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Y2S2-Anatomy-GI > Anatomy of the stomach > Flashcards

Anatomy of the stomach Flashcards

1
Q

What is the stomach?

A
  • It is the most dilated part of the digestive tube
  • It intervenes between the esophagus and the duodenum
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2
Q

In which abdominal regions is the stomach situated?

A

1) Left hypochondriac

2) Epigastric

3) Umbilicus

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3
Q

What are the different shapes of the stomach

A
  • In a cadaver it is sickle shaped, while in a living person is it J-shaped

1) Sthenic/normal: The longer limb of J is slightly oblique

2) Hypersthenic: The J is very oblique and it is prone to suffer from duodenal ulcers

  • Due to the fact that most gastric contents settle in the duodenum

3) Hyposthenic: The J-shape is almost vertical and the person with such a stomach is prone to suffer from gastric ulcers

  • Due to the fact that most gastric contents settles in the body of stomach
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4
Q

Which clinical variation of stomach shape is associated with a higher risk of duodenal ulcers?

A

Hypersthenic

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5
Q

Which clinical variation of stomach shape is associated with a higher risk of gastric ulcers?

A

Hyposthenic

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6
Q

What are the parts of the stomach?

A

1) 2-orifices

2) 2-Curvatures

3) 2-Surfaces

4) 3-Subdivisions

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7
Q

What are the orifices of the stomach?

A

1) Cardiac

2) Pyloric

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8
Q

What are the curvatures of the stomach?

A

1) Lesser curvature

2) Greater curvature

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9
Q

What are the surfaces of the stomach?

A

1) Antero-superior surface

2) Postero-inferior surface

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10
Q

What are the subdivisions of the stomach?

A

1) Fundus

2) Body

3) Pyloric

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11
Q

In which part of the stomach is the lesser omentum formed?

A

At the lesser curvature of the stomach, the lesser omentum has two parts (Hepatogastric ligament, and a hepatoduodenal ligament)

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12
Q

What structures are found in the hepatoduodenal ligament?

A

1) Portal vein

2) Hepatic artery

3) Bile duct

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13
Q

What structure is attached to greater curvature of the stomach?

A

The greater omentum, it is a large fold of the peritoneum, it hangs from the greater curvature and loops back up to the transverse colon, it contains the (Gastrophrenic ligament, gastrocolic ligament “stomach to transverse colon”, and the gastrosplenic ligament)

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14
Q

What is the fundus of the stomach?

A
  • The part of the stomach that contains air and it can be seen under the left diaphragm in an X-ray
  • It lies above the esophageal opening
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15
Q

What are the structures found in the pyloric part of the stomach?

A

1) Angular notch (incisura angularis)

2) Pyloric antrum

3) Pyloric canal

4) Pyloric sphincter

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16
Q

What is the angular notch (AKA: incisura angularis?

A
  • A sharp bend at the lesser curvature
  • It is the most dependent part of the lesser curvature
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17
Q

What is the pyloric antrum?

A

It is the dilated proximal part of the pylorus, and it serves as a reservoir, and facilitates the mixing of the gastric content

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18
Q

What is the pyloric canal?

A

The narrowest and distal portion of the pylorus, it is characterized by the thickened circular muscles that eventually forms the pyloric sphincter

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19
Q

What forms the pyloric sphincter?

A
  • It is an anatomical sphincter that regulates the flow of materials between the stomach and the duodenum through the pyloric orifice

1) Inner circular muscular layer, it becomes thicker as we approach the pyloric canal forming a strong band-like structure that regulates the passage of chyme into the duodenum

2) Outer-longitudinal layer, it is thinner and runs along the stomach’s outer surface (it does not form the sphincter directly)

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20
Q

What is meant by hypertrophic pyloric stenosis?

A

It is a congenital defect in which there is an abnormal thickening + neuro-muscular incoordination of the pyloric sphincter muscle, narrowing/blocking the pyloric lumen, disrupting the normal passage of food into the duodenum

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21
Q

What attached to the greater curvature of the stomach?

A

1) Gastrophrenic ligament

2) Gastro-splenic ligament

3) The anterior 2-layers of the greater omentum

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22
Q

What is the greater sac?

A
  • Immediately visible after opening the abdominal wall
  • It encompasses most of the peritoneal cavity
  • It includes spaces around the major organs
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23
Q

What is the lesser sac (Omental bursa)?

A
  • Located behind the liver, stomach, and the lesser omentum
  • It allows the movement of the stomach, as it allows it to expand depending on the food content, and it interacts with the surrounding structures like its connections to organs (duodenum & spleen) via the ligaments
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24
Q

How does the lesser sac forms?

