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GIT Module > Stomach > Flashcards

Stomach Flashcards

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1
Q

What factors influence the form and position of the stomach?

A
  1. Posture and build of the individual
  2. Extent to which the stomach is filled
  3. Position of the surrounding viscera
  4. Tone of the abdominal wall and
  5. Gastric musculature
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2
Q

Where is the stomach found?

A

Found within the superior aspect of the abdomen and spans the epigastric, left hypochondriac and umbilical regions

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3
Q

Describe the shape of an empty stomach

A

commonly J-shaped

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4
Q

What are the different types of stomach?

A
  1. Sthenic [normal]
  2. Hypersthenic
  3. Hyposthenic
  4. Asthenic
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5
Q

What is the clinical significance of hypersthenic stomachs?

A

Very oblique → prone to duodenal ulcers
[seen in obese patients]

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6
Q

What is the clinical significance of hyposthenic stomachs?

A

vertical → prone to gastric ulcers

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7
Q

What are the 4 subdivisions of the stomach?

A
  • Cardia
  • Fundus
  • Body
  • Pylorus
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8
Q

What is th emost fixed part of the stomach?

A

Cardia

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9
Q

what is the cardia of the stomach?

A

found at T11, it surrounds the esphageal orifice

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10
Q

What is the funduc of the stomach?

A

dome shaped portion of the stomach that lies above a horizontal line from the cardiac notch to the greater curvature of the stomach

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11
Q

Relations of the Fundus

A

Lies in contact with left dome of diaphragm

apex level with left 6th rib anteriorly

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12
Q

What is the body of the stomach?

A

the largest of the stomach, that extends from fundus to angular incisiure superiorly and the from the fundus to an inconstant indentation inferiorly

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13
Q

What is the contents of the fundus?

A

Gas

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14
Q

What is the Pylorus of the Stomach?

A

portion of the stomach that connects it to the duodenum

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15
Q

What are the parts of the Pylorus?

A
  1. Pyloric antrum
  2. Pyloric canal
  3. Pyloric sphincter
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16
Q

Where is the Cardiac Orifice found?

A
  • on body at left 6/7th costal cartilage in erect position
  • lies ~2.5 cm away from the median plane at T11
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17
Q

What marks the pyloric orifice?

A

dentified by thick pyloric sphincter (in cadaveric specimen by green-colored bile stain)

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18
Q

Where is the Pyloric orifice located?

A

located at Level of transpyloric plane (tip of 9th costal cartilage anteriorly and L1 vertebral body posteriorly )

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19
Q

Cardiac vs. Pyloric Orifice

A

Pyloric orifice is more superficial than cardiac orifice & more mobile

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20
Q

Which curvature of the stomach is more fixed?

A

Lesser Curvature of the Stomach

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21
Q

What does the angular notch indicate?

A

indicate junctions of body and pyloric region

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22
Q

Which arteries are found along the lesser curvature of the stomach?

A

Right and Left Gastric arteries

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23
Q

Which part of the stomach is more prone to ischemia and why?

A
  1. lesser curvature
  2. has minimal arterial anastomosis, which when occluded would leaf to ischemia and ulcerations
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24
Q

What structure is attached to the lesser curvature of the stomach?

A

Lesser omentum [hepatogastric ligament]

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25
Q

Which arteries run along the greater curvature of the stomach?

A

short gastric artery

Right and Left gastroepiploic// omental artery

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26
Q

What structures are attached to the Greater curvature of the stomach?

A
  1. Gastrophrenic ligament
  2. Gastrosplenic ligament
  3. Anterior 2 layers of the Greater Omentum
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27
Q

Superior relation of the stomach

A
  1. Eosphagus
  2. Left dome of the Diaphragm
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28
Q

Anterior relations of the Stomach

A
  1. Diaphragm
  2. Greater Omentum
  3. Anterior Abdominal wall
  4. Left lobe of the liver
  5. Gall bladder
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29
Q

Posterior relations of the Stomach

A
  1. Lesser sac (omental bursa)
  2. Pancreas
  3. Left kidney and adrenal gland
  4. Spleen
  5. Splenic artery
  6. Transverse colon
  7. Transverse mesocolon
  8. Left crus of the diaphragm
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30
Q

What structure is affected by posterior perforation of the stomach?

A

Contents of the stomach bed, especially the splenic artery

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31
Q

Inferior and Lateral relations of the Stomach

A

Transverse mesocolon

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32
Q

Empty vs. Distended stomach

A

Empty: surfaces tend to face superiorly and inferiorly, rather than anterior and posterior

Distended: surfaces become progressively more anteriorly and posteriorly

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33
Q

What are some possible effect of pancreatitis on the stomach?

A

posterior wall of the stomach may adhere to the posterior wall of the lesser sac that covers the pancreas

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34
Q

What is the gastric triangle and what is the clincal significance of this space?

