This document provides an overview of the anatomy, physiology, and common pathologies of the stomach. It describes the embryological development and parts of the stomach, including the proximal and distal gastric units. It details the stomach's blood supply from various arteries, lymphatic drainage, and nerve supply including the vagus and gastric nerves. Common gastrointestinal procedures are mentioned such as barium studies, endoscopy, and various surgical interventions for the stomach like gastrectomy, pyloroplasty, and gastric bypass surgery. Finally, it lists several gastrointestinal disorders and conditions that can affect the stomach.

1. Stomach – anatomy & physiology
& its applied
Dr Thana Ram Patel , Resident Doctor
Department of General Surgery
SMS Medical College , Jaipur

2. embryology

3. Surface anatomy

4. Parts of stomach

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8. Gastric surgical unit
• Proximal gastric surgical unit- cardiac , fundus
,body
• Distal gastric surgical unit – gastric antrum ,
pylorus , first part of duodenum

9. Proximal & distal stomach

10. Peritoneal reflections & lig

11. Nerve supply
• Parasympathetic – vagus nerve branches
• Anterior (left) gastric nerve- hepatic , gastric ,
crow’s foot (nerve of Latarjet)
• Posterior (right) gastric nerve – Coeliac
branch, Crow’s foot , Criminal nerve of Grassi
• Nerve of latarjet – pylorus relaxation

12. Nerve supply

13. Criminal nerve

14. Blood supply
• Right gastric artery (branch of common
hepatic artery)
• Left gastric artery (branch of coeliac trunk)
• Right gastroepiploic artery (branch of
gastroduodenal artery)
• Left gastroepiploic artery (branch of splenic
artery)
• 5-7 short gastric vessels from splenic artery

15. Arterial supply

16. Lymphatic drainage

17. ..

18. ..

19. Gastric secretion -physiology

20. investigations
• Imaging - Barium meal, CT scan
• Lab investigation - culture for H pylori
• endoscopy

21. Barium study

22. CT scan

23. interventions
• Lifestyle modification & health education
• Medical intervention – acid suppresion
therapy
• Surgical intervention (gastrectomy , [drainage
procedure – Gastrojejunostomy GJ
pyloroplasty,] vagotomy , bariatric surgery,
Billroth Reconstruction )

24. Acid suppresion therapy

25. surgery
• Gastrectomy
• Pyloroplasty- Heinke Mikulicz
• Pyloromyotomy (Ramstaedt)-for congenital
hypertrophic pyloric stenosis

26. Gastrectomy

27. pyloroplasty

28. Finney pyloroplasty

29. vagotomy
• Truncal vagotomy –complications – GB stone ,
pylorus spasms (t/t – drainage procedure- GJ,
pyloroplasty) , diffuse atony of stomach,
diarrhoea
• Highly selective vagotomy
• Parietal cell vagotomy

30. truncal

31. selective

32. Parietal cell

33. Billroth
• Billroth 1 – gastroduodenal anastomosis
• Billroth 2 – gastrojejunal anastomosis

34. Billroth 1

35. Billroth2

36. Bariatric surgery
• Malabsorptive (jejunoileal , jejunocolic
bypass)- no longer recommended
• Mostly malabsorptive (biliopancreatic
diversion)
• Restrictive (vertical banded gastroplasty,
adjustable silicone gastric banding, sleeve
gastrectomy)
• Mostly restrictive (short limb & long limb roux
en Y gastric bypass)

37. Bariatric surgery

38. Vertical band

39. Gastric bypass

40. manifestations
• Dyspepsia
• gastritis
• Gastric ulcers – as part of peptic ulcer (gastric & duodenal
ulcer)
• Gastric perforation
• Gastric bleeding
• Gastric outlet obstruction
• Gastric surgeries complications –
• dumping syndrome (postcibal syndrome) – early (osmotic
overload) & late (reactive hyperglycemia)
• Loop syndrome (afferent & efferent)
• Malabsoption (iron deficiency anemia, B12 deficiency)

41. disorders
• Congenital – congenital hypertrophic pyloric
stenosis
• Gastric volvulus
• Bezoars
• Infections – H Pylori infections
• Tumors - adenocarcinoma , gastrointestinal
stromal tumors /GIST
• Menetriers disease, Dieulafoy’s lesion , gastric
antral vascular ectasia (watermelon stomach)

42. THANK YOU
THANK YOU