stomach Flashcards
describe the stomach?
most dilated part of the digestive tube
intervenes between the esophagus and duodenum
describe the location of the stomach?
occupies the epigastric , left hypochondriac and umbilical region
what are the curvatures of the stomach?
lesser curvature —> right side
greater curvature —-> left side of the stomach
what are the parts of the stomach?
fundus
cardia
body
pylorus
what is the shape of the stomach?
cadaver ———–> sickle shaped
living ——-> J shaped
what are the 3 clinical shapes of the stomach?
sthenic /normal
hypersthenic
hyposthenic
describe the sthenic/normal shape of the stomach?
longer limb of J is slightly oblique
describe hypersthenic shape of stomach?
J is very oblique
what could happen in hyperthenic stomach?
stomach is oblique —–> duodenum is prone to ulcer
because most of the stomach content will be in the duodenum
describe hyposthenic?
J is almost vertical
what could hyposthenic lead to?
gastric ulcer —> cuz the gastric content will settle in the body of the stomach
what are the 2 orifices of the stomach?
cardiac
pyloric
what are the 2 surfaces of the stomach?
antero superior
psotero inferior
what are the 3 subdivision ?
fundus
body
pyloric
describe the fundus of the stomach?
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
what is the angular notch ?
most dependent part of the lesser curvature
what is the extension of the pyloric part?
extends from the angular notch to the pyloric sphincter which separates the stomach from the duodenum
what are the division of the pyloric part?
proximal dilated pyloric antrum
distal tubular pyloric canal
what is the pyloric sphincter ?
thickening of the circular muscles coat of the stomach ( anatomical sphincter )
what is the locations of pyloric sphincter?
usually located at trans pyloric plane
what is the function of pyloric sphincter ?
regulates the flow of material between the stomach and duodenum through pyloric orifice
what is the hypertrophic pyloric stenosis ?
congenital defect with neuromuscular incoordination of the thickened pyloric sphincter
result in food being stuck in the stomach
what are the attachment on the greater curvature?
gastro phrenic ligament
gastro splenic ligament
Gastro colonic ligament
Anterior 2 layers of greater omentum
what are the attachments given by the lesser omentum?
hepatogastric ligament
hepatduodenal ligament
what behind the greater omentum?
greater sac
what behind the lesser omentum ?
lesser sac
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
what are the anterior superior relations of the stomach?
covered by peritoneum
left lobe of liver
diaphragm
intermediate triangular part : ant abdominal wall
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
what are the boundaries of the triangle ?
right side —–> lower border of the liver
left side —–> left costal margin
below it ——-> transverse colon
what are the uses of the gastric triangle?
in cases of complete esophageal obstruction it can be used for :
gastrostomy
tube
Triangle
Feeding
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
what covers the posterior inferior surface of the stomach?
peritoneum of the lesser sac EXCEPT THE BARE AREA
what is the bare area ?
area of the stomach not covered by peritoneum ( along the greater curvature )
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 )
what is the epiploic foreman?
part of the lesser omentum that leads to the lesser sac behind
what lines the interior of the stomach?
Rugae –> longitudinal folds of mucous membrane
what is the gastric canal?
the rugae are arranged in a oblique coat along the lesser curvature creating a channel / canal
what runs in this gastric canal?
fluid runs along this canal quicker than solids
why is the gastric canal more prone for ulcers?
because fluid pass through it like alcohol —> denudation of mucous due to alcohol irritants
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
what is the arterial supply?
celiac trunk
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
what are 3 main branches of celiac trunk?
left epigastric
common hepatic
splenic –> spiral around
what branches does the splenic artery give ?and where is the location?
short gastric arteries
left gastroepiploic —-> at greater curvature
what are the branches of common hepatic artery?
gastroduodenal artery
right gastric artery
what are the branches of gastroduodenal artery ?
right gastroepiploic
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
what is the venous drainage of stomach?
corresponding arteries drain into corresponding veins
Drain into portal vein
where does the portal vein ascend ?
the free edge of the lesser omentum to the porta hepatis —-> divides into right and left branches
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
what separates the inferior vena cava from the portal vein?
opening into omental bursa
what is the lymphatic drainage of stomach?
3 sets of inter communicating plexus :
sub mucous
inter muscular
sub serous
where do the lymph vessels anastomose ?
anastomose freely in the stomach wall
why it is impossible to remove all lymph nodes?
because theres extensive lymph drainage
what is the final destination of the lymph?
coeliac nodes
what is the local spread in cases of carcinoma?
local spread –> affect adjacent anterior and posterior relations
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 )
what is the hematogenous spread of carcinoma?
it spreads to the liver because veins draining the stomach ultimately drain into portal circulation
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
what is the nerve supply of the stomach?
parasympathetic
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
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 )
where does the anterior vagal trunk come from and where it runs?
left vagus
runs towards the lesser curvature
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
what does the anterior nerve of latarget supply?
pyloric region
where does the posterior vagal trunk come from and where it runs?
right vagus
runs towards the lesser curvature
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
what does the posterior nerve of latarget supply?
pyloric antrum ( NOT THE SPHINCTER)
what is the benefit of vagotomy?
was used to reduce acid production and improves peptic ulcer
what is truncal vagotomy?
cutting the trunks at the level of the abdominal esophagus
what is selective vagotomy ?
vagal trunks are cut distal to the hepatic branch of anteiror vagus and celiacbranch of posteior vagus
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
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
from where does the postganglionic fibers come from?
ganglion to the viscera
what is the function of sympathetic nervous system on stomach?
vasoconstriction
motor to pyloric sphincter
inhibit peristalsis ( decreasing motility )
pain leading to guarding
how does the pain signals come from the stomach?
sensory sympathetic fibers
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
what is gastroscopy?
inside of esophagus and stomach and duodenum are visualized directly by a gastroscope and biopsy may be taken
why does the carcinoma of stomach spread to the esophagus easier?
cuz no sphincter or muscles to block
