Erbil polytechnic University

Soran Technical Institute

Nursing department
First stage

(Stomach)

Prepared by:
kubra edris
Waleed shukr
Runaky nawzad
Omer xatab
Aryan farhad
Amin ali

Supervisor by:
Dr. Pakistan Muhamedamen
CONTENT

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Introduction and definition

The stomach is a muscular organ that is found in our upper abdomen. If we were to locate it
on our bodies, it can be found on our left side just below the ribs. In simple terms, the
stomach is a kind of digestive sac. It is a continuation of the esophagus and receives our
churned food from it. Therefore, the stomach serves as a kind of connection between the
esophagus and the small intestine, and is a definite pit stop along our alimentary canal.
Muscular sphincters, which are similar to valves, allow some separation between these
organs. The stomach’s functions benefit from several morphological attributes. The stomach
is able to secrete enzymes and acid from its cells, which enables it to perform its digestive
functions. With its muscular lining, the stomach is able to engage in peristalsis (in other
words, to form the ripples that propel the digested food forward) and in the general
“churning” of food. Likewise, the abundant muscular tissue of the stomach has ridges in its
linings called rugae. These increase the surface area of the stomach and facilitate its
functions, which we will describe in more detail below

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Function

the main function of the stomach involves mechanical and chemical digestion of ingested food.

Ingested food enters the stomach from the esophagus via the cardiac orifice, falling into gastric
juice produced by the stomach. Repetitive muscle contractions physically churn food particles,

breaking them into smaller fragments which are mixed with the gastric juice. The various
enzymes and hydrochloric acid (pH 1-2) in the gastric juice break food down even more,
forming a semi-liquid substance called chyme. This ultimately passes into the duodenum
through the pyloric orifice by a process called gastric peristalsis. Being a muscular organ, the
stomach can distend quite a lot, accumulating anywhere between 2 and 3 liters of food.

In addition to digestion, this organ is also involved in a small degree of absorption.

Specifically, it can absorb water, caffeine, and a small proportion of ingested ethanol. The
stomach also plays a role in controlling secretion and motility within the digestive tract by
releasing several hormones such as gastrin, cholecystokinin, secretin, and gastric inhibitory
peptide.

Your stomach’s purpose is to digest food and send it to your small intestine. It has three
functions:

 Temporarily store food.

 Contract and relax to mix and break down food.

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  Produce enzymes and other specialized cells to digest food.

How does the stomach work with the rest of the GI tract?

Each part of your GI tract breaks down food and liquid and carries it through your body.
During the digestive process, your body absorbs nutrients and water. Then, you expel the
waste products of digestion through your large intestine.

Food moves through your GI tract in a few steps:

1. Mouth: As you chew and swallow, your

tongue pushes food into your throat. A small
piece of tissue called the epiglottis covers
your windpipe. The epiglottis prevents
choking.
2. Esophagus: Food travels down a hollow
tube called the esophagus. At the bottom,
your esophageal sphincter relaxes to let food
pass to your stomach. (A sphincter is a ring-
shaped muscle that tightens and loosens.)
3. Stomach: Your stomach creates digestive
juices and breaks down food. It holds food
until it is ready to empty into your small
intestine.
4. Small intestine: Food mixes with the
digestive juices from your intestine, liver and
pancreas. Your intestinal walls absorb
nutrients and water from food and send waste
products to the large intestine.
5. Large intestine: Your large intestine turns
waste products into stool. It pushes the stool
into your rectum.

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 6. Rectum: The rectum is the lower portion of your large intestine. It stores stool until
you have a bowel movement.

Where is the stomach located?

The stomach is the most dilated part of the digestive

system, lying between the esophagus and duodenum.
More precisely, the stomach spans the region between
the cardiac and pyloric orifices of the gastrointestinal
tract. It is covered and connected to other organs
by peritoneum. The lesser omentum connects the
stomach to the liver and then extends around the
stomach. The greater omentum then continues inferiorly
from the stomach, hanging from it like a curtain.The
peritoneum has a convoluted course that requires
visualization for a complete understanding, so study the
following resources to avoid taking a wrong turn. They
trace the trajectory of the peritoneum and provide you
with an overview of the entire digestive system,
including labeling worksheets and a study unit: The
stomach is located inside the abdominal cavity in a small area called the bed of the
stomach, onto which the stomach lies when the body is in a supine position, or lying face
up. It spans several regions of the abdomen, including the epigastric, umbilical, left
hypochondriac, and left flank regions. The stomach also has some precise anatomical
relations and comes in contact with several neighboring structures.

