Dr. Nurzarina Abdul Rahman Faculty of Medicine and Health Sciences

USIM

بسم اهللا الرحمن الرحيم

¨  At the end of the lecture, the student should be able to:

¨  describe the surface marking of the stomach ¨  identify the parts of the stomach and name of its borders ¨  describe the relation of the stomach to the peritoneal

cavity and the name of the peritoneal folds ligament attach to the organ

¨  describe the relation of the stomach to the other organs including the structures present at the stomach bed

¨  mention the blood supply of the stomach

¨  Muscular bag forming the widest and most distensible part of digestive tract

¨  Connected above to lower end of the oesophagus and below to duodenum

¨  Function – reservoir of food and prepares food for digestion

¨  Developmentally related to the foregut

¨  Position : upper left quadrant - epigastrium, left hypochondrium and umbilical region

¨  Lies under cover of left costal margin and ribs

¨  Shape : J-shape (empty) or pyriform (partially distended)

¨  Capacity : 1000-1500 ml

¨  25 cm long

¨  Relatively fixed at both ends

¨  Upper end ¡  cardio-oesophageal

junction ¡  left of mid line (T10) ¡  40 cm from incisor teeth

¨  Lower end ¡  pylorus ¡  right of the mid line (L1)

L1

Midline of the abdomen

T10

4 parts ¡  Cardia ¡  Fundus ¡  Body ¡  Pylorus

Surfaces and borders ¨  2 ends : cardiac end and

pyloric end ¨  2 borders : right lesser

curvature and left greater curvature

¨  2 surfaces : anterior and posterior

1. Cardia The part surrounding the cardial orifice

1. Cardia Also known as

Oesophagogastric (OG) junction

¨  40cm from incisor teeth ¨  Lower oesophageal

sphincter, distal 1-4 cm of the oesophagus

¨  not an anatomical sphincter

¨  zone of high intraluminal resting pressure (higher than the pressure in the fundus)

2. Fundus Dilated superior part, related to left dome of diaphragm Above level of cardia Superior part reaches level of left 5th Intercostal space Cardial notch – between esophagus and fundus

3. Body Major part between fundus

and pylorus From fundus to incisura

angularis Incisura angularis

separates body from the pyloric part

4. Pyloric part Funnel-shaped outflow

region of stomach Incisura angularis

separates body from the pyloric part

4. Pyloric part (pyloros = gateguard) Three parts:

Pyloric part

Pyloric antrum Pyloric canal

Pyloric sphinter Duodenum

Lesser curvature ¨  Concave to right ¨  For attachment of lesser

omentum ¨  Has angular notch (incisura

angularis) between body and pylorus

Greater curvature ¨  Convex to left ¨  For attachment of greater

omentum ¨  Has cardiac notch between

esophagus and fundus

Stomach is completely covered by peritoneum

(intraperitoneum organ) .

Area where the stomach is not covered with peritoneum :

¨  A bare area at the back of cardial orifice

¨  Where blood vessels run along its curvatures

Stomach has peritoneal folds: ¨  lesser omentum ¨  greater omentum ¨  gastrophrenic ligaments ¨  gastro- splenic ligaments

Gastrophrenic ligament ¨  from the fundus to the

diaphragm Gastrosplenic ligament ¨  from the greater curvature to the hilum of spleen Greater omentum ¨  from the greater curvature

to the transverse colon (gastro-colic ligament) Lesser omentum ¨  from lesser curvature to

the liver porta hepatis and fissure for ligamentum venosum

(gastro-hepatic ligament)

Anteriorly related to: ¨  diaphragm ¨  left lobe of the liver ¨  anterior abdominal

wall

Posteriorly related to: ¨  Lesser sac (Omental

bursa) ¨  Pancreas Posterior surface of

stomach forms most of the anterior wall of the omental bursa

Anterior

Posterior

Posteriorly related to: ¨  Lesser sac (Omental

bursa) ¨  Pancreas Posterior surface of

stomach forms most of the anterior wall of the omental bursa

Anterior

Posterior

¨  Definition : the bed on which the stomach rests on SUPINE position

¨  Structures at the stomach bed form the posterior wall of Lesser sac (omental bursa)

¨  Structures at the stomach bed THAT are separated from the stomach by the cavity of lesser sac

¨  Structures at the stomach bed THAT are separated from the stomach by the cavity of lesser sac:

(From superior to inferior) 1.  left crus of diaphram - related to the bare area at the

back of the cardiac end of the stomach 2.  spleen – separated from stomach by cavity of greater

sac 3.  left suprarenal gland 4.  left kidney 5.  splenic artery along upper border of PANCREAS 6.  pancreas 7.  left colic flexure 8.  transverse mesocolon and colon

From coeliac artery A) along lesser curvature -

two arteries 1.  left gastric artery and 2.  right gastric artery B) along the greater

curvature - three arteries 1.  short gastric arteries from

splenic artery to fundus 2.  left gastro-epiploic artery

(from the splenic artery) 3.  right gastro-epiploic artery

(from the branches of hepatic artery)

¨  the veins accompany the arteries

¨  empty into portal circulation

B A

C

D

Stomach – lymphatic drainage

A : Pancreaticosplenic area – drains into pancreaticosplenic nodes along splenic artery to the coeliac nodes B : Drains into left gastric nodes to the coeliac nodes C : Drains into right gastroepiploic nodes, into hepatic nodes then into coeliac nodes D : into plyloric, hepatic and left gatric nodes, then all into coeliac nodes

¨  anterior ulcers perforate ¨  posterior ulcer erode (GIT bleeding) or

penetrate ¡  gastric ulcer erodes pancreas, splenic artery

Protrusion of part of stomach (cardia and part of fundus) into the mediastinum through the oesophageal hiatus of the diaphragm

Occurs in people after middle age (due to weakening of the muscular part of diaphragm)

nurzarina@usim.edu.my