The document discusses the anatomy, blood supply, histology, and physiology of the stomach and duodenum, describing their locations, structures like the gastric glands and layers, innervation by the sympathetic and parasympathetic nervous systems, and secretions including hydrochloric acid and intrinsic factor. Key aspects covered include the divisions of the stomach, its blood supply from the celiac trunk, and how gastric acid secretion is stimulated by foods in the stomach and inhibited by foods entering the duodenum.

1. Stomach and duodenum Surgery
Dr. Sherzad Hasand MD, MS
Dept. of Surgery
Shaikh zayed University

2. Introduction
 The stomach is a remarkable organ with
important digestive, nutritional, and endocrine
functions.
 Located between esophagus and small
intestine.

3.  Appears in week 5.
 A pliable, saccular organ.
 Located in the LUQ and epigastrium.
 Separated from the GI tract (2 locations).
(Lower Esophageal Sphincter - Pyloric Sphincter)

4. Gastric Anatomy
Two borders:
 Greater curvature
 Lesser curvature
Foure regions:
 Cardia
 Fundus
 Body
 Antrum
 Pylorus

5. From surgeon’s point of view:
Proximal gastric unit
 Distal esophagus, cardia, fundus, body
Distal gastric unit
 Gastric antrum, pylorus, 1st part of
duodenum

7. Gastric blood supply
Celiac trunk:
Arises from aorta at T12
1. Left Gastric Artery
Esophageal Branch
Gastric Branch
2. Common Hepatic Artery
Proper Hepatic Artery
Right Gastric Artery
Gastroduodenal Artery Right Gastroepiploic
Art
3. Splenic Artery
Left Gastroepiploic Artery
Short Gastric Artery

8. Gastric blood supply

9. Gastric Nerve Supply
 Extrinsic:
Sympathetic
Reduces Motility, Contracts Sphincters, Inhibits
Secretions
Parasympathetic
Increase Motility, Secretions, Relaxation of sphincters
 Intrinsic:
Auerback (Myenteric)
Motility
Meissner’s Plexus (Submucosal)
Secretory function

10. Extrinsic supply

11. Intrinsic Supply

12. Gastric Histology
 Mucosa
 Submucosa
Collagen layer, Strongest layer
Submucosal Plexus(Meissner’s)
 Muscularis
Outter longitudinal, middle circular, inner
oblique
Auerback Plexus
 Serosa
Visceral Peritoneum

14.  Mucosa
◦ Epithelium, lamina propria
◦ Simple columnar epithelium composed of mucous
cells
◦ Gastric pits lead into gastric glands

15. Gastric Physiology
Gastric Glands:
Cardia:
Mostly mucus secreting Goblet cells
Fundus and body:
Parietal cells (HCl, Intrinsic factor) and Chief cells
(Pepsinogen)
Pylorus and antrum:
G-cell (Gastrin), D-cells (Somatostatin), Entero-chromaffin
(Histamine), endocrine cells (Ghrelin-hunger hormone)
Surface Epithelial cells: Mucus, Bicarb, Prostaglandin

16. (b) Enlarged view of gastric pits and gastric glands
Mucous neck cells
Parietal cell
Surface epithelium
(mucous cells)
Gastric pits
Chief cell
Enteroendocrine cell
Gastric
pit
Gastric
gland

17. Secretions in Stomach

18. Acid Stimulation and Inhibition
 Cephalic phase:
Sight, Smell, Thought, Taste
Cortex and hypothalamus Vagus nerve
20%-30% of HCl
 Gastric Phase:
Presence of food in stomach G cells release
Gastrin
Stretch/mechanical distention
70% of HCl
 Intestinal Phase:
Entry of chime into duodenum
10% of HCl

19. ‫مننه‬ ‫نړۍ‬ ‫مو‬ ‫څخه‬ ‫پاملرنې‬ ‫له‬