Stomach Flashcards
What level is the cardiac orifice
T11, 2.5cm to the left of the midline, 40cm from the incision teeth
Pyloric orgicie
Lower part of L1 (transpyloric plane), is 1.25cm to the righ of the midline
Pre pyloric vein lies in front of it
Where is fundus
Extends above up to 5th ICS
Where is the stomach covered in peritoneum
The stomach is covered by peritoneum except along lesser and greater curvatures where blood vessels run and a small small area posteriorly near the cardiac orifice. This is known as bare area of the stomach and it is directly related to the left crus of the diaphragm.
What are the peritoneal folds extending from the lesser and greater curvatures?
Lesser omentum extends from the lesser curvature of the stomach to the liver.
Greater omentum hangs dorn in the abdominal cavity from lower two-third of the greater curvature.
Gastrosplenic ligament extends from the upper one-third of the greatercurvatureto the hilum of spleen
Gastrophrenic ligament extends from the uppermost part of the greater curvature to the diaphragm.
What is in the lesser omentum in the lesser curvature of the stomach
Left gastric vessels
Right gastric vessels
Right and left gastric group of lymph nodes
Branches of gastric nerves
What is in the free margin of lesser omentum
Hepatic artery proper
Portal vein
Bile duct
Arterial supply of stomach
Arteries along the lesser curvature are:
Left gastric (from celiac trunk)
Right gastric (from hepatic artery, branch of celiac trunk)
Arteries along the greater curvature:
Short gastric arteries (from splenic artery, branch of celiac trunk)
Left gastroepiploic artery (from splenic artery, branch of celiac trunk)
Right gastroepiploic artery (from gastroduodenal, branch of hepatic which is a branch of celiac trunk)
Venous drainage of the stomach
All the veins drain directly or indirectly into portal vein.
Right and left gastric veins – into portal vein
Short gastric and left gastroepiploic veins – splenic vein
Right gastroepiploic vein – superior mesenteric vein
Pre-pyloric vein – right gastric vein
Drainage of stomach
Right part is further divided into upper 2/3rd and lower 1/3rd.
Left part is divided onto upper 1/3rd and lower 2/3rd .
The lymphatics from the above mentioned region drains into the following lymph nodes
Para cardiac lymph nodes: Cardiac end and the adjoining area.
Left gastric lymph nodes – Upper 2/3rd of right 1/3rd of stomach.
Right gastric lymph nodes – Lower 1/3rd of right 1/3rd of stomach.
Pancreatico-splenic lymph nodes: Upper left 1/3rd of stomach.
Right gastroepiploic lymph nodes – Lower left 2/3rd of stomach.
Pyloric and hepatic lymph nodes – Pyloric part of stomach.
Efferents from all the above lymph nodes terminate into celiac group of pre-aortic nodes. From the coeliac lymph nodes to cysterna chyli and then to thoracic duct.
What is posterior to the stomach
Diaphragm
Left suprarenal gland
Left kidney
Splenic artery
Pancreas
Transverse colon
Splenic flexure of colon
Spleen
Innervation of stomach - sympathetic
Preganglionic fibers Arise from T6-T10 spinal segment ( reach coelic ganglion via greater splanchnic nerves)
Postganglionic fibers Arise from coeliac ganglia.
Vasometer, motor to pyloric sphincter, inhibitor to the rest of the musculature, pain sesnation
Parasympathetic innervation to stomach
Pre-ganglionic: Arise from left and right vagus
Post: Arise from ganglion in submucosal and myentric plexuses.
Secremotor, inhibitor to pyloric sphincter, motor to musculature
Why is gastric canal common site for peptic ulcer
The mucosal folds (rugae) are arranged longitudinally on either side of the lesser curvature to form the canal which allows rapid passage of fluids along the lesser curvature and as a result this area is irritated most by the swallowed liquids.
Submucosal plexus is absent along the lesser curvature. Mucosal arteries arise from intramuscular plexus.
Occlusion of these may produce ischemia and is thought to be one of the reason for frequent occurrence of peptic ulcers along the lesser curvature.
More number of secretomotor supply from vagal trunks, which run along lesser curvature.
explain the malignancy trend
Malignancy from stomach usually spreads to oesophagus but not to duodenum because at the cardiac end the gastric lymph vessels are connected to the lymphatic vessels of oesophagus, whereas at the pyloric end the lymphatics are not continuous with the lymphatics of duodenum due to the presence of connective tissue septum in the submucosa of pyloric end.
