stomah,small intestine
TRANSCRIPT
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Stomach Stomach is the most dilated part of the alimentary tract.
It extends from the cardiac end
( 7th costochondral junction ) to the pyloric end (point 2.5cm to the right of midline on the transpyloric plane)
Upper end continues with esophagus
Lower end continues with the duodenum..
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Shape : pear shaped
Upper part is broader than the lower part It has 2 ends
Cardiac end, pyloric end
two surfaces:
Anterior and posterior
Two curvatures
Lesser curvature and greater curvature
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Sub-divisions
Fundus is the dilated upper part
Body is between the fundus and the incisura
angularis.(Lesser curvature)
Pylorus: the body continues as the pyloric part and it has
pyloric antrum- a proximal dilated portion
Pyloric canal
Pyloric sphincter, the thickened distal end of the canal.
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Stomach
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Relations
Lesser curvature gives attachment to lesser omentum (which stretches
towards the liver.)
It encloses the right and left gastric arteries and formanastomotic channels.
Greater curvature-
It gives attachments to the following peritoneal folds fromabove downwards
1.Gastrophrenic ligament from fundus(cardiac orifice) to
diaphragm 2.Gastrosplenic omentum, from fundus to hilum of
spleenEncloses short gastric arteries from splenic artery.
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3.Greater omentum (from G.C to transverse colon.
Encloses right and left gastroepiploic areteries.
Relations
Anterior surface:
1.left lobe of liver (inferior surface)
2. Diaphragm which separates it from the 7
th
and 8
th
ribsand their costal cartilages.
3. Anterior abdominal wall
4.Gastric area of the spleen(upper left corner of the
anterior surface of the stomach)
Posterior surface
Structures related to the posterior surface is known as
stomach bed.
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Stomach bed structures
1.Head,neck and body of pancreas 2.Root of transverse mesocolon
3.transverse colon
4.upper part pf the anterior surface of the left kidney
5. Anterior surface of the upper of the left suprarenal.
6.splenic artery running along the upper part of the body ofpancreas.
7.diaphragm
8. The gastric surface of spleen
The spleen is separated from the stomach by the greatersac of peritoneum while all the other other structures areseparated by the lesser sac.
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Blood supply
The following arteries supply 1.left gastric artery- a branch from coeliac axis descends
along the lesser curvature between the layers of the lesseromentum.
2.Right gastric artery-branch of hepatic artery run along
lesser omentum. The two arteries anastomose to form a chain.
3. Left gastroepiploic artery- a branch of the splenic arterydescends in between the layers of greater omentum alongthe greater curvature.
4. Right gastroepiploic artery- branch of gastro duodenal-run along greater curvature- between the layers of thegreater omentum.
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blood supply
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5.short gastric arteries- branch from gastro duodenal- run
along the greater curvature between the layers of thegreater omentum.
They reach the stomach through the gastrosplenicomentum.
venous drainage
1. Right and left gastric veins-lesser curvature- ends inportal vein.
2.right and left gastroepiploic veins-greater curvature-
The right vein ends in superior vein and the left ends insplenic vein.
3.Short gastric veins- 4 or 5 drain the fundus of thestomach pass along the gastrosplenic omentum and endsin splenic vein.
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4. Prepyloric vein of Mayo
Cross anterior surface of pylorus and connects the right
gastroepiploic vein with the right gastric vein or portal
vein.
It helps to identify the pylorus in the living.
Lymphatic drainage
There are four lymphatic zones The whole surface is
divided into right and left zones.
The right zone is unequally divided into a larger upper
zone A, and a smaller B zone. The left zone is divided into two equal parts, the upper C
and the lower D
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zone A drains into superior gastric nodes.
Zone B drains into lower hepatic group Zone C drains into splenic nodes
Zone D drains into sub pyloric nodes.
Nerve supply
Sympathetic from T6-10-via coeliac plexus
- are vasomotor, motor to pyloric sphincter, but inhibitoryto other parts of the gastric musculature and carries painimpulses from the stomach
Parasympathetic- gastric nerves- branch from vagus.
Anterior gastric nerve is a branch from left vagus andposterior gastric nerve is a branch from right vagus.
-increase the motility of the stomach and the secretion ofgastric juice rich in pepsin and HCL
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Interior of the stomach
The mucosa of the stomach is thrown into irregular folds
called gastric rugae.
The rugae get flattened when the stomach is distended.
there are 2 longitudinal folds in the gastric mucosa along
the lesser curvature form a canal- the gastric canal
(Magenstrasse)- allow the rapid passage for the fluids
directly to the lower part of the stomach.
Thus the lesser curvature bears the maximum insults of the
swallowed liquids, which makes it vulnerable to ulcers.
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DUODENUM Duodenum is the most fixed part of the small intestine.
It extends from the pylorus to the duodenojejunal flexure.
It is situated in the posterior abdominal wall It is C shaped- the concavity is directed upwards and to the
left.
Length is 25 cm and width 3.75cm.
