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stomach Flashcards

1
Q

describe the stomach?

A

most dilated part of the digestive tube

intervenes between the esophagus and duodenum

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2
Q

describe the location of the stomach?

A

occupies the epigastric , left hypochondriac and umbilical region

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3
Q

what are the curvatures of the stomach?

A

lesser curvature —> right side

greater curvature —-> left side of the stomach

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4
Q

what are the parts of the stomach?

A

fundus

cardia

body

pylorus

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5
Q

what is the shape of the stomach?

A

cadaver ———–> sickle shaped

living ——-> J shaped

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6
Q

what are the 3 clinical shapes of the stomach?

A

sthenic /normal

hypersthenic

hyposthenic

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7
Q

describe the sthenic/normal shape of the stomach?

A

longer limb of J is slightly oblique

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8
Q

describe hypersthenic shape of stomach?

A

J is very oblique

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8
Q

what could happen in hyperthenic stomach?

A

stomach is oblique —–> duodenum is prone to ulcer

because most of the stomach content will be in the duodenum

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9
Q

describe hyposthenic?

A

J is almost vertical

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10
Q

what could hyposthenic lead to?

A

gastric ulcer —> cuz the gastric content will settle in the body of the stomach

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11
Q

what are the 2 orifices of the stomach?

A

cardiac

pyloric

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12
Q

what are the 2 surfaces of the stomach?

A

antero superior

psotero inferior

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13
Q

what are the 3 subdivision ?

A

fundus

body

pyloric

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14
Q

describe the fundus of the stomach?

A

part above the level of the esophageal opening

Air in the fundus can be seen in a plain X-ray film below the left dome of the diaphragm

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15
Q

what is the angular notch ?

A

most dependent part of the lesser curvature

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16
Q

what is the extension of the pyloric part?

A

extends from the angular notch to the pyloric sphincter which separates the stomach from the duodenum

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17
Q

what are the division of the pyloric part?

A

proximal dilated pyloric antrum

distal tubular pyloric canal

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18
Q

what is the pyloric sphincter ?

A

thickening of the circular muscles coat of the stomach ( anatomical sphincter )

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19
Q

what is the locations of pyloric sphincter?

A

usually located at trans pyloric plane

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20
Q

what is the function of pyloric sphincter ?

A

regulates the flow of material between the stomach and duodenum through pyloric orifice

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21
Q

what is the hypertrophic pyloric stenosis ?

A

congenital defect with neuromuscular incoordination of the thickened pyloric sphincter

result in food being stuck in the stomach

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22
Q

what are the attachment on the greater curvature?

A

gastro phrenic ligament

gastro splenic ligament

Gastro colonic ligament

Anterior 2 layers of greater omentum

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23
Q

what are the attachments given by the lesser omentum?