A

It is formed due to the rotation of the primitive stomach in such a way that its left surface becomes anterior creating a diverticulum in the peritoneal cavity (AKA lesser sac)

  • It connects the stomach to the liver
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25
What are the antero-superior relations of the stomach?
- It is covered by the peritoneum 1) Left lobe of the liver 2) Diaphragm 3) Intermediate triangular part is covered by the anterior abdominal (This area is not covered by an organ, allowing access for procedures such as needle aspiration or laparoscopic access "Gastric triangle")
26
What are the borders of the gastric triangle?
1) Right side: The lower border of the liver 2) Left side: The left costal margin 3) Lower border: Transverse colon - This areas allows access for procedures
27
What are the relations of the postero-inferior surface of the stomach?
1) Transverse colon 2) Transverse mesocolon 3) Body of pancreas 4) Splenic artery 5) Spleen 6) Left kidney 7) Left suprarenal gland 8) Left cusp of the diaphragm 9) Left colic flexure
28
What can happen to the posterior wall of the stomach after pancreatitis?
It might adhere to the posterior wall of the omental bursa which covers the pancreas
29
Which ligaments forms the lesser omentum?
1) Hepatogastric ligament 2) Hepatoduodenal ligament
30
What is the main artery that supplies the foregut?
The celiac trunk
31
What are the branches of the celiac trunk?
1) Splenic artery (supplies the spleen, parts of the stomach and the pancreas) 2) Left gastric artery (supplies the esophagus, and the lesser curvature of the stomach) 3) The common hepatic artery (it supplies the liver, stomach, duodenum and the pancreas)
32
What are the complications of a gastric ulcer in the posterior wall?
-A posterior ulcer can erode into the pancreas->causing back pain “referred pain” OR damage the splenic artery = Hemorrhage
33
What is the epiploic foramen of winslow?
It is a hole that connects the greater sac to the lesser sac, and it is a site of herniation
34
If i need to approach the lesser sac through the greater sac, which of the foramen i need to pass through?
Epiploic foramen (Right free margin of the lesser omentum)
35
Describe the interior of the stomach
1) Rugae - Formed of longitudinal folds of mucous membrane 2) Gastric Canal oblique muscle layer/channel along the lesser curvature Function: Directs fluids rapidly toward the pylorus (Liquids are quicker in absorption (than solid) however, Fluids (alcohol, acidic drinks, and irritants) can pass Rapidly = eroding the protective mucous membrane = Lesser curvature more prone to GASTRIC ULCER + Denudation (loss of surf layers/epithelium)
36
What is one of the possible causes of gastric ulcers along this curvature?
Denudation (loss of the surface layers/epithelium) of the mucous membrane with irritants like alcohol
37
What is the bare area of the stomach?
- It is an area behind the cardiac end in relation to the left crus of the diaphragm, left suprarenal gland, and the left gastric artery
38
Why is the lesser curvature more prone to gastric ulcers?
Because it lacks complete peritoneal covering and is exposed to direct acid irritation along the gastric canal - This area can serve as a pathway for infection, tumor spread or surgical access
39
What is the arterial supply of the stomach?
1) Left gastric 2) Right gastric 3) Short gastric 4) Left gastro-epiploic 5) Right gastro-epiploic 6) Posterior gastric
40
What are the branches of the celiac artery?
1) Abdominal Aorta 2) Celiac trunk 3a) Left gastric artery 3b) Splenic artery 3c) Common hepatic artery
41
FYI What does the left gastric artery supply?
- It gives off esophageal branches (as it ascends towards the cardia of the stomach), it supplies the lesser curvature of the stomach and the lower esophagus - it will then anastomose with the right gastric artery
42
FYI What does the common hepatic artery supply?
It gives one branch to the stomach and the duodenum (gastroduodenal artery) - The gastrodudenal artery will give rise to the right gastroepiploic artery and the anterior pancreaticduodenual artery
43
FYI What does the splenic artery supply?
- It goes posteriorly, reaching the greater curvature, branching into left gastroepiploic artery, which will anastomose with the right gastroepiploic artery - Some short gastric arteries will supply the fundus and the upper gastric curvature
44
What does the left gastric artery supply?
1) Lesser curvature of the stomach 2) Lower esophagus
45
What does the right gastric artery supply?
1) Lesser curvature of the stomach
46
What does the short gastric and posterior gastric arteries supply?
1) Fundus 2) upper gastric curvature 3) The posterior gastric artery also supplies the posterior wall of the stomach
47
What does the left & right gastro-epiploic artery supply?
- Branch of splenic artery 1) Greater curvature of the stomach
48
What are the anastomoses of the blood supply of the stomach?
1) Lesser curvature: - Left gastric artery with the right gastric artery 2) Greater curvature - Left gastroepiploic artery with the right gastro epiploic artery
49
Which major artery supplies the stomach?
celiac artery
50
A 60-year-old male with a history of chronic NSAID use presents with severe epigastric pain, dizziness, and hematemesis (vomiting blood). His blood pressure is 90/60 mmHg, and he has a heart rate of 110 bpm, suggesting hypovolemic shock. Endoscopy reveals a posteriorly located gastric ulcer that has perforated a major artery. Which of the following arteries is most likely affected?
Splenic artery
51
Which artery is most affected in bleeding duodenal artery?