It is the widest part of the small intestine. Subdivisions
It is subdivided into 4 parts
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First part- 5 cm, extends from the pyloric junction,
to the right side and form a superior duodenalflexure
Second part-7.5 cm in length, extends verticallydownwards on the right side of the vertebral
column from the superior duodenal flexure to thelevel of the third lumbar vertebra
Third part-10cm, extends transverse fromL3 tothe left side of the vertebra.
Fourth part 2.5 cm, ascends up vertically on theleft side from the level of L2 and continuous withjejunum.
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Relations
Relations
1stpart- first 2.5 cm is completely covered by peritoneum.
Post.surf related to lesser sac which separates the head ofpancreas.
2nd 2.5 cm is anteriorly covered with peritoneum
Above and anteriorly- quadrate lobe of liver
Above and posteriorly opening of lesser sac.
Posteriorly
Gastroduodenal trunk, bile duct, portal vein and IVC
Below head of pancreas
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II part
Anteriorly-covered with peritoneum except where it is
crossed by transverse mesocolon.
Right lobe of liver
Coils of small intestine
Posteriorly: covered by peritoneum
Hilum and anterior surface of right kidney Structures entering and leaving the hilum (right renal
vessels and pelvic part of ureter.
Laterally:rt.kidney, right colic flexure.
Medially:Head of pancreas, ampulla of vater pierces thewall of the 2ndpart of duodenum-major duodenal papilla. Itis guarded by a valve called as hood of monk.
Opening of accessory pancreatic duct in the minorduodenal papilla, if it is present.
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Opening of bile duct
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III part:
Peritoneum covers except where it is crossed by and its
contents(superior mesenteric vessels and nerves)
Coils of small intestine
Posteriorly:
It crosses the following structures from right to left.
1.right ureter
2.right psoas major
3.IVC
4.right testicular or ovarian vessels. 5.abdominal aorta
6.Inferior mesenteric artery
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Above: lower border of head of pancreas, uncinate process
Below; peritoneum, small intestine IV part:
Right side: abdominal aorta
Left side: left kidney and ureter
Anteriorly: peritoneum,coils of jejunum. Posteriorly
Left psoas muscle
Left renal artery
Inferior mesenteric vein
Left testicular or ovarian vessels
Left sympathetic chain
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Suspensory muscle of the duodenum(ligament of Treitz)
From right crus of diaphragm to the duodenojejunalflexure.
It runs behind the head of the pancreas but in front of theaorta and encircle the coeliac axis.
Duodenojejunal flexure, where the fourth part of
duodenum continuous as jejunum It is at the L2 level.
Superiorly: root of transverse mesocolon and body ofpancreas
Posteriorly:inferior mesenteric vein
Medially: abdominal aorta, root of mesentery
Anteriorly:continuous as jejunum
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Blood supply:
Supraduodenal Retro duodenal
Recurrent duodenal branches of gastro duodenal artery
Supra duodenal artery branches are end arteries necrosisof the mucosa- ulcer formation.
Most common part of ulcer formation is the 1st part.
II,III,IV parts are supplied by superior and inferiorpancreatico duodenal arteries , superior mesenteric artery.
Venous drainage: corresponding veins-splenic,superior
mesenteric and portal veins Nerve supply:sympathetic- from T1-9 and parasympathetic
by vagus.
Lymphatic drainage
Pancreatico duodenal nodes
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Small intestine
The coils of jejunum and ileum are suspended by mesentryfrom the posterior abdominal wall and are freely movable
Extent:jejunum starts from duodeno jejunal flexure L2 and
forms 3/5 of small intestine
and 2/5 form the ileum. It ends in the ileocaecal junction.
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intestine
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FATTY ABSORPTION
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DIFFERNCE BETWEEN JEJUNUM AND
ILEUM
colour
Thickness of
wall
JEJUNUMred
thick
ILEUMpale
thin
Mesentry
1.presence of fat
2.presence of
lymph nodes
less
less
more
more
arteries larger vasa
rectae arteries
window spaces-
lar e
shorter vasa
rectae arteries
window spaces-
smaller
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DIFFERENCE BETWEEN SMALL AND
LARGE INTESTINE
LARGE INTESTINE
1. APPENDICES
EPIPLOICAE PRESENT 2.3 TAENIA COLI
PRESENT
3.COLON IS FIXED
EXCEPT TRANSVERSE
& PELVIC COLON
SMALL INTESTINE
ABSENT
ABSENT
FREE EXCEPTDUODENUM
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Meckls diverticulum or diverticulum ilei.
short, 2(5 cm) in length occurs in 2% of individuals
It is persisting proximal part of the vitellointetinal duct.
it may give rise to umbilical fistula, umbilical sinus, orcysts
mucosa of gastric or pancreatic in nature-lead to ulcerformation,perforation or diverticulitis
blood supply
12-15 branches from superior mesentric artery.
each branch divide into 2 and anastomose with each other.-to form one chain, from which series of straight arteriesarise called vasa rectae
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nerve- sympathetic from T9-10
parasympathetic-vagai lymphatics
mesentric nodes-aortic nodes
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