Lecture 8 part 2- the stomach

Question 1

The stomach:
Lies in:

Answer 1

sup aspect of the abdomen

Question 2

Position of the stomach

Answer 2

• Supracolic compartment
• Left (and right) upper quadrant
• Epigastric, left hypochondrium , umbilical, left lumbar

Question 3

Question 4

Stomach has 4 anatomical divisions:

Answer 4

cardiac region
Fundus
body
pylorus

Question 5

1. Cardiac region

Answer 5

• Posterior to 6th left costal cartilage

Question 6

2. Fundus

Answer 6

• Cardiac notch
• Posterior to 6th rib in left midclavicular line

Question 7

4. Pylorus

Answer 7

• Antrum ,canal, sphincter surrounding the pyloric orifice
• Level of 9th costal cartilages (L1) to the left of the midline

Question 8

Stomach features:

Answer 8

Greater curvature
* Greater omentum

Lesser curvature
* Angular incisura
* Lesser omentum

Gastric folds/ rugae
* Greater curvature near pylorus

Question 9

Question 10

Sphincters of the stomach:

Answer 10

Inferior Oesophageal Sphincter
Pyloric sphincter

Question 11

Inferior Oesophageal Sphincter

Answer 11

• Oesophageal hiatus at T10.
• Inferior oesophageal sphincter at T11 level
• Transition between oesophagus & stomach
• Allows food to pass through cardiac orifice into stomach
• Not under voluntary control.
• (Note: Superior oesophageal sphincter is located in pharynx)

Question 12

Pyloric Sphincter

Answer 12

• Between pylorus and 1st part of duodenum.
• Controls of exit of gastric contents
• An anatomical sphincter containing smooth muscle
• Normally pylorus is contracted so that orifice is small
• Prevents premature emptying of stomach contents

Question 13

Question 14

Stomach: Relations

Answer 14

Intraperitoneal

Anteriorly:
– Diaphragm, left lobe of the liver, anterior abdominal wall

Posteriorly:
* – Pancreas
* – Omental bursa
* – Left crus and dome of the diaphragm
* – Splenic artery, body of the pancreas
* – Transverse mesocolon
* – Left kidney and suprarenal gland
* – Spleen and left colic flexure

Question 15

Stomach: Surface anatomy

Answer 15

• Epigastrium, Umbilical, left hypochondrium

Question 16

Associated landmarks of stomach

Answer 16

• Cardiac part:
  – Deep to 7th costal cartilage, 2.5cm to the left of the midline
• Pylorus:
  – On transpyloric plane, 2.5cm to the right of the midline
  – Vertebral height L1 / L2
• Fundus:
  – Superior of a plane that extends horizontally from the cardia
• Body:
  – Lies inferior of the above- mentioned plane

Question 17

blood supply of stomach

Answer 17

Coeliac trunk:
* Left gastric
* Common Hepatic Artery: Right gastric
* Gastroduodenal: Right gastro-omental
* Splenic artery:
Short and posterior gastric Left gastro-omental

Portal and splenic veins Superior mesenteric vein
* Prepyloric vein

Question 18

Question 19

Stomach: Lymphatic drainage

Answer 19

• First divide stomach into left and right side and then work in thirds
  Right side:
• First 2/3rds drain into superior gastric group of nodes
• Inf 1/3rd drains into suprapyloric group of lymph nodes
  Left side:
• 1/3rd drains into pancreaticosplenic lymph nodes
• 2/3rds on the greater curvature drains into the inferior gastric group
  This is initial drainage
  During secondary drainage:
• Lymph drains to celiac lymph nodes

Question 20

Question 21

Stomach innervation:

Answer 21

• Receives from autonomic nervous system
  Vagus nerve(CNX)
• Parasympathertic fibres- Anterior and posterior vagal trunks
• Motor (muscles and glands)

Sympathetic nerve supply (T6-9)
* Greater splanchnic nerves to coeliac plexus
* Pain: T 7/8

Question 22

Peptic Ulcer Disease (PUD)

Answer 22

• Gastric vs duodenal
• Gastric – anywhere in the stomach, but often found near the pylorus
• Duodenal- stomach contents enters into the duodenum – will irritate ulcer
• Causes: Helicobacter pylori, NSAIDs, smoking and stress
• Complications:
  – Perforation
  – Peritonitis
  – Gastric outlet obstruction