1.1 stomach and duodenum
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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.
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1.1 stomach and 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
- 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
- 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