A
  1. Anterior surface of the stomach where it is in direct contact with the anterior abdominal wall
  2. A feeding tube is inserted through this area in cases of complete esophageal obstruction
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35
Q

What are the boundaries of the Gastric triangles?

A
  • R: inferior border of the liver
  • L: left costal margin
  • Inferiorly: transverse colon
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36
Q

What are the boundaries of Traube’s space?

A
  • S: lower border of left lung
  • I: left costal margin
  • Right side: lower border of left lobe of liver
  • Left side: spleen
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37
Q

What is Traube’s space?

A

Topographic area overlying the fundus of the stomach

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38
Q

What is the clinical significance of Traube’s space?

A

Examination: tympanic on percussion

Pathology: the space is obliterated by enlargement of liver, spleen or left-sided pleural effusion

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39
Q

Describe the interior surface of the Pyloric Orifice

A

Mucosa appears slightly thickened, forming part of the ‘mucosal rosette’ that lines the orifice and contributes to its closure

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40
Q

Describe the interior surface of the Gastric Canal

A

Smoother mucosa along lesser curvature forms a temporary, continuous furrow ‘gastric canal’

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41
Q

Function of Gastric Canal

A

Facilitates saliva and liquids entering stomach to be fast-tracked to the pylorus during swallowing,

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42
Q

Which portion of the interior surface of the stomach prone to injury and why?

A

Gastric canal is prone to injury by irritant liquids

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43
Q

Interior of the Stomach

A

Gastric Rugae and Gastric canal

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44
Q

Describe the appearance of the gastric rugea is a distended and empty stomach

A

Distended: disppear

Empty: contracted or shrunken state

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45
Q

Gastric Rugae

A

Are mucosal longitudinal folds with submucosal CT found in the body and, to a lesser extent, the fundus

These are most obvious on the anterolateral, lateral and posterolateral parts of stomach, towards greater curvature.

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46
Q

What are the two sphincters of the stomach? Which is anatomic and physiologic?

A

Cardiac Orifice: physiological

Pyloric orifice/Sphincter: anatomical

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47
Q

Branching of the Celiac trunk

A
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48
Q

What are the branches of the Splenic artery supply the stomach?

A
  1. Short gastric
  2. Left gastro-epiploic
  3. Posterior Gastric
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49
Q

What are the branches of the Common hepatic artery supply the stomach?

A

Gastroduodenal artey

  1. Right gastric
  2. Right gastroepiploic
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50
Q

Path of Pyloric artery

A

They pierce duodenal wall around its entire circumference just distal to the sphincter and reach submucosa of the pyloric canal and terminate in mucosa of pyloric antrum

51
Q

What is the terminal branch of gastroduodenal artery?

A

Right gastro-omental artery

52
Q

Arterial anastomosis of the cardia/esophagus

A

Esophageal arteries originating from thoracic aorta anastomose with vessels supplying the fundus of stomach in cardiac orifice region.

53
Q

Arterial anastomosis of the pylorus

A

extensive network of vessels supplying the duodenum allows for some anastomosis between branches of the superior mesenteric artery and pyloric vessels derived from arteries arising from the coeliac trunk.

54
Q

Arterial anastomosis of the greater curvature

A

anastomoses by right and left gastro-omental aa

55
Q

Arterial anastomosis of the lesser curvature

A

Anastomoses form along lesser curvature by right and left gastric arteries

56
Q

Arterial anastomosis of the fundus

A

Anastomoses exist in the fundus between short gastric and left gastric aa

57
Q

Arterial anastomosis of the antrum

A

Anastomoses between the right gastric and right gastroepiploic aa

58
Q

In which part of the stomach do we see extensive anastomoses

A
59
Q

What is a site of portocaval anastomosis in the stomach?

A

Lower end of esophagus

60
Q

Venous drainage of the stomach

A
  1. hepatic portal vein
  2. Splenic vein
  3. Superior mesenteric vein
61
Q

What veins drain into the superior mesenteric vein?

A

Short gastric vein, left and right gastro-omental veins

62
Q

What veins drain into the hepatic portal vein?

A

Right and left gastric veins

63
Q

Congenital (Infantile) hypertrophic pyloric stenosis

A
  1. Hypertrophied circular muscles of the pylorus sphincter, with narrowed lumen
    • treated by pyloromyotomy
  2. → distension of stomach → projectile vomiting [two weeks-two months]
    • Vomit does not have bile
  3. Incidence is common in monozygotic twins
64
Q

Lymphatic drainage of the Stomach

A
65
Q

What is Trosier’s sign?

A

enlarged & palpable left supraclavicular node may be the first sign of gastric cancer

66
Q

Is the following statement true or false, and explain why?

