STOMACH

By:
Sameer
THERE ARE 4 REGIONS AND 9 QUADRANTS OF
ABDOMEN
 INTRODUCTION
• SYNONYM: It is also called as gaster or venter(Greek belly)
• DEFINITION: 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 the digestion of carbohydrates, proteins and
fats.
LOCATION:
• It lies obliquely in the upper and left part of the abdomen.
• It is located in the left hypochondriac, epigastric and ubilical regions.
• Most of it lies under cover of the left costal margin and the ribs.

SHAPE:
• In normal active persons(sthenic), it’s shape is J shaped.
• In thin, tall persons(hyposthenic), it’s shape is J shaped and is more vertical.
• In obese persons(hypersthenic), it’s shape is J shaped and is more oblique.
CAPACITY:
• It varies with age.
• In new borns: 30 ml
• In puberty: 1 L
• In adults: 1.5 – 2 L
• In old age capacity decreases.

LENGTH: 25 cm.
 EXTERNAL FEATURES
• It has 2 orifices: (1) Cardiac orifice.

(2) Pyloric orifice.

• It has 2 curvatures or borders: (1) Lesser curvature.

(2) Greater curvature.

• It has 2 surfaces: (1) Anterior surface.

(2) Posterior surface.

• It has 2 parts: (1) Cardiac: body & fundus.

(2) Pyloric: pyloric antrum,

Pyloric canal &
pylorus
ORIFICES:
(1) Cardiac orifice:
• It is joined by the lower end of the oesophagus.
• It lies behind the 7th costal cartilage, 2.5 cm away from it’s junction with the sternum and
at the level of vertebra T11.
• There is a physiological evidence of the sphincteric action, but cannot be demonstrated
anatomically.
(2) Pyloric orifice:
• It opens into the duodenum.
• It is thick and nodular.
• It lies behind the 9th costal cartilage, 1.2 cm right to the median plane and at the level of the
lower border of L1.
• It is present physiologically and demonstrated anatomically.
 CURVATURES
(1) Lesser curvature:
• It is concave and forms the right border of the stomach.
• It provides attachment to the lesser omentum.
• There is a small notch near its end called angular notch or incisura angularis.

(2) Greater curvature:

• It is convex and forms the left border of the stomach.
• It provides attachment to the greater omentum, gastrosplenic and gastrophrenic
ligaments.
• It is 5 times longer than the lesser omentum.
• At its upper end, it presents a cardiac notch which separates it from the
oesophagus.
 SURFACES

(1) Anterior or Anterosuperior:

• It faces forwards and upwards.

(2) Posterior or Posteroinferior:

• It faces backwards and downwards.
FUNDUS:
• It is an upper convex dome shaped part above a horizontal line drawn at the
level of cardiac orifice.
• It is distended with gas.

BODY:
• It is present between fundus and pyloric antrum.
• The gastric glands in the fundus and body contains 3 types of secretory
cells, namely:
(1) The mucous cells.
(2) The chief, peptic or zymogenic cells: secretes digestive enzymes.
(3) The parietal or oxyntic cells: secretes HCL.
PYLORIC ANTRUM:
• Below and to the right of the body is pyloric antrum about 7.5 cm long.
• It is limited by the faint sulcus intermedius.
• It presents pyloric glands rich in mucous cells.

PYLORIC CANAL:
• To the right of the pyloric antrum lies a 2.5cm long tubular pyloric
canal.
• It terminates at the pylorus.
 RELATIONS
PERITONEAL RELATIONS:
• Lesser omentum
• Gretaer omentum
• Gastrosplenic ligament
• Gastrophrenic ligament
• Cranial to the gastrophrenic
Ligament, lies bare area of
The stomach.
VISCERAL RELATIONS:

Anteriorly:
Diaphragm, liver and the
anterior abdominal wall.
TRAUBE’S SPACE:
• The space between the left costal margin and
the lower edge of the left lung on stomach is
called Traube’s space.
 POSTERIORLY:
• The posterior surface of stomach is related to the structures forming the stomach bed.