How big is your stomach?

The size of the stomach varies from person to person. Your stomach expands when full and
deflates when empty. Because of this, your stomach size can vary depending on how
recently and how much you have eaten.

Parts

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The stomach consists of several important anatomical parts. The four main sections of the
stomach are the cardia, fundus, body, and pyloric part. As the name implies,
the cardia surrounds the cardiac orifice, which is the opening between the esophagus and the
stomach. It is the first section that ingested food passes through, representing the inflow part.
The fundus is the superior dilation of the stomach, which is located superiorly relative to the
horizontal plane of the cardiac orifice. 

Anatomy of the stomach (anterior view)

Next, we have the corpus, or gastric body, which is the largest part of the organ. Finally,
the pyloric part represents the outflow section of the stomach, passing stomach contents into
the duodenum. The pylorus is further divided into two distinct areas – the pyloric
antrum connected to the stomach and the pyloric canal connected to the duodenum. The
contents of the pyloric canal enter into the duodenum via the pyloric orifice, the opening and
closing of which are controlled by the pyloric sphincter (pylorus), a circular layer of smooth
muscle. As you might notice in the stomach diagram illustrated above, the organ has a
characteristic J-shape created by two unequal curvatures. The longer and convex curvature
located on the left of the stomach is called the greater curvature, this starts from the cardiac
notch that is formed between the esophageal border and fundus. In contrast, the shorter concave
curvature found to the right is the lesser curvature. The latter contains a small notch called
the angular incisure which marks the line of intersection between the body and pyloric part of
the stomach.

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 Mnemoni You might be wondering if there's an easy way to remember the parts of the
stomach, which stands for:

 Cardium

 Fundus

 Body

 Pylorus

Structure

The stomach is an expanded section of the gastrointestinal tract between the esophagus and
the duodenum of the small intestine. The stomach is on the left side of theabdominal cavity
with the most superior part laying against the diaphragm . Inferior to the stomach is the
pancreas and the greater omentum which hangs from the greater curvature. The major regions
of the stomach are thecardia, fundus, body, antrum, and the pylorus. Additionally you have
the greater and lesser curvatures, which are the right and left sides of the stomach,
respectively. The esophageal sphincter is contained within the carida region. The esophageal
sphincter controls the flow of material coming into the stomach. The fundus is the section of
the stomach that is formed by the upper curvature and the body is the main area of the
stomach. The final part of the stomach is the antrum where the pylorus, the exit of the
stomach and entrance to the duodenum of the small intestine is located. Within the pylorus is
the pyloric sphincter that controls what leaves the stomach into the duodenum.

The inside of the stomach is composed of three layers, from the innermost layer to the
outermost layer: muscosa, submuscosa, muscularis externa, and the serosa. The muscosa is
where stomach acid is produced and secreted into the stomach. The submuscosa is layer
composed of connective tissue that separates the muscosa from the muscularis externa. The
muscularis externa is composed of three layers of smooth muscle: inner oblique, middle
circular, and outer longitudinal. These are the muscles that are primarily responsible for
mixing material that has come into stomach with digestive enzymes and moving the material
through the stomach. The final layer is the serosa, which is a layer of connective tissue that

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attaches and is continuous with the peritoneum, the lining of the abdominal cavity. Several
layers of muscle and other tissues make up your stomach:

 Mucosa is your stomach’s inner lining. When your stomach is empty, the mucosa has
small ridges (rugae). When your stomach is full, the mucosa expands, and the ridges
flatten.
 Submucosa contains connective tissue, blood vessels, lymph vessels (part of
your lymphatic system) and nerve cells. It covers and protects the mucosa.
 Muscularis externa is the primary muscle of your stomach. It has three layers that
contract and relax to break down food.
 Serosa is a layer of membrane that covers your stomach.