“Carcinoma of the stomach readily spreads into duodenum than esophagus”

A

False, near the pyloric end of the stomach, the gastric lymph vessels fail to communicate with the duodenal lymph plexus due to the pyloric sphincter

67
Q

Lymphatic drainage of the gastro-esophageal junction

A

continous with those draining lower esophagus

68
Q

Lymphatics of other organs are important for draining the stomach during disease. What are these organs?

A

Liver and Pancreas

69
Q

Sympathetic supply of the stomach is derived from?

A

(T5) T6 to T10 (T12)

70
Q

Pain sensation from stomach

A
  1. Poorly localized pain
  2. pain referred to epigastric region
    • gastro-esophageal junction to lower retrosternal and subxiphoid areas
71
Q

Sympathetic nerve of Stomach

A
  • Postganglionic fibers reach peri-arterial coeliac plexus through greater and lesser splanchnic nn.
  • Additional innervation comes from hepatic plexus, which pass to upper body and fundus via lesser omentum
72
Q

Action of Sympathetic system on stomach

A
  • Inhibitorytogastricmusculature → suppress gastric motility
  • Motor to the pyloric sphincter → causes vasoconstriction, and constricts the pylorus
  • Main pathway for pain sensation → Afferent sensory pathways, including pain, travel with sympathetic efferentn n.
  • Vasomotor to the blood vessels
73
Q

Parasympathetic supply of the stomach is derived from?

A

Right and left vagus through esophageal plexus, coeliac plexus & gastric nerves

74
Q

Action of Parasympathetic System on Stomach

A
  • Motor to gastric musculature (increases peristalsis/gastric motility)
  • Inhibitory to the pyloric sphincter (relaxation)
  • Secretomotor to the glands of the stomach (increase gastric juice)
  • Vagus nn also carry sensations of pain, fullness, and nausea from stomach
75
Q

Where is the pyloric sphincter located?

A

1–2 cm to the right of midline in transpyloric plane (lower border of L1). [supine position + empty stomach]

76
Q

What marks the location of the pyloric sphincter?

A

Prepyloric vein, which crosses the anterior surface in a caudal direction

77
Q

What forms the pyloric sphincter?

A
  • Circumferential thickening of circular smooth mm
  • interlaced with CT septa and
  • some longitudinal mm fibers
78
Q

What are the four layers of the stomach?

A
  1. Mucosa
    • epithelium
    • lamina propria
    • muscularis mucosa
  2. Submucosa
  3. Muscularis externa
  4. Serosa
79
Q

Where are gastric glands located?

A

in LP

80
Q

What type of epithelium lines the stomach?

A

Simple columnar epithelium

81
Q

Surface mucous cells

A

apical cups of mucinogen granules

82
Q

Function of surface mucous cells

A

secretes thich, viscous alkaine, gel-like coat that adheres to the epithelial layer to protect it

83
Q

What makes the secretios of surface mucous cells alkaline?

A

High levels of Bicarbonate and Potassium

84
Q

What role does Prostaglandin have in protecting the gastric mucosa?

A
  1. Stimulate secretion of bicarbonates
  2. increase thickness of mucous layer with vasodilation in lamina propria.
  3. improves blood supply to any damaged area of gastric mucosa
85
Q

What can the stomach lining absorb?

A
  • Water
  • Salts
  • Alcohol
  • Lipid Soluble drugs
86
Q

How can drugs enter the lamina propria?

A

Drugs [aspirin, NSAIDs] damage the surface epithelium

87
Q

What are gastric pits?

A

Invaginations of th surface epithelium that extends to muscularis mucosa. The base of each pit recieves several gastric glands

88
Q

What are the 3 types of Gastric glands and how are they classified as?

A

Classified according to the region where its found

  1. Cardiac glands [cardia]
  2. Principal glands [fundus+body]
    1. Pyloric mucus-secreting glands [pylorus]
89
Q

Describe the appearance of Principal glands

A

flask shaped with short gastric pits, that are found in the fundus and body of the stomach

90
Q

What type of cells populate the principal cells?

A

digestive enzyme producing parietal and chief cells,

91
Q

Describe the appearance of pyloric mucus-secreting glands

A

small glands with long gastric pits that have convoluted tubes into base of deep gastric pits

92
Q

What type of cells populated the Pyloric mucus-secreting glands?

A

mucus-secreting cells but they also contain neuroendocrine cells, especially G cells (secrete gastrin) when activated by appropriate mechanical stimulation (causing increased gastric motility and secretion of gastric juices).

93
Q

Mucous neck cells

A
  • Cells that are shorter than surface cells and are typically mucus-secreting cells, displaying apical secretory vesicles, containing mucins, and basally displaced nuclei
  • Release of mucinogen granules is induced by vagal stimulation
94
Q

Where is the serosa absent?

