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STOMACH
DR SANA YASEEN
ANATOMY DEPARTMENT
Stomach
INTRODUCTION
 It is the muscular bag. It is the widdest and the most
dilated portion of alimentary canal.
 It has many functions:
1. Storage of food (stomach capacity of adult is1500ml).
2. Mixes food with gastric secretions to form a semifluid
chyme.
3. Protein digestion
4. Kills micro organism via HCl
5. Instrinsic factor is release that help in absorption of
Vit B12
6. Secrets mucous
2 Orifices:
 Cardiac orifice
 Pyloric orifice
2 Borders:
 Greater curvature
 Lesser curvature
2 Surfaces:
 Anterior surface
 Posterior surface
3 Parts:
 Fundus
 Body
 Pylorus:
The pylorus is formed of 3 parts
 Pyloric antrum
 Pyloric canal
 Pyloric sphincter
PARTS OF STOMACH
Stomach
OPENINGS/ ORIFICES
GASTROESOPHAGEAL JUNCTION/ OPENING:
 It is a physiological rather than an anatomical, sphincter. Lying at
level of T10&T11.
 Consists of a circular layer of smooth muscle (under vagal and
hormonal control).
 It helps to Prevents regurgitation (reflux) of food.
 NB. Notice the abrupt mucosal transition from esophagus to
stomach (Z- line)
GASTRODUODENAL JUNCTION:
 The pyloric antrum extends from Incisura angularis to the pylorus
 The pylorus is a tubular part of the stomach
 It lies in the transpyloric plane at L1-2
 It has a thick muscular end called pyloric sphincter.
 The cavity of the pylorus is the pyloric canal.
Stomach
CURVATURES/ BORDERS
 Lesser curvature:
 It extends from right border of stomach and cardiac orifice to
the pylorus. It is composed of;
 Hepato gastric ligament
 Hepato duodenal ligament
 Also known as lesser omentum.
 Greater curvature:
 Is longer than the lesser curvature.
 It extends from the left of the cardiac, over the dome of
fundus, and along the left border of stomach to pylorus.
 It is connected to spleen via gastrosplenic omentum .
 it extends from upper part of greater curvature ,and to the
transverse colon via greater omentum.
 It attaches to diaphragm through Gastro phrenic ligament
Stomach
FUNDUS AND BODY OF STOMACH
FUNDUS:
 Dome-shaped
 Located to the left of the cardiac orifice
 Usually full of gas.
 In X-Ray film it appears black
BODY:
 Extends from fundus to The level of Incisura Angularis:
 A constant notch on the lesser curvature
Muscular Layers of Stomach
 It has 3
muscular
layers:
1. Longitudinal
layer: outer
most layer
2. Circular layer:
inner layer
3. Oblique layer:
inner most
layer
It’s mucous membrane is thrown into folds and called rugae.
Stomach
Stomach
PERITONEAL RELATIONS
 Anterior and posterior surface is covered by
peritoneum.
BARE AREA OF STOMACH:
 Posterior surface of stomach just cranial to
gastrophrenic ligament
 Greater and lesser curvature along peritoneal
reflection.
RELATIONS
Anterior Relations of
stomach
 Anterior abdominal
wall
 Left costal margin
 Diaphragm
 Left lobe of the liver
 Posterior Relations of
stomach
 Diaphragm
 Spleen
 Left suprarenal gland
 Upper part of left kidney
 Splenic artery
 Pancreas
 Transverse mesocolon
 Transverse colon
Stomach
POSTERIOR RELATIONS OF STOMACH
Stomach
ARTERIAL SUPPLY OF STOMACH
 As it is derived from the foregut (celiac trunk)
1- Left gastric artery: It is a branch of celiac artery.
 Runs along the lesser curvature.
2- Right gastric artery: branch of cieliac trunk.
 Runs to the left along the lesser curvature.
3-Short gastric arteries – arise from the splenic artery.
 Pass in the gastrosplenic ligament.
4- Left gastroepiploic artery: from splenic artery
 Pass in the gastrosplenic ligament, along the greater
curvature
5- Right gastroepiploic artery: from the gastroduodenal artery of
hepatic .
 Passes to the left along the greater curvature.
ARTERIAL SUPPLY OF STOMACH
VENOUS DRAINAGE OF STOMACH
 Left and right gastric veins portal vein
 Short gastric vein and left gastroepiploic veins
splenic vein
 Right gastroepiploic vein superior
mesenteric vein
Stomach
LYMPHATIC DRAINAGE
Is into four zones:
 Pancreatico-spleenic nodes
 R- gastric epiploic nodes
 Pyloric nodes
 L- gastric nodes
 They all drain into cieliac nodes and to supra clavicular
nodes, one of the first area to detect in case of gastric
carcinoma.
Stomach
Stomach
INNERVATION
 Sympathetic fibers are vasoconstrictors, antiperistaltic and
carry pain sensation. It is derived from the celiac plexus.
 From segments T6-T10
 Parasympathetic fibers from both vagi are for motility &
secretory
 Anterior vagal trunk/ anterior gastric nerve:
 Formed from the left vagus
 Supply the anterior surface of the stomach
 Gives off a hepatic branchalso to pylorus.
 Posterior vagal trunk/ posterior vagus nerve:
 Formed from the right vagus
 Supply the posterior surface of the stomach
 Gives off a large branch to the celiac and the superior
mesenteric plexuses.
