The Stomach and Spleen

Question 1

Is the stomach intra- or retro-peritoneal?

Answer 1

Intra-peritoneal, although its oesophageal and pyloric ends are relatively fixed.

Question 2

What type of epithelium does the oesophagus have?

Answer 2

Stratified squamous.

Question 3

What is the name of the part of the stomach which receives the oesophagus?

What does the epithelium change to at this region?

Answer 3

The cardial notch.

Simple columnar.

Question 4

What is the name of the section of stomach leading up to the pyloric sphincter?

Answer 4

The pyloric antrum/pylorus.

Question 5

What is the name of the prominent bend in the stomach in the lesser curvature in the pylorus area?

Answer 5

The incisura angularis.

Question 6

What are the X4 layers of the GI tract?

In which layer are each of the X2 parts of the enteric nervous system found?

Answer 6

(1) Mucosa
- epithelium
- lamina propria
- muscularis mucosa

(2) Submucosa
- contains MEISSNER’S plexus

(3) Muscularis externa
- contains AUERBACH’S plexus
- has a outer longitudinal (thin) layer and an inner circular (thick) layer

NB: stomach has a 3rd layer of muscle = inner oblique layer

(4) Adventitia or Serosa
- extrinsic nerves/blood vessels

Question 7

What are the folds in the lining of the stomach called?

Answer 7

Rugae.

Question 8

Which great vessels travel posteriorly to the stomach and which artery and vein (which are branches of the previously mentioned great vessels) travel posteriorly to the stomach but move anteriorly across the duodenum?

Answer 8

The abdominal aorta and the inferior vena cava.

The superior mesenteric artery and vein.

Question 9

Which group of vessels birfurcate from the aorta close to the incisura angularis?

Answer 9

The coeliac trunk.

Question 10

Which X3 vessels does the coeliac trunk birfurcate into?

Answer 10

(1) Left gastric artery
(2) Common hepatic artery
(3) Splenic artery

Question 11

What is the journey of the left gastric artery?

Answer 11

It bifurcates off of the coeliac trunk, travels superiorly (briefly) to the oesophagus then follows the left side of the lesser curvature of the stomach where it connects with the right gastric artery (which is a branch of the proper hepatic artery, ITSELF a branch of the common hepatic artery).

Question 12

What is the journey of the splenic artery and what branches does it give off?

Answer 12

It leaves the coeliac trunk and travels left, following the superior boarder of the pancreas.

It gives off the left gastroepiploic artery which anastomoses with the right midway across the greater curvature of the stomach.

Question 13

What does the common hepatic artery birfurcate into?

Answer 13

(1) proper hepatic artery = which itself gives rise to the right gastric artery
(2) gastroduodenal artery = travels behind the stomach and downwards to the duodenum, giving off the right gastroepiploic artery in the process.

Question 15

Which great vein do the foregut structures eventually drain into?

What venous system is this?

Answer 15

The portal vein (the hepatic portal system) to be taken into the liver and eventually the IVC.

Question 16

Which vein/system do the plexus of veins at the gastroesophageal junction drain into?

Where does this vein itself drain into?

Answer 16

The azygos vein, which connects to the SUPERIOR vena cava.

Question 17

What are the X5 main groups of lymph nodes around the stomach called?

Answer 17

NB: think of interactions of the stomach with surrounding structures, link their names together and work your way around the stomach clockwise.

• Right gastric
• Left gastric
• Pancreaticolienal
• Pyloric
• Right gastro-omental

Question 18

Where do the all the lymph nodes surrounding the stomach drain into?

Describe their journey from these nodes back to the venous system.

Answer 18

All nodes drain to —> coeliac trunk (pre-aortic) —> CISTERNS CHYLI —> thoracic duct —> left lympho-venous portal.

Question 19

What do the gastroepiploic arteries supply?

Where do the right and left gastroepiploic come from respectively?

Answer 19

The greater curvature of the stomach.

They also give branches to supply the greater omentum.

Right gastroepiploic = comes from the gastroduodenal, ITSELF coming from the common hepatic artery of the coeliac trunk.

Left gastroepiploic = comes from the splenic artery, ITSELF a branch of the coeliac trunk.

Question 20

What is the main parasympathetic nerve supply to the GI tract up until the point of the splenic flexure?

Answer 20

The vagus nerve

Question 21

What does the vagus do when it reached the stomach?

Answer 21

The right and left vagus are directed onto the oesophagus to form an oesophageal plexus

They then travel anteriorly and posteriorly to supply the front and back of structures

Question 22

What is the sympathetic nerve supply of the stomach?

Answer 22

Via the greater splanchnic nerves (T6-T9) which for a coeliac plexus (around the coeliac trunk)

Question 23

Between what ribs is the spleen positioned?

Answer 23

Between the 9th and 11th

Question 24

What are the different ‘surfaces’ of the spleen, which are the areas where the areas which are in contact with other organs?

Answer 24

1) gastric
2) renal
3) colic (from splenic flexure of colon)

Question 25

What are the X2 splenic ligaments acting as mesenteries and what does each attach to?

Answer 25

1) gastrosplenic ligament = spleen to stomach

2) splenorenal ligament = spleen to kidney