A
  • At the attachment sites of the greater and lesser where peritoneal layers are separated by vessels and nerves.
  • Over a small superioposterior area near the cardiac orifice where the stomach is attached to the diaphragm via gastrophrenic and gastropancreatic folds.
95
Q

Epithelium of Serosa

A

Mesothelium [simple squaomous that secrete serous fluid]

96
Q

What three layers form the muscularis externa?

A
  1. Inner Oblique
  2. Middle Circular
  3. Outer Longitudinal
97
Q

Function of inner oblique layer of muscularis externa?

A

Works in unison with other layers to produce physical motion and contractions of the stomach required for digestion

98
Q

Function of middle circular layer of muscularis externa

A

plays an important role in forming the pyloric sphincter

99
Q

describe the changes of the muscularis externa in the different parts of the stomach

A
  • Cardia: 3 layers are well developed to create a sphincter to prevent acid reflux
  • Fundus: poorly developed [lot less churning in this region]
  • Pylorus: muscularis externa is well developed [to propel chyme into duodenum]
  • Body: all layers present except in the anterior and posterior part of stomach, where the longitudinal muscle is largely absent
100
Q

inner oblique muscle

A
  • arranged in ‘U’ shaped loops
  • Fails to reach the lesser curvature stomach due to cardiac notch
  • Contraction of right free margin of the oblique muscle decreases angle between stomach and esophagus → prevents reflux of gastric contents into esophagus
101
Q

Where is the myenteric (Auerbach’s) plexus located?

A

Within the muscularis externa

102
Q

myenteric (Auerbach’s) plexus

A

carries both sympathetic and parasympathetic fibers to smooth muscle layers

103
Q

What controle the activity of ICC?

A

Autonomic Nervous System

104
Q

Function of muscularis mucosa

A

help expel the secretions of the gastric glands into the stomach lumen.

105
Q

Layers of Muscularis mucosa

A

smooth muscle [inner circular and outer longitudinal layer]

106
Q

What is found within the Lamina Propria?

A

blood and lymphatic vessels, complex peri-glandular vascular plexus, and lymphoid tissue (gastric lymphatic follicles)

107
Q

Where is Meissner’s plexus found>

A

within the submucosa

108
Q

Submucosal (Meissner’s) plexus

A

Parasympathetic innervation

109
Q

Submucosa

A
  • durable, yet flexible and mobile
  • rich in vasculature and lymphatics
110
Q

Replacement period for different cells in the stomach

A
  • Surface and gastric pit cells turnover is 4 to 7 days
  • Typical replacement period for surface mucous cells is 3 days
  • Mucous neck cells is 1week.
111
Q

Where are stem cells located?

A

ituated in the isthmus of the gland and bases of gastric pits (transitional area between gastric glands and gastric pits)

112
Q

Where are chief cells located?

A

in deeper part of fundic glands

113
Q

What do chief cells secrete?

A

pepsinogen and gastric lipase

114
Q

Appearance of Chied cells

A
  • basophilic cuboidal cells with rounded and euchromatic nuclei
  • smaller than parietal cells
    • located basally
115
Q

What do Chief cells contain?

A

Contain secretory zymogen granules and their abundant cytoplasmic RNA renders them strongly basophilic.

116
Q

What do parietal cells secrete?

A

gastric acid [hydrocholic acid] and Intrinsic factor

117
Q

Changes of Parietal cells

A
  • precise structure of the cell varies with its secretory phase:
    • When stimulated, number and surface area of microvilli increase up to five-fold, probably as a result of the rapid fusion of the tubulovesicular system with the plasma membrane.
    • At the end of stimulated section this process is reversed, when the excess membrane retreats back into the tubulo-alveolar system and microvilli are lost.
118
Q

Appearance of Parietal cells

A
  • Are large, oval and strongly eosinophilic, and have centrally placed nuclei.
  • Occur intermittently along the walls of the more apical half of the gland but can reach as far as the isthmus;
  • Bulge laterally into the surrounding connective tissue
119
Q

structure of parietal cells

A
  • Luminal aspects: covered by plasma membraine rich in H+/K+ ATPase antiporter changes
120
Q

What enhances the secretion of hydrocholic acid?

A

Histamine + Gastrin produced by Enteroendocrine cells

121
Q

Where are enteroendocrine cells located?

A

Scattered throughout all types of gastric glands but more frequently in the body and fundus of the stomach

122
Q

Function of enteroendocrine cells

A

control of gut motility and glandular secretion.

123
Q

What are the different enteroendocrine cells of the stomach and what is their functions?

A
  • gastrin producing G cells (stimulate gastric acid secretion) ;
  • somatostatin producing D cells;
  • histamine producing ECL (enterochromaffin-like) cells;
  • Serotonin-producing enterochromaffin cells;
  • ghrelin-producing P/D(1)-type endocrine cells (stimulate growth hormone
  • secretion and also appetite and perception of hunger)

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