The stomach

Question 1

What are the four main anatomical divisions of the stomach?

Answer 1

Cardia
Fundus
Body
Pylorus

Question 2

Where is the Cardia of the stomach?

Answer 2

Surrounds superior opening of stomach

Vertebral level T11

Question 3

Where is the Fundus of the stomach?

Answer 3

Rounded portion at superior aspect of stomach - usually gas filled

Question 4

Where is the Body of the stomach?

Answer 4

Large central portion, inferior to fundus

Question 5

Where is the Pylorus of the stomach?

Answer 5

Connects stomach to the duodenum
Divided into antrum, canal and sphincter
Pyloric sphincter at transpyloric plane (L1)

Question 6

What is the blood supply to the greater curvature of the stomach?

Answer 6

Short gastric arteries

Right and Left gastro-omental arteries

Question 7

What is the blood supply to the lesser curvature of the stomach?

Answer 7

Left gastric artery

Right gastric branch of Hepatic artery

Question 8

What are the anatomical relations of the stomach?

Answer 8

Superior - oesophagus and diaphragm
Anterior - diaphragm, abdominal wall, left lobe of liver, gallbladder
Posterior - pancreas, left kidney, left adrenal gland, spleen, transverse mesocolon, splenic artery

Question 9

What vertebral level is the inferior oesophageal sphincter?

Answer 9

T11

Question 10

At what vertebral level does the oesophagus pass through the diaphragm?

Answer 10

T10

Question 11

What is the inferior oesophageal sphincter?

Answer 11

Physiological sphincter

Under involuntary control

Question 12

What is the pyloric sphincter?

Answer 12

Anatomical sphincter

Limits exit of chyme from stomach into duodenum through smooth muscle contractions

Question 13

What is the blood supply to the stomach?

Answer 13

Branches of coeliac trunk:
L gastric
Common Hepatic Artery (branches into R gastric and R gastro-omental)
Splenic Artery (branches into L gastro-omental)

Question 14

What is the venous drainage of the stomach?

Answer 14

R and L gastric veins drain into the hepatic portal vein.

Short gastric vein and L + R gastro-omental veins drain into the SMV

Question 15

What is the parasympathetic nerve supply to the stomach?

Answer 15

Vagus (CN X)

Question 16

What is the sympathetic nerve supply to the stomach?

Answer 16

T6-T9

Passes to coeliac plexus via greater splanchnic nerve

Question 17

What is the lymphatic drainage of the stomach?

Answer 17

Travel with arteries along greater and lesser curvatures
Drain into gastric and gastro-omental lymph nodes found at curvatures
Lymphatic vessels connect to Coeliac lymph nodes located on posterior abdmoinal wall.

Question 18

What are rugae?

Answer 18

Large temporary folds of the stomach mucosa

Question 19

What epithelium lines the stomach mucosa?

Answer 19

Non-ciliated simple columnar epithelium

Question 20

What cells are found in the gastric glands?

Answer 20

Simple columnar epithelium + 3 types of exocrine gland cells that secrete into lumen: 
Mucus neck cells (secrete mucus) 
Parietal cells (secrete HCl and IF) 
Chief cells (secrete Pepsinogen) 

+ G-Cells that secrete Gastrin directly into blood stream!

Question 21

What are the layers of the muscularis layer of the stomach from inside out?

Answer 21

Inner = oblique layer
Middle = circular layer
Outer = longitudinal layer

Question 22

What is the epiploic foramen?

Answer 22

A hole in the lesser omentum allowing for communication between the greater and lesser sacs

Question 23

What does the lesser omentum attach to?

Answer 23

Lesser curvature of stomach and duodenum and the posterior aspect of the liver (hepatoduodenal and hepatogastric ligaments)

Question 24

What does the greater omentum attach to?

Answer 24

The greater curvature of the stomach and the transverse colon (+ a free border anteriorly)
Gastrocolic ligament

Question 25

What are the subdivisions of the peritoneal cavity?

Answer 25

``` Greater sac (which is further divided into the supracolic and infracolic compartments by the transverse mesocolon) Lesser sac (omental bursa) ```

Question 26

Why is the peritoneal cavity referred to as 'potential space'?

Answer 26

Normally only filled with a thin layer of peritoneal fluid (function is lubrication, enabling free movement of viscera, and antibody movement to fight infection) - fluid in space can build up causing ascites (most commonly caused by portal hypertension but can also be due to infection, peritonitis, malignancy etc.)

Question 27

What is the clinical relevance of the paracolic gutters?

Answer 27

Infection spread between infracolic and supracolic compartments E.g. right subphrenic abscesses can be caused by appendicitis due to pus travelling up through paracolic gutter

Question 28

What separates the right and left subphrenic recesses?

Answer 28

Falciform ligament

Question 29

What organ and artery would be at risk of a gastric ulcer eroded posteriorly?

Answer 29

``` Pancreas Splenic artery (runs superiorly to pancreas) ```