Stomach and Pylorus Flashcards
Stomach blood supply
Vast blood supply. Off the celiac aa.
Venous drainage from gastroduodenal and splenic
Stomach anatomy
Submucosa is the critical holding layer.
Antrum- mucus glands.
Body and fundus- Parietal, Chief, and enteroendocrone.
Basics of gastric surgery
Seromuscularis can be pinched and elevated
Large incision. Use balfour retractors.
Minimize contamination. Pack off the stomach. Use stay sutures. Stay sutures to hold the stomach.
Gastric closure
Double layer. Must incorporate submucosa. Double layer inverting or appositional followed by inverting.
First line: hemostasis of mucosa/submucosa. Second line: security for gastric content leakage. PDS, Maxon, Monocryl
Gastric Healing
Enhancement by redundant blood supply and additional collagen production. Superficial injuries- epithelialization. Ulcer- scar or perforation (when penetrates to the submucosa). Surgical- no scars and normal phases of healing.
Gastrotomy
Pack off the stomach- stay sutures. Make incision halfway between greater and lesser curvature to avoid vasculature. Pinch seromuscularis.
Obstructions are often at the level of the pylorus.
Partial gastrectomy
ID viable tissue (no purple green, grey. Very thin, no peristalisis, no bleeding)
Pyloric stenosis
Vomiting partially digested food several hours after eating. No apparent nausea, will resume eating. Chronic presentation. Pylorotomy and pyloroplasty techniques to relieve gastric outflow obstruction
Pyloro-myotomy (Fredet-Ramstedt)
seromuscularis incised to let submucosa bulge out. Hypertrophy/ neoplasia has to be localized to serosa and muscularis to allow bulging. Can’t take full thickness biopsies.
Pyloroplasty
Full thickness biopsy. Ventral pylorus, 2-3cm aboral/oral. Widen the lumen by cutting transverse
Y-U pyloroplasty
Suture to make it wide. Full thickness biopsy