A

hepatogastric ligament

hepatduodenal ligament

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24
what behind the greater omentum?
greater sac
25
what behind the lesser omentum ?
lesser sac
26
describe the development of the lesser sac?
the primitive stomach rotates so that its left surface becomes anterior thus creating a diverticulum in the peritoneal cavity ( lesser sac ) the left surfaces moves to the anterior side and becomes to the anterior surface and becomes greater omentum
27
what are the anterior superior relations of the stomach?
covered by peritoneum left lobe of liver diaphragm intermediate triangular part : ant abdominal wall
28
what is the gastric triangle ?
a triangle between stomach and liver that is only covered by skin fascia and muscles Directly lead to the stomach
29
what are the boundaries of the triangle ?
right side -----> lower border of the liver left side -----> left costal margin below it -------> transverse colon
30
what are the uses of the gastric triangle?
in cases of complete esophageal obstruction it can be used for : gastrostomy tube Triangle Feeding
31
what are the structure on the postero inferior surface of the stomach forming the bed of the stomach?
left kidney left suprarenal artery spleen Splenic artery body of pancreas transverse colon transverse mesocolon left colic flexure left crus of the diaphragm
32
what covers the posterior inferior surface of the stomach?
peritoneum of the lesser sac EXCEPT THE BARE AREA
33
what is the bare area ?
area of the stomach not covered by peritoneum ( along the greater curvature )
34
what could happen in pancreatitis?
posterior wall of the stomach may adhere to the posterior wall of the lesser sac that covers the pancreas ( omental bursa )
35
what is the epiploic foreman?
part of the lesser omentum that leads to the lesser sac behind
36
what lines the interior of the stomach?
Rugae --> longitudinal folds of mucous membrane
37
what is the gastric canal?
the rugae are arranged in a oblique coat along the lesser curvature creating a channel / canal
38
what runs in this gastric canal?
fluid runs along this canal quicker than solids
39
why is the gastric canal more prone for ulcers?
because fluid pass through it like alcohol ---> denudation of mucous due to alcohol irritants
40
the peritoneum covers the stomach everywhere except in ?
bare area ---> behind the cardiac end in relation to left crus ; left suprarenal and left gastric artery Along the lesser curvature ---> cuz lesser omentum Along the greater curvature cuz greater omentum
41
what is the arterial supply?
celiac trunk
42
what are the branches from the celiac trunk that supply the stomach?
left gastric Right gastric Short gastric left gastro epiploic right gastro epiploic posterior gastric
43
what are 3 main branches of celiac trunk?
left epigastric common hepatic splenic --> spiral around
44
what branches does the splenic artery give ?and where is the location?
short gastric arteries left gastroepiploic ----> at greater curvature
45
what are the branches of common hepatic artery?
gastroduodenal artery right gastric artery
46
what are the branches of gastroduodenal artery ?
right gastroepiploic
47
what are the anastomosis that happen between those arteries?
right gastric and left gastric at the lesser curvature left gastroepiploic and right gastroepiploic at the greater curvature
48
what is the venous drainage of stomach?
corresponding arteries drain into corresponding veins Drain into portal vein
49
where does the portal vein ascend ?
the free edge of the lesser omentum to the porta hepatis ----> divides into right and left branches
50
what is the situation of the portal vein in the lesser omentum?
behind hepatic artery on the left ( left to it ) Bile duct on the right of portal vein
51
what separates the inferior vena cava from the portal vein?
opening into omental bursa
52
what is the lymphatic drainage of stomach?
3 sets of inter communicating plexus : sub mucous inter muscular sub serous
53
where do the lymph vessels anastomose ?
anastomose freely in the stomach wall
54
why it is impossible to remove all lymph nodes?
because theres extensive lymph drainage
55
what is the final destination of the lymph?
coeliac nodes
56
what is the local spread in cases of carcinoma?
local spread --> affect adjacent anterior and posterior relations
57
what is the lymphatic spread in cases of carcinoma?
celiac nodes ( pre aortic nodes )--> around the stem of the celiac trunk after passing through various outlying groups : gastric ( along the lesser curvature ) , splenic, pancreatico splenic, gastroepiploic, pyloric groups Left supraclavicular lymph nodes ---> cuz celiac nodes and cristerna chyli and thoracic duct and venous circulation at the left venous angle , because the backflow of lymph from the thoracic duct , lymph can pass into nearby supraclavicular nodes ( virchow node ) and thoracic duct ( troisers sign )
58
what is the hematogenous spread of carcinoma?
it spreads to the liver because veins draining the stomach ultimately drain into portal circulation
59
what is the ovarian metastasis in cases of carcinoma?
route of metastasis to ovaries has been a mystery one theory assume direct seeding across the peritoneal cavity. the other theory is the retrograde lymphatic spread
60
what is the nerve supply of the stomach?
parasympathetic
61
describe the parasympathetic supply of the stomach?
anterior and posterior vagal trunks enter the abdomen through the esophageal hiatus preganglionic fibers synapse in ganglia lying in the wall of the viscera
62
what is the function of parasympathetic system on stomach?
motor to the smooth muscle of the wall of the abdominal viscera to increase motility secretomotor to the glands of the stomach inhibitory to the sphincter ( Rest and digest )
63
where does the anterior vagal trunk come from and where it runs?
left vagus runs towards the lesser curvature
64
what are the branches of the anterior vagal trunk?
several gastric branches which supply the fundus and body one large branch ---> anterior nerve of latarget hepatic branch
65
what does the anterior nerve of latarget supply?
pyloric region
66
where does the posterior vagal trunk come from and where it runs?
right vagus runs towards the lesser curvature
67
what are the branches of the posterior vagal trunk?
several gastric branches which supply the fundus and body. one large branch ---> posterior nerve or latarget celiac branch to the celiac plexus
68
what does the posterior nerve of latarget supply?
pyloric antrum ( NOT THE SPHINCTER)
69
what is the benefit of vagotomy?
was used to reduce acid production and improves peptic ulcer
70
what is truncal vagotomy?
cutting the trunks at the level of the abdominal esophagus
71
what is selective vagotomy ?
vagal trunks are cut distal to the hepatic branch of anteiror vagus and celiacbranch of posteior vagus
72
what is highly selective vagotomy?
aka parietal cell vagotomy only branches to the fundus and body are cut --> leaving the antral and pyloric branches intact
73
where do the preganglionic fibers of sympathetic nervous system come from?
T5-T9 segments of spinal cord via greater and lesser splanchnic nerves , celiac and hepatic plexus
74
from where does the postganglionic fibers come from?
ganglion to the viscera
75
what is the function of sympathetic nervous system on stomach?
vasoconstriction motor to pyloric sphincter inhibit peristalsis ( decreasing motility ) pain leading to guarding
76
how does the pain signals come from the stomach?
sensory sympathetic fibers
77
from where do the sensory sympathetic fibers come from?
cell bodies located in dorsal root ganglia of T6 and T9 Also explain why the pain from gastric ulcer is sometimes felt in the epigastric region due to same segmental supply of somatic and autonomic nerves and it is on the same dermatome NOTE : PAIN SINGALS TRAVEL IN POSTERIOR HORN
78
what is gastroscopy?
inside of esophagus and stomach and duodenum are visualized directly by a gastroscope and biopsy may be taken
79
why does the carcinoma of stomach spread to the esophagus easier?
cuz no sphincter or muscles to block

ANATOMYY2S2 (19 decks)

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