Stomach slide
Cell types in principal gland
Stomach
Stomach
Stomach
Stomach
Stomach
Stomach
Stomach
Perforation through stomach wall
Stomach
Stomach
STAGES OF ADINOCARCINOMA
Leather bottle appearance
Stomach
Stomach
Stomach
VAGOTOMY
 a surgical operation in which one or more branches
of the vagus nerve are cut, typically to reduce the
rate of gastric secretion
Stomach
GASTRECTOMY
 surgical removal of a part or the whole of the
stomach.
Stomach
Stomach
Stomach
Stomach
Stomach

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Stomach

  • 3. INTRODUCTION  It is the muscular bag. It is the widdest and the most dilated portion of alimentary canal.  It has many functions: 1. Storage of food (stomach capacity of adult is1500ml). 2. Mixes food with gastric secretions to form a semifluid chyme. 3. Protein digestion 4. Kills micro organism via HCl 5. Instrinsic factor is release that help in absorption of Vit B12 6. Secrets mucous
  • 4. 2 Orifices:  Cardiac orifice  Pyloric orifice 2 Borders:  Greater curvature  Lesser curvature 2 Surfaces:  Anterior surface  Posterior surface 3 Parts:  Fundus  Body  Pylorus: The pylorus is formed of 3 parts  Pyloric antrum  Pyloric canal  Pyloric sphincter PARTS OF STOMACH
  • 6. OPENINGS/ ORIFICES GASTROESOPHAGEAL JUNCTION/ OPENING:  It is a physiological rather than an anatomical, sphincter. Lying at level of T10&T11.  Consists of a circular layer of smooth muscle (under vagal and hormonal control).  It helps to Prevents regurgitation (reflux) of food.  NB. Notice the abrupt mucosal transition from esophagus to stomach (Z- line) GASTRODUODENAL JUNCTION:  The pyloric antrum extends from Incisura angularis to the pylorus  The pylorus is a tubular part of the stomach  It lies in the transpyloric plane at L1-2  It has a thick muscular end called pyloric sphincter.  The cavity of the pylorus is the pyloric canal.
  • 8. CURVATURES/ BORDERS  Lesser curvature:  It extends from right border of stomach and cardiac orifice to the pylorus. It is composed of;  Hepato gastric ligament  Hepato duodenal ligament  Also known as lesser omentum.  Greater curvature:  Is longer than the lesser curvature.  It extends from the left of the cardiac, over the dome of fundus, and along the left border of stomach to pylorus.  It is connected to spleen via gastrosplenic omentum .  it extends from upper part of greater curvature ,and to the transverse colon via greater omentum.  It attaches to diaphragm through Gastro phrenic ligament
  • 10. FUNDUS AND BODY OF STOMACH FUNDUS:  Dome-shaped  Located to the left of the cardiac orifice  Usually full of gas.  In X-Ray film it appears black BODY:  Extends from fundus to The level of Incisura Angularis:  A constant notch on the lesser curvature
  • 11. Muscular Layers of Stomach  It has 3 muscular layers: 1. Longitudinal layer: outer most layer 2. Circular layer: inner layer 3. Oblique layer: inner most layer It’s mucous membrane is thrown into folds and called rugae.
  • 14. PERITONEAL RELATIONS  Anterior and posterior surface is covered by peritoneum. BARE AREA OF STOMACH:  Posterior surface of stomach just cranial to gastrophrenic ligament  Greater and lesser curvature along peritoneal reflection.
  • 15. RELATIONS Anterior Relations of stomach  Anterior abdominal wall  Left costal margin  Diaphragm  Left lobe of the liver  Posterior Relations of stomach  Diaphragm  Spleen  Left suprarenal gland  Upper part of left kidney  Splenic artery  Pancreas  Transverse mesocolon  Transverse colon
  • 19. ARTERIAL SUPPLY OF STOMACH  As it is derived from the foregut (celiac trunk) 1- Left gastric artery: It is a branch of celiac artery.  Runs along the lesser curvature. 2- Right gastric artery: branch of cieliac trunk.  Runs to the left along the lesser curvature. 3-Short gastric arteries – arise from the splenic artery.  Pass in the gastrosplenic ligament. 4- Left gastroepiploic artery: from splenic artery  Pass in the gastrosplenic ligament, along the greater curvature 5- Right gastroepiploic artery: from the gastroduodenal artery of hepatic .  Passes to the left along the greater curvature.
  • 21. VENOUS DRAINAGE OF STOMACH  Left and right gastric veins portal vein  Short gastric vein and left gastroepiploic veins splenic vein  Right gastroepiploic vein superior mesenteric vein
  • 23. LYMPHATIC DRAINAGE Is into four zones:  Pancreatico-spleenic nodes  R- gastric epiploic nodes  Pyloric nodes  L- gastric nodes  They all drain into cieliac nodes and to supra clavicular nodes, one of the first area to detect in case of gastric carcinoma.
  • 26. INNERVATION  Sympathetic fibers are vasoconstrictors, antiperistaltic and carry pain sensation. It is derived from the celiac plexus.  From segments T6-T10  Parasympathetic fibers from both vagi are for motility & secretory  Anterior vagal trunk/ anterior gastric nerve:  Formed from the left vagus  Supply the anterior surface of the stomach  Gives off a hepatic branchalso to pylorus.  Posterior vagal trunk/ posterior vagus nerve:  Formed from the right vagus  Supply the posterior surface of the stomach  Gives off a large branch to the celiac and the superior mesenteric plexuses.
  • 28. Cell types in principal gland
  • 44. VAGOTOMY  a surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
  • 46. GASTRECTOMY  surgical removal of a part or the whole of the stomach.