Stomach Anatomy , Physiology & its applied

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

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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