STOMACH BED:
• Left crus of diaphragm
• Left kidney
• Left suprarenal gland
• Left colic flexure
• Pancreas
• Splenic artery
• Transverse mesocolon
 INTERIOR LAYERS OF STOMACH
There are 4 interior layers of stomach:
• (1) Mucosal layer
• (2) Submucosal layer
• (3) Muscle coat
• (4) Serous coat
 (1)MUCOSAL LAYER
• The mucosa of empty stomach is thrown into folds known as
gastric rugae.
• These 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 called gastric pits.
The gastric glands open into these pits.
• The part of the lumen of stomach along the lesser curvature,
and has longitudinal rugae, is called the gastric canal or
magenstrasse.
(2) SUBMUCOSAL LAYER
• It is made up of connective tissue, arterioles and nerve plexus.

(3) MUSCLE COAT

• Inner oblique muscle layer
• Middle circular muscle layer
• Outer longitudinal muscle layer

(4) SEROSA COAT

It consists of peritoneal
covering
 BLOOD SUPPLY OF STOMACH
Arterial supply:
VENOUS DRAINAGE:
 LYMPHATIC DRAINAGE OF STOMACH

• All lymphatics drains into coeliac nodes >>>>> intestinal lymph trunk >>>>>>>
Cisterna chyli >>>>>> thoracic duct
 NERVE SUPPLY

• The stomach is supplied by sympathetic and parasympathetic nerves.

SYMPATHETIC:
• T6 to T10
These nerves are
• Vasomotor,
• Motor to pyloric sphincter and inhibitory to the rest of the gastric
musculature
• The chief pathway for pain sensation
 PARASYMPATHETIC:

• Vagus nerves and its branches.

Anterior gastric nerve contains mainly the
left vagal fibres.
• Branches: gastric and pyloric branches.
Posterior gastric nerve contains mainly the
right vagal fibres.
• Branches: gastric and coeliac branches.
FUNCTIONS OF STOMACH:
• The stomach acts primarily as a reservoir of food. It also acts as a mixer of
food.
• By its peristaltic movements, it softens and mixes the food with the gastric
juice
• The gastric glands produce the gastric juice which contains enzymes that
play an important role in digestion of food.
• The gastric glands also produce hydrochloric acid which destroys many
organisms present in food and drink.
• The lining cells of the stomach produce abundant mucus which protects the
gastric mucosa against the corrosive action of hydrochloric acid.
• Some substances like alcohol, water, salt and a few drugs are absorbed in the
stomach.
• Stomach produces the ‘intrinsic factor’ of Castle which helps in the
absorption of vitamin B12.
 APPLIED ANATOMY
• Gastric pain is felt in the epigastrium because the
stomach is supplied from segments T6 to T10 of the
spinal cord

• VAGOTOMY:
(1) Truncal vagotomy: completely cutting each vagus
nerve.
(2) Selective vagotomy: section the nerves of Laterjet
of both vagi.
(3) Highly selective vagotomy: section the small
branches of both nerves of Laterjet.
 GASTRITIS:
• Inflammation of stomach. It can be acute or chronic.

PEPTIC ULCER:
• It is the ulcerative lesion in GI track due to increased acid
pepsin secretion.
• It is divided into gastric and duodenal ulcer.

GASTRIC ULCER: (hurry, worry and curry)

• It occurs typically along the lesser curvature of the
stomach.
• To promote healing the irritating effect of the acid is
prevented by antacids, partial gastrectomy or vagotomy.
 GASTRIC CARCINOMA:
• It is the malignant growth of the cells.
• It commonly occurs along the greater
curvature.
• Metastasis can occur through the thoracic duct
to the left supraclavicular lymph node
(Troisier’s sign)--- SIGNAL NODES.
• It is common in blood group A.
 PYLORIC STENOSIS:

• It is a condition in which opening between stomach and small intestine is

thickened.
• It is mostly congenital. It causes vomiting after meals.

HYPOSTHENIC STOMACH is (long and narrow) more prone for gastric

ulcer, while HYPERSTHENIC STOMACH is (short and broad) prone for
duodenal cancer.