Presented by-

Dr. Sandeep Kashyap

MD (Anatomy)
Assistant Professor, NCA
 INTRODUCTION
• The stomach is a muscular bag forming the widest
and most distensible part of the digestive tube.
• It is connected above to the lower end of the
oesophagus, and below to the duodenum.
• It acts as a reservoir of food and helps in digestion
of carbohydrates, proteins and fats.
 LOCATION
• The stomach lies obliquely in the upper and left part
of the abdomen.
• occupying: the epigastric, umbilical and left
hypochondriac regions.
• Most of it lies under cover of the left costal margin
and the ribs
 Shape
• The shape of the stomach depends upon the degree of its
distension and that of the surrounding viscera.
• When empty, the stomach is somewhat J-shaped (vertical);
• When partially distended, it becomes pyriform in shape.
• In obese persons, it is more horizontal.
• The shape of the stomach can be studied in the living by
radiographic examination after giving a barium meal.
 SIZE AND CAPACITY

• The stomach is a very distensible organ.

• It is about 25 cm long, and the mean capacity is one

ounce (30 ml) at birth, one litre (1000 ml) at puberty,
and 1½ to 2 liters or more in adults.
 EXTERNAL FEATURES
The stomach has:
• Two orifices or openings: The cardiac and the pyloric
orifices
• Two curvatures or borders: The greater and the lesser
curvatures
• Two surfaces: Anterior and posterior surfaces
 THE CARDIAC ORIFICE
• The cardiac orifice is joined by the lower end of the
oesophagus. It lies behind the left 7th costal cartilage 2.5
cm from its junction with the sternum, at the level of
vertebra T11.
• The cardiac sphincter is a specialized valve found
between the esophagus and the stomach. It prevents
backflow of food and digestive enzymes.
 THE PYLORIC ORIFICE

• It opens into the duodenum.

• In an empty stomach and in the supine position, it

lies 1.2 cm to the right of median plane, at the level
of lower border of vertebra L1.
 THE LESSER CURVATURE

• The lesser curvature is concave and forms the right

border of the stomach.
• It provides attachment to the lesser omentum.
• The most dependent part of the curvature is marked
by the angular notch or incisura angularis
 THE GREATER CURVATURE

• The greater curvature is convex and forms the left border

of the stomach.
• It provides attachment to the greater omentum.
• At its upper end the greater curvature presents the cardiac
notch which separates it from the oesophagus.
• It is 5 times longer than lesser curvature.
 TWO SURFACES
• The anterior surface faces forwards and
upwards.

• The posterior surface faces backwards and

downwards.
 PARTS OF THE STOMACH
• The stomach is divided into four parts.
1. Cardia - surrounds the superior opening of the stomach
2. Fundus - rounded dome shaped part situated to the left
of cardia
3. Body - inferior to fundus, main large central part of the
stomach
4. Pylorus – has two parts:
a) Pyloric Antrum b) Pyloric Canal
 RELATIONS OF STOMACH
1. Peritoneal Relations
• The stomach is lined by peritoneum on both its surfaces.
• At the lesser curvature the layers of peritoneum lining the
anterior and posterior surfaces meets to form the Lesser
omentum
• Along the greater part of the greater curvature the two
layers meet to form the Greater omentum.
2. Visceral Relations:
• The anterior surface of the stomach is related to the liver, the diaphragm , the tranverse mesocolon and the
anterior abdominal wall.
• The diaphragm separates the stomach from the left pleura, the pericardium, and the sixth to ninth ribs.
• The postero-inferiorsurface of the stomach is related structures forming the “Stomach Bed”.
These structures are:
a. Diaphragm.
b. Left kidney.
c. Left suprarenal gland.
d. Pancreas
e. Transverse mesocolon.
f. Splenic flexure of the colon.
g. Splenic artery.
 BLOOD SUPPLY
The stomach is supplied along
• The lesser curvature by: The left gastric artery, a branch of the
coeliac trunk and the right gastric artery, a branch of the proper
hepatic artery.
• Along the greater curvature it is supplied by the right
gastroepiploic artery, a branch of t gastroduodenal and the left
gastroepiploic artery, a branch of the splenic.
• Fundus is supplied by 5 to 7 short gastric arteries, which are also
branches of the splenic artery.
 VENOUS DRAINAGE

