You are on page 1of 18

STOMACH

Dr Adil Asghar

Introduction

The stomach is the most dilated part of the gastrointestinal tract and has a J-like shape Positioned between the abdominal esophagus and the small intestine the stomach is in the epigastric, umbilical, and left hypochondrium regions of the abdomen.

Parts of stomach
The stomach is divided into four regions: cardia, which surrounds the opening of the esophagus into the stomach. fundus of stomach, which is the area above the level of the cardial orifice. body of stomach, which is the largest region of the stomach. pyloric part, which is divided into the pyloric antrum and pyloric canal and is the distal end of the stomach.

Openings of stomach

Cardiac opening-inlet Physiological sphincter Pyloric opening-outlet The outlet of the stomach (pyloric orifice) is marked on the surface of the organ by the pyloric constriction and surrounded by a thickened ring of gastric circular muscle (the pyloric sphincter). The pyloric orifice is just to the right of midline in a plane that passes through the lower border of vertebra L1 (the transpyloric plane)

Features of stomach
Features of the stomach include: the greater curvature, which is a point of attachment for the gastrosplenic ligament and the greater omentum. the lesser curvature, which is a point of attachment for the lesser omentum. the cardial notch, which is the superior angle created when the esophagus enters the stomach. Gastrophrenic ligament attached. the angular incisure, which is a bend on the lesser curvature. Two surface:-anterior and posterior Two part:- Cardiac (Body + fundus) and pyloric ( Antrum +canal) Two orifice:- cardiac orifice and pyloric orifice

Anterior relation
Anterior relations: Anterior abdominal wall. Medial segment of left lobe and anterior segment of right lobe of liver. Neck of gallbladder. (if stomach is empty)

Posterior relation
Posterior relations: Stomach bed at supine posture Floor of lesser sac --Transverse mesocolon. -- diaphragm --left kidney --left supra-renal gland --pancreas --spenic artery --splenic flexure --Spleen Aorta and celiac trunk and its branches Celiac ganglion and plexus Hepatic triad Gastroduodenal artery

Internal surface of stomach


Histologically four layers:
1. 2.

Mucosa Sub-mucosa

3.
4.

Muscular layer
Serosa Gastric mucosa thrown into longitudinal ridges called gastric folds or rughae: along greater curvature and marked best near pylorus. During swallowing a temporary groove formed along lesser curvature called gastric canal.

Arterial supply
Each of the principal arteries of supply originates from the celiac trunk: Left gastric A., common Hepatic A., Splenic A. Lesser curvature Left gastric ascending branch (gives rise to esophageal) descending branch (gives rise to gastric) right gastric (Hepatic A.) Greater curvature: Right gastro-epicloic Artery (Hepatic A.) Left Gastro-epicloic Artery(splenic A.) Fundus Short gastric branches and posterior gastric artery (splenic A.)

Venous drinage

Lymphatics

Zone I (inferior gastric) drains into the subpyloric and omental nodes Zone II (splenic) drains into the pancreaticosplenic nodes Zone III (superior gastric) drains into the superior gastric nodes Zone IV (hepatic) drains into the suprapyloric nodes

Nerve supply

Parasympathetic supply: Both Vagus nerve form anterior and posterior vagal trunk. Right vagus forms posterior vagal trunk and left vagus form anterior vagal trunk. Sympathetic and sensory supply T5 to T7 spinal segment through greater splanchnic nerve.

Nerve supply

Clinical aspect

Pylorospasm -2 -12 weeks of new born causing vomiting and discomfort. Congenital hypertrophic pyloric stenosis- male child after 6weeks , visible peristalsis. Cancer of stomach: gastrectomy (partial or total) with lymphnode resections peptic ulcer: Pain at epigastrium because supplied by T5-T7 spinal segment Vagotomy used for treatment of peptic ulcer: truncal, selective gastric and selective proximal to reduce HCL secretion.

Truncal vagotomy

Selective gastric vagotomy

Selective proximal gastric vagotomy