Stomach, Duodenum, Coeliac Trunk

Question 1

What structure connects the liver to the stomach?

Answer 1

The lesser Omentum

Question 2

What are the inlet and the outlet of the stomach refered to as?

Answer 2

Inlet = gastro-oesophageal junction

Outlet = pylorus (transpyloric plane- L1)

Question 3

What is the rule of 2s for the stomach?

Answer 3

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

Question 4

Name the regions of the stomach

Answer 4

cardia - surrounds the GO sphincter

fundus - at the top where air rises to

body

antrum

pylorus

incisura = crease above pyloris

Question 5

What are the three muscle layers of the stomach?

Answer 5

outer = longitudinal

inner = circular

innermost = oblique = collar at OG junction

Question 6

What are the mucosa layers of the stomach?

Answer 6

Nodules

rugae - trap food for further digestion

Magenstrasse= longitudinal folds for liquids to pass through

Question 7

Identify the blood supply to the stomach

Answer 7

*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

Question 8

Describe the lymph drainage to the stomach

Answer 8

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*

Question 9

Describe the innervation of the stomach

Answer 9

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

Question 10

What are the relations of other structures to the stomach?

Answer 10

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*

Question 11

What is the epiploic foramen of Winslow?

Answer 11

It is the entrance to the lesser sac

Question 12

What are the borders to the epiploic foramen of Winslow?

Answer 12

Superiorly = caudate lobe of liver

posteriorly = IVC

inferior = duodenum

anteriorly = free edge of lesser omentum

Question 13

What does the epiploic foramen of winslow contain?

Answer 13

portal vein posteriorly

common bile duct (right anterior)

hepatic artery (left anterior)

Question 14

What manoeuvre do we use to sqeeze the hepatic artery, common bile duct, and the portal vein?

Answer 14

Pringles maneuvre - used during surgery - stops blood flow to the liver temporarily

Question 15

What are the layers of the duodenum?

Answer 15

Longitudinal muscle layer - external

circular muscle layer - intermediate

duodenal glands = most interior

Question 16

What structure indicates we have moved from the first part of the duodenum into the second part?

Answer 16

The ampulla of vader = where the bile duct and the pancreatic duct enter the duodenum

Question 17

What are the relations of the duodenum to other structures?

Answer 17

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

Question 18

describe the blood supply to the duodenum

Answer 18

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.