Ileum
• 6 - 7 m. long, jejunum is
2/5 and ileum is 3/5.
• Most of jejunum lies in
the left upper quadrant
• -while most of ileum lies
in the right lower
quadrant.
• Terminal ileum usually
lies in the pelvis.
 Jejunum and Ileum in living
• Color - deeper red
• - paler pink
• caliber - 2-4 cm • 2-3 cm
• wall - thick and heavy • thin and light
• vascularity =greater • less
• vasa recta - long • short
• arcades- few large • many short loops
• fat-mesentery = less • more
• circular fold = large,tall • low and sparse, absent
and closely packed in distal part
• many Peyer’s patches
• Lymphoid - few
• Blood supply:
• SMA - arises from abdominal aorta at level of L1 vertebra
•  form loops or arches  arterial arcades vasa recta
(straight arteries)
Arterial Supply
The superior
mesenteric vein drains
the jejunum and ileum.

The SMV ends

posterior to the neck of
the pancreas,
where it unites with the
splenic vein to form
the

- hepatic portal vein.

• Specialized lymphatic vessels that absorb fat - lacteals - in
intestinal villi empty into lymphatic plexus in walls of j and I .
Lymphatic drainage
 Nerve supply

Sympathetic stimulation Parasympathetic stimulation

reduces peristaltic and increases peristaltic and

secretory activity of the secretory activity of the

intestine and acts as a intestine, restoring the digestion

vasoconstrictor, reducing or process following a sympathetic

stopping digestion. reaction.

 Root of the mesentery
1. From left L2 transverse
process to right sacro-iliac
joint (S2)
2. 6 inches long
3. Crosses
a. 3rd part of duodenum
b. Aorta
c. IVC
d. Right psoas
e. Right ureter
f. Right testicular / ovarian
vessels
 Contents of the mesentery

1. Jejunum and ileum

2. Jejunal and ileal branches of
superior mesenteric vessels
3. Lacteals and mesenteric lymph
nodes
4. Loose areolar tissue
5. Fat