Blood vessels

The overall blood supply of the stomach originates from the abdominal aorta and is provided
from two anastomotic systems along the curvatures and several direct branches. The
anastomosis along the lesser curvature is created by the union of the right and left gastric

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arteries which originate from the common hepatic artery and celiac trunk respectively. The
greater curvature anastomosis is formed by the union of the right and left gastroomental
arteries (gastroepiploic), which originate from the gastroduodenal and splenic arteries
respectively. The splenic artery also sends out short and posterior gastric arteries, which
directly supply the fundus and upper body of the stomach. The pyloric part receives arterial
blood from the gastroduodenal artery, which stems from the common hepatic artery. The veins
draining the stomach follow the course and nomenclature of the arteries very closely. They
ultimately drain into three large vessels called the hepatic portal, splenic, and superior
mesenteric veins. .

Nerve supply of the stomach

(a) Anterior gastric nerve and

(b) The posterior gastric nerve.

The anterior gastric nerve divides into:

1. A number of gastric branches for the anterior surface of the fundus and body of the
stomach.

2. Two pyloric branches, one for the pyloric antrum and another for the pylorus.

The posterior gastric nerve divides into:

1. Smaller, gastric branches for the posterior surface of the fundus, the body and the
pyloric antrum.

2. Larger, coeliac branches for the coeliac plexus. Parasympathetic nerves are motor and
secretomotor to the stomach. Their stimulation causes increased motility of the stomach
and secretion of gastric juice rich in pepsin and HCL. These are inhibitory to the pyloric
sphinct

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Greater and Lesser Curvatures

The medial and lateral borders of the stomach are curved, forming the lesser and greater
curvatures:

 Greater curvature – forms the long, convex, lateral border of the stomach.
o Arising at the cardiac notch, it arches backwards and passes inferiorly to the
left.
o It curves to the right as it continues medially to reach the pyloric antrum.
o The short gastric arteries and the right and left gastro-omental arteries supply
branches to the greater curvature.
 Lesser curvature – forms the shorter, concave, medial surface of the stomach.
o The most inferior part of the lesser curvature, the angular notch, indicates the
junction of the body and pyloric region.
o The lesser curvature gives attachment to the hepatogastric ligament and is
supplied by the left gastric artery and right gastric branch of the hepatic artery.

Veins of the stomach

The veins drain into the portal circulation.

• The left and right gastric veins drain directly into the portal vein.
• The short gastric veins and the left gastroepiploic veins join the splenic vein.

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 • The right gastroepiploic vein joins the superior mesenteric vein.

Lymphatics

The lymphatic drainage of the stomach is variable between individuals but the same regional
lymph nodes are generally involved. These are the:

 juxtacardial nodes (a.k.a. paracardial nodes),

 gastric nodes (of which there are left and right, corresponding to the left and right
gastric arteries),

 short gastric nodes (corresponding to the short gastric arteries)

 gastroomental nodes (a.k.a. gastroepiploic, of which there are left and right following
the arteries of the same names),

 pyloric nodes (made up of the supra-, infra- (or sub-) and retropyloric groups).

These groups drain into the celiac nodes which drain through the intestinal lymphatic trunk into
the cisterna chyli (if present) and from there flow into the thoracic duct. Some drainage will
often occur from the stomach to the splenic and superior mesenteric nodes.

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Stomach Conditions

 Gastroesophageal reflux: Stomach contents, including acid, can travel backward up the
esophagus. There may be no symptoms, or reflux may cause heartburn or coughing.
 Gastroesophageal reflux disease (GERD): When symptoms of reflux become bothersome
or occur frequently, they’re called GERD. Infrequently, GERD can cause serious
problems of the esophagus.
 Dyspepsia: Another name for stomach upset or indigestion. Dyspepsia may be caused by
almost any benign or serious condition that affects the stomach.
 Gastric ulcer (stomach ulcer): An erosion in the lining of the stomach, often causing pain
and/or bleeding. Gastric ulcers are most often caused by NSAIDs or H. pylori infection.
 Peptic ulcer disease: Doctors consider ulcers in either the stomach or the duodenum (the
first part of the small intestine) peptic ulcer disease.
 Gastritis: Inflammation of the stomach, often causing nausea and/or pain. Gastritis can be
caused by alcohol, certain medications, H. pylori infection, or other factors.
 Stomach cancer: Gastric cancer is an uncommon form of cancer in the U.S.
Adenocarcinoma and lymphoma make up most of the cases of stomach cancer.
 Zollinger-Ellison syndrome (ZES): One or more tumors that secrete hormones that lead
to increased acid production. Severe GERD and peptic ulcer disease result from this rare
disorder.

