Stomach, Duodenum, Coeliac Trunk Flashcards
What structure connects the liver to the stomach?
The lesser Omentum
What are the inlet and the outlet of the stomach refered to as?
Inlet = gastro-oesophageal junction
Outlet = pylorus (transpyloric plane- L1)
What is the rule of 2s for the stomach?
2 openings - gastro-oesophageal + pyloric
2 curvatures- greater and lesser
2 omenta - lesser and greater
2 ligaments -gastrosplenic and gastrophrenic
2 surfaces- ant. and post.
2 nerves- right and left vagus nerves
Name the regions of the stomach
cardia - surrounds the GO sphincter
fundus - at the top where air rises to
body
antrum
pylorus
incisura = crease above pyloris
What are the three muscle layers of the stomach?
outer = longitudinal
inner = circular
innermost = oblique = collar at OG junction
What are the mucosa layers of the stomach?
Nodules
rugae - trap food for further digestion
Magenstrasse= longitudinal folds for liquids to pass through
Identify the blood supply to the stomach
*all of the blood to the stomach comes from the caeliac trunk at T12 just below the diaphragm*
left gastric- left side lesser curve.
right gastric - right side of lesser curve
left gastro-epiploic - left side of greater curve
right gastro-epiploic - right side of greater curve
short gastric branches - come from splenic art. supply the fundus
Describe the lymph drainage to the stomach
Coeliac nodes
superior 2/3 of stomach = coeliac + gastric arteries
Inferior 1/3 of stomach = Right gastroepiploic nodes
*Troisier’s sign (virchow’s node) - is indicative of duodenal/stomach cancer*
Describe the innervation of the stomach
Sympathetics from the coeliac plexus -
parasympathetics from vagus nerves (ant. and post. along lesser curvature)- the parasympathetic nerves are responsible for gut motility and acid secretions of the stomach
What are the relations of other structures to the stomach?
Anterior = abdominal wall, costal margin, diaphragm, left lobe of liver
posterior = lesser sac, pancreas, splenic artery, spleen, left kidney, and adrenal gland, transverse mesocolon
*posterior erosion of stomach ulcer could rupture splenic artery*
What is the epiploic foramen of Winslow?
It is the entrance to the lesser sac
What are the borders to the epiploic foramen of Winslow?
Superiorly = caudate lobe of liver
posteriorly = IVC
inferior = duodenum
anteriorly = free edge of lesser omentum
What does the epiploic foramen of winslow contain?
portal vein posteriorly
common bile duct (right anterior)
hepatic artery (left anterior)
What manoeuvre do we use to sqeeze the hepatic artery, common bile duct, and the portal vein?
Pringles maneuvre - used during surgery - stops blood flow to the liver temporarily
What are the layers of the duodenum?
Longitudinal muscle layer - external
circular muscle layer - intermediate
duodenal glands = most interior
What structure indicates we have moved from the first part of the duodenum into the second part?
The ampulla of vader = where the bile duct and the pancreatic duct enter the duodenum
What are the relations of the duodenum to other structures?
1st part- Ant= liver, gall bladder
post= portal vein, CBD, gastroduodenal artery
2nd part - Ant= transverse colon
post = right kidney, ureter
3rd part - ant= root of mesentery
post = IVC and aorta
describe the blood supply to the duodenum
The duodenum receives arterial blood from two different sources. The transition between these sources is important as it demarcates the foregut from the midgut. Proximal to the 2nd part of the duodenum (approximately at the major duodenal papilla – where the bile duct enters) the arterial supply is from the gastroduodenal artery and its branch the superior pancreaticoduodenal artery. Distal to this point (the midgut) the arterial supply is from the superior mesenteric artery (SMA), and its branch the inferior pancreaticoduodenal artery supplies the 3rd and 4th sections.