• The veins of the stomach drain into the portal,

superior mesenteric and splenic veins.
• Right and left gastric drain in the portal vein. Right
gastroepiploic ends in superior mesenteric vein;
while left gastroepiploic and short gastric veins
terminate in splenic vein.
 LYMPHATIC DRAINAGE
• The stomach can be divided into four lymphatic
territories. The drainage of these areas is as follows.
Area (a) – Pancreaticosplenic nodes.
Area (b) – Left gastric nodes
Area (c) – Right gastroepiploic nodes
Area (d) – pyloric, hepatic and left gastric nodes.
• lymph from all areas of the stomach ultimately reaches
the coeliac nodes
 B A

D
C
 NERVE SUPPLY
• The stomach is supplied by sympathetic and
parasympathetic nerves.
• The sympathetic nerves are derived from T6 to T10
segments of the spinal cord, via the coeliac and
hepatic plexus
• The parasympathetic nerves are derived from vagus
nerve.
 INTERIOR OF STOMACH
Features:
The stomach has four layers:
1. Mucosal layer
2. Submucosal layer
3. Muscular layer
4. Serous layer
 THE MUCOSA
• The mucosa of an empty stomach is thrown into folds
termed as gastric rugae. The rugae are longitudinal along
the lesser curvature and are irregular elsewhere. The
rugae are flattened in a distended stomach.
• On the mucosal surface there are numerous small
depressions that can be seen with a hand lens. These are
the gastric pits. The gastric glands open into these pits.
• The part of the lumen of the stomach that lies along the
lesser curvature, and has longitudinal rugae, is called the
gastric canal of magenstrasse. This canal allows rapid
passage of swallowed liquids along the lesser curvature
directly to the lower part before it spreads to the other
part of stomach.
• Thus lesser curvature bears maximum insult of the
swallowed liquids, which makes it vulnerable to peptic
ulcer.
 THE SUBMUCOSA

• Submucous coat is made of connective tissue,

arterioles and nerve plexus.
 THE MUSCULAR COAT
• Muscle coat is arranged as under:
a. Longitudinal fibres are most superficial, mainly along the
curvature.
b. Inner circular fibres encircle the body and are thickened at pylorus
to form pyloric sphincter
c. The deepest layer consists of oblique fibres which loop over the
cardiac notch. Some fibres spread in the fundus and body of
stomach. Rest form a well-developed ridge on each side of the lesser
curvature
 SEROUS COAT

• Serous coat consists of the peritoneal covering.

 CLINICAL ANATOMY
1. Peptic ulcer – can be seen in stomach, lower end of
oesophages, first part of duodenum.
2. Gastric ulcer – typically occurs along the lesser curvature
3. Gastric carcinoma – is more common on greater curvature
4. Pyloric obstruction
5. Gastro Esophageal Reflex Disease (GERD)
6. Bariatric surgery
etc
 SURFACE ANATOMY
1. Cardiac orifice: It is marked by two short parallel lines 2
cm apart, directed downwards and to the left on 7th
costal cartilage, 2.5 cm to the left of median plane.

2. Pyloric orifice: It is marked by two short parallel lines 2

cm apart, directed upwards and to the right, on
transpyloric plane, 1.2 cm to the right of the median
plane.
3. Lesser curvature: It is marked by joining the right margin of the cardiac orifice with
upper margin of the pyloric orifice by a J-shaped curved line. The lowest point of
this line reaches a little below the transpyloric plane

4. Fundus: This is marked by a line convex upwards drawn from the left margin of the
cardiac orifice to highest point in the left 5th intercostal space just below the nipple.

5. Greater curvature: This is marked by a curved line convex to the left and downwards,
drawn from the fundus to the lower margin of the pyloric orifice. It cuts the left costal
margin between the tips of the 9th and 10th costal cartilages and extends down to the
subcostal plane, i.e. level of lumbar 3 vertebra.
Thank
You…