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 Gastric varices: In people with severe liver disease, veins in the stomach may swell and
bulge under increased pressure. Called varices, these veins are at high risk for bleeding,
although less so than esophageal varices are.
 Stomach bleeding: Gastritis, ulcers, or gastric cancers may bleed. Seeing blood or black
material in vomit or stool is usually a medical emergency.
 Gastroparesis (delayed gastric emptying): Nerve damage from diabetes or other
conditions may impair the stomach’s muscle contractions. Nausea and vomiting are the
usual symptoms.

Stomach Tests

 Upper endoscopy (esophagogastroduodenoscopy or EGD): A flexible tube with a camera

on its end (endoscope) is inserted through the mouth. The endoscope allows examination
of the esophagus, stomach, and duodenum (the first part of the small intestine).
 Computed tomography (CT scan): A CT scanner uses X-rays and a computer to create
images of the stomach and abdomen. 
 Magnetic resonance imaging: Using a magnetic field, a scanner creates high-resolution
images of the stomach and abdomen.
 pH testing: Using a tube through the nose into the esophagus, acid levels in the esophagus
can be monitored. This can help diagnose or change treatment for GERD.
 Barium swallow: After swallowing barium, X-ray films of the esophagus and stomach
are taken. This can sometimes diagnose ulcers or other problems.
 Upper GI series: X-rays are taken of the esophagus, stomach, and upper part of the small
intestine.
 Gastric emptying study: A test of how rapidly food passes through the stomach. The food
is labeled with a chemical and viewed on a scanner.
 Stomach biopsy: During an endoscopy, a doctor can take a small piece of stomach tissue
for tests. This can diagnose H. pylori infection, cancer, or other problems.
 H. pylori test: While most people with H. pylori infection don't develop ulcers, simple
blood or stool tests can be done to check for infection in people with ulcers or to verify
that the infection is wiped out after treatment..

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Stomach Treatments

 Histamine (H2) blockers: Histamine increases stomach acid secretion; blocking histamine
can reduce acid production and GERD symptoms.
 Proton pump inhibitors: These medicines directly inhibit the acid pumps in the stomach.
They must be taken daily to be effective.
 Antacids: These medicines can help against the effects of acid but don't kill bacteria or
stop acid production.
 Endoscopy: During an upper endoscopy, tools on the endoscope can sometimes stop
stomach bleeding, if present.
 Motility agents: Medicines can increase contraction of the stomach, improving symptoms
of gastroparesis.
 Stomach surgery: Cases of severe stomach bleeding, ruptured ulcers, or cancer require
surgery to be cured.
 Antibiotics: H. pylori infection can be cured with antibiotics, which are taken with other
medicines to heal the stomach.

When should I call my doctor?

Call your healthcare provider right away if you have:

 Chest pain.
 Fever.
 Nausea and vomiting.
 Pus or blood in your stool.
 Severe dehydration or diarrhea.
 Sudden and intense abdominal pain.

ConclusionYour stomach is a muscular organ in your upper abdomen. It is part of your

GI tract. During digestion, your stomach contracts, relaxes and produces acids that help
break down food. Your stomach size can vary depending on when and how much you

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 have eaten. You can keep your stomach and digestive system healthy by eating healthy
foods, exercising and managing stress

References
 Hoffman, Matthew MD (2017). “Picture of the Stomach: Human Anatomy.” Web
MD. Retrieved on 2017-08-26 from http://www.webmd.com/digestive-
disorders/picture-of-the-stomach#1
 MedicineNet (2017). “Medical Definiton of Stomach.” MedicineNet. Retrieved on
2017-08-27 from http://www.medicinenet.com/script/main/art.asp?
articlekey=5560
 Medline Plus (2017). “Stomach Disorders.” Medline Plus. Retrieved on 2017-08-
28 from https://medlineplus.gov/stomachdisorders.htm
 Human Physiology/The gastrointestinal system  Source:
http://en.wikibooks.org/w/index.php?oldid=1753452  Contributors

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