STOMACH

Dr. Edzelito T. Legaspi

Description
o Dilated portion of the alimentary canal
o J shaped
o Two openings, cardiac and pyloric orifices
o Two curvatures, greater and lesser curvatures
o Two surfaces, anterior and posterior surfaces
o Relatively fixed at both ends
o Very mobile in between
o Tends to be high and transversely arrange in short ,obese
person
o Elongated vertically in tall, thin person
o Undergoes considerable variation in the same person
depending on the volume of its content, position and phase
of respiration

Functions
 Stores food
 Mixes with gastric secretions
 Controls the rate of delivery of chyme
Location
o Upper part of the abdomen
o Extending from the beneath the left costal margin into the
epigastric and umbilical regions
o Much of the stomach lies under cover of the lower ribs
Divided into the following parts:
 Fundus
o This is dome-shaped and projects upward and to the left
of the cardiac orifice
o It is usually full of gas
o Bounded superiorly by the diaphragm and laterally by the
spleen
o The angle of His is where the fundus meets the left side of
the GE junction
o The inferior extent of the fundus is considered to be the
horizontal plane of the GE junction, where the
body(corpus) of the stomach begin
 Cardia
o Part of the stomach attach to the esophagus
o Just proximal to the cardia at the GE junction is the
anatomically indistinct but physiologically demonstrable
lower esophageal sphincter
 Body
o This extends from the level of the cardiac orifice to the
level of the incisura angularis, a constant notch in the
lower part of the lesser curvature
o Contains most of the parietal cells, some of which are also
present in the cardia and fundus
 Pyloric antrum
o This extends from the incisura angularis to the pylorus
o At the angularis, incisura the lesser curvature turns
abruptly to the right, marking the anatomic beginning of
the antrum, which comprises the distal 25% to 30% of the
stomach
 Pylorus
o This is the most tubular part of the stomach
o The thick muscular wall is called the pyloric sphincter,
connects the stomach to the proximal duodenum
o The cavity of the pylorus is the pyloric canal
 Lesser curvature
o Forms the right border of the stomach
o Extends from the cardiac orifice to the pylorus
o It is suspended from the liver by the lesser omentum
 Greater curvature
o Much longer than the lesser curvature
o Extends from the left of the cardiac orifice, over the dome of
the fundus, and along the left border of the stomach to the
pylorus
o The gastrosplenic omentum (ligament) extends from the
upper part of the greater curvature to the spleen
o Greater omentum extends from the lower part of the greater
curvature to the transverse colon
 Cardiac orifice
o Is where the esophagus enters the stomach
o Although no anatomic sphincter can be demonstrated here,
a physiologic mechanism exist that prevents regurgitation
of the stomach contents into the esophagus
 Pyloric orifice
o Formed by the pyloric canal which is about 1 in. (2.5cm)
long
o Circular muscle coat of the stomach is much thicker here
and forms the anatomic and physiologic pyloric sphincter
Mucous membrane
- Thick and vascular
- Thrown into folds called rugae
- Mainly longitudinal in direction
- Folds flattened when the stomach is distended
Muscular wall of the stomach
Contains:
 Longitudinal
 Circular
 Oblique fibers
Peritoneum
o Completely surrounds the stomach
o Leaves the lesser curvature as the lesser omentum and
greater curvature as the gastrosplenic omentum and the
greater omentum
 Relations
Anteriorly
- Anterior abdominal wall Left gastroepiploic artery
- Left costal margin o Arises from the splenic artery at the hilum of the spleen
- Left pleural and lung o Passes forward in the gastrosplenic omentum (ligament) to
- Diaphragm supply the stomach along the upper part of the greater
- Left lobe of the liver curvature
Posteriorly
- Lesser sac Right gastroepiploic artery
- Diaphragm o Arises from the gastroduodenal branch of the hepatic artery
- Spleen o Passes to the left and supplies the stomach along the lower
- Left suprarenal gland part of the greater curvature
- Upper part of the kidney
- Splenic artery VEINS
- Pancreas o Drain into the portal circulation
- Transverse mesocolon o Left and right gastric veins drain directly into the portal vein
- Transverse colon o Short gastric veins and left gastroepiploic veins join the
splenic vein
Blood supply o Right gastroepiploic vein joins the superior mesenteric vein

ARTERIES
LYMPH DRAINAGE
Arteries are derived from the branches of the celiac artery o Follows the arteries into the left and right gastric nodes, the
 Left gastric artery left and right gastroepiploic nodes and short gastric nodes
 Right gastric artery o All lymph from the stomach eventually passess to the celiac
 Short gastric arteries nodes located around the root of the celiac artery on the
posterior abdominal wall
 Left gastroepiploic artery
 Right gastroepiploic artery
NERVE SUPPLY
Celiac artery
Sympathetic – pain transmitting nerve fibers
Parasympathetic – secretomotor to gastric glands and motor
to the muscular wall of the stomach

Includes:
- Sympathetic fibers derived from the celiac plexus
- Parasympathetic fibers from the right and left vagus nerves

Anterior vagal trunk

o Formed in the thorax mainly from the left vagus nerve
o Enters the abdomen in the anterior surface of the
esophagus
o The trunk divides into branches that supply the anterior
surface
o A large hepatic branch passes up the liver and from this a
pyloric branch passes down to the pylorus

Posterior vagal trunk

o Formed in the thorax mainly from the right vagus nerve
Left gastric artery
o Enters the abdomen on the posterior surface of the
o Arises from the celiac artery
esophagus
o Passes upward and to the left to reach the esophagus and
o Divides into branches to supply the posterior surface of the
then descends along the lesser curvature
stomach
o Supplies the lower third of the esophagus and upper right
o A large branch passes to the celiac and superior
part of the esophagus
mesenteric plexus and is distributed to the intestine as far
as the splenic flexure and to the pancreas
Right gastric artery
o Arises from the hepatic artery at the upper border of the
pylorus
Pyloric sphincter receives motor fibers from the sympathetic
o Runs to the left along the lesser curvature
system and inhibitory fibers from the vagi
o Supplies the lower right part of the stomach

Short gastric arteries

o Arise from the splenic artery at the hilum of the spleen
o Pass forward in the gastrosplenic omentum (ligament) to END
supply the fundus