THE STOMACH


This is the widest part of the GIT, connecting esophagus and the duodenum.

   

Position :  
  • Supra colic

  • Extends from Epigastric to Left hypochondrial regions
    .
  • Above transpyloric plane

 

   

   

Parts

  • Cardiac part
  • Body.
  • Fundus.
  • Pylorus

Surfaces

  • Anterior and posterior surfaces,
  • These meet along the lesser curvature and along the greater curvature.
   

Relations :  
Anteriorly:
Posteriorly:
  • The thoracic diaphragm
  • Left and quadrate lobes of the liver.
  • The anterior abdominal wall.

Separated by omental bursa from stomach bed containing:

  • Diaphragm above.
  • Spleen.
  • Left kidney and suprarenal.
  • Splenic artery.
  • Pancreas.
  • Transverse mesocolon.
  • Transverse colon and left colic flexure.
   
   

Blood supply  

Arteries:

 

On the lesser curvature:-

  • Right gastric, from hepatic artery
  • Left gastric, from coeliac trunk.

On the greater curvature:-

  • Right gastroepiploic, from the gastroduodenal artery.
  • Left gastroepiploic, from the splenic artery.

At the fundus:-

  • Short gastric arteries from the splenic artery.

These arteries anastomose extensively.

  • Posterior gastric artery frequently from the splenic artery.

Venous drainage

The veins of the stomach accompany the arteries for some distance.

  • The right gastro epiploic vein joins the superior mesenteric vein.

  • The left gastro epiploic vein joins the splenic vein.

  • Right gastric and left gastric join the portal vein.

 

 

   

Lymphatic drainage  

The lymphatics of the stomach tend to follow blood vessels and drain four main areas, with overlap:

  • Both surfaces of the upper body drain to left gastric nodes.
  • Fundus and lower left part of the body reach pancreatico splenic nodes close to the hilum of the spleen.
  • Lower right part of the greater curvature pass to the right gastro epiploic nodes.
  • Pylorus drains into pyloric, left gastric and hepatic nodes.

The valves of the lymphatics are arranged so that lymph tend to pass from the right part of the stomach towards the lesser curvature; and from the left part of the stomach towards the greater curvature.

   

Innervation :  

The stomach receives both sympathetic and parasympathetic innervation.

  • Sympathetic fibres are derived mainly from the coeliac plexus and travel along the branches of the coeliac artery. Occasional branches also reach the stomach from the left phrenic plexus, and sympathetic trunks. These fibres are probably vasomotor. Sensory fibres carrying pain follow these sympathetic pathways to the spinal cord.
  • Parasympathetic supply is from the vagus.
   

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Chapter 32: The Peritoneum and the Organs of the Gastrointestinal System
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