gastroduodenal artery
52
What is the venous drainage of the lesser curvature and where does it empty into?
1) Left gastric vein 2) Right gastric vein - They drain into the portal vein
53
What is the venous drainage of the greater curvature and where does it empty into?
1) Left gastroepiploic vein (drains into the splenic vein) 2) Right gastro epiploic vein (drains into the superior mesentric veins) - if the splenic vein is blocked (because of e.g pancreatic cancer) = gastric varices
54
What is the venous drainage of the upper curvature/fundus and where does it empty into?
short gastric vein - It drains into the splenic vein - Portal hypertension ->dilation of short gastric veins->gastric varices-> rupture->upper GI bleeding.
55
What does the posterior gastric vein drains into?
It drains the posterior aspect of the stomach into the splenic vein
56
Describe the full stomach venous drainage
1) Portal vein - left gastric vein - Right gastric vein 2) Splenic vein - Short gastric vein - posterior gastric vein - Left gastroepiploic vein 3) Superior mesentric vein - Right gastroepiploic vein - The superior mesentric and splenic veins will join together to form the portal vein
57
A 50-year-old male with cirrhosis presents with massive hematemesis. Endoscopy reveals bleeding esophageal varices. Which vein is most likely responsible for the formation of these varices?
Left gastric vein
58
Where is the portal vein located?
- It ascends in the free edge of the lesser omentum to the porta hepatis where it divides into right and left branches - In the lesser omentum it lies behind the hepatic artery on the left and the bile duct on the right
59
What are the sets of lymphatic drainage?
1) Submucous 2) Intra-muscular 3) Sub serous - The lymph vessels anastomoses freely in the stomach wall - Due to the extensive lymph drainage of the stomach and the impossibility of removing all the lymph nodes creates a surgical problem in carcinoma of the stomach
60
The lymphatic drainage of the stomach eventually drains into what?
Celiac lymph nodes
61
Which set of lymph nodes drains the upper part of the lesser curvature?
The left gastric nodes
62
Which set of lymph nodes drains part of the greater curvature and the pyloric region of the stomach?
The right gastroepiploic and pyloric nodes - Some of the pyloric nodes drains into the coeliac nodes
63
What set of lymph nodes drains the fundus and upper gastric curvature (via the short gastric vessels)?
Pancreaticosplenic nodea (found along the splenic artery posterior of the stomach)
64
What are all of the sets of lymph nodes that drains the stomach and what is their final destination?
1a) Left gastric nodes 1b) Pancreatico-splenic nodes 1c) Right gastroepiploic nodes 1d) Pyloric nodes They eventually drain into the coeliac nodes - cisterna chyli - thoracic duct - left venous angle
65
Where can stomach cancer spread?
1) Local spread (affects the adjacent anterior and posterior relations) 2) Lymphatic spread (Left gastric nodes → Celiac nodes → Thoracic duct) - Celiac nodes - Left supraclavicular lymph nodes (due to the backflow of the lymph from the thoracic duct, lymph can pass into the nearby supraclavicular nodes "virchow node" which also drains into the thoracic duct "troiser's sign) 3) Hematogenous spread (Cancer spreads via venous drainage into the portal system and reaches distant organs) 4) Ovarian metastasis (One theory assumes direct seeding across the peritoneal cavity. The other theory is the retrograde lymphatic spread)
66
What is the nerve supply of the stomach?
1) Parasympathetic (Vagus nerve "cranial nerve 10) - The anterior (derived mostly from the left vagus nerve) and posterior vagal (derived mainly from the right vagus nerve) trunks enters the abdomen through the esophageal hiatus 2) Sympathetic
67
What is the function of the parasympathetic nerve supply of the stomach?
1) Motor to the smooth muscles of the wall of the abdominal viscera to increase the motility 2) Secretomotor to the gland 3) Inhibitory to the sphincters
68
Describe the route of the anterior vagal trunk?
- Derived mainly from the left vagus - Runs towards the lesser curvature
69
What are the branches of the anterior vagal trunk?
1) Several gastric branches (supplies the fundus and body) 2) One large branch that supplies the pyloric region along the sphincter (anterior nerve of latarget) 3) Hepatic branch
70
Describe the route of the posterior vagal trunk
- Mainly from the right vagus - Runs towards the lesser curvature of the stomach
71
What are the branches of the posterior vagal trunk?
1) Several gastric branches which supplies the fundus and body 2) Posterior nerve of latarget which supplies the pyloric antrum (but not the pyloric sphincter) 3) Celiac branch to the celiac plexus
72
What are the differences between the anterior and posterior vagal trunks?
1) The anterior supplies the sphincter while the posterior does not 2) The anterior vagal trunk has a hepatic branch while the posterior does not
73
What is vagotomy?
It is a technique to surgically remove the vagus nerve in order to reduce the acid production improving peptic ulcer
74
What are the different types of vagotomy?
1) Truncal vagotomy 2) Selective vagotomy 3) Highly selective vagotomy
75
What is the function of the sympathetic nerve supply of the stomach?
1) Vasoconstriction 2) Motor to the pyloric sphincter 3) Inhibits peristalsis (decreases the motility)
76
What is meant by gastroscopy?
It is a device used to visualize the inside of the esophagus, stomach and duodenum with an ability to get a biopsy

Y2S2-Anatomy-GI (9 decks)

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