The stomach
stomach dilated portion of the digestive
system located primarily in the
upper left quadrant
body of stomach part of the stomach between the
fundus and the pylorus
fundus of stomach expanded superior part of the
stomach above the entrance of the in X rays of patients filmed in a
esophagus
angular notch of stomach bend along lesser curvature
stomach rotates during embryonic
development so that the lesser
curvature (originally the anterior
surface) faces superiorly and to
the right, the greater curvature
(originally the posterior surface)
faces inferiorly and to the left
mucosal surface of the body of the
stomach near the lesser curvature
has gastric folds
fundus may contain a gas bubble
standing position (Latin, fundus =
bottom)
marks transition from body to
pylorus
cardiac portion of stomach area around the opening of the joined by esophagus
esophagus

pylorus of stomach constricted lower part, containing
pyloric antrum & sphincter
the antrum exists as the path from
the body to the pylorus region of
the stomach; the sphincter leads
from the pylorus to the duodenum
(Latin, pylorus = gatekeeper)

rugae of stomach folds of the mucosal lining of the (Latin, rugae = a wrinkle)
stomach

gastric canal furrow formed temporarily between

longitudinal rugae of the gastric
mucosa along the lesser curvature
during swallowing; observed
radiographically and
endoscopically, it is formed
because of the firm attachment of
the gastric mucosa to the muscular
layer, which is devoid of an oblique
layer at this site; said to form a
passageway favored by saliva and
small quantities of masticated food
and other fluids as they flow from
cardia to gastroduodenal junction.
Topographical
representation
The cardiac orifice is opposite the seventh left costal cartilage
about 2.5 cm. from the side of the sternum; it
corresponds to the level of the tenth thoracic
vertebra

The pyloric orifice is on the transpyloric line about 1 cm. to the

right of the middle line, or alternately 5 cm.
below the seventh right sternocostal
articulation; it is at the level of the first
lumbar vertebra

the lesser curvature A curved line, convex downward and to the

left, joining these points

the greater curvature a curved line is drawn from the cardiac orifice
to the summit of the fundus, thence
downward and to the left, finally turning
medialward to the pyloric orifice, but passing,
on its way, through the intersection of the left
lateral with the transpyloric line
The portion of the stomach can be represented roughly by a
triangular area the base of which is
formed by a line drawn from the tip of
the tenth left costal cartilage to the tip of
the ninth right cartilage, and the sides by
two lines drawn from the end of the
eighth left costal cartilage to the ends of
the base line

the fundus of the stomach reaches as high as the fifth interspace or

the sixth costal cartilage, a little below
the apex of the heart
 Traube's semilunar space
A crescentic space about 12 cm wide,
bounded:
- medially by the left border of the sternum,
- above by an oblique line from the sixth costal
cartilage to the lower border of the eighth or
ninth rib in the mid-axillary line and
- below by the costal margin;
The percussion tone here is normally
tympanitic, because of the underlying
stomach
 RELATIONS OF STOMACH

Anteriorly the diaphragm, the left lobe

of liver, and the anterior
abdominal wall
Posteriorly the omental bursa and
pancreas
Inferiorly and laterally The transverse colon as it
courses along the greater
curvature of the stomach to
the left colic flexure
 The bed of the stomach, on which the
stomach rests in the supine position, is
formed by, from superior to inferior:
-the left dome of the diaphragm
-spleen
-left kidney and suprarenal gland
-splenic artery
-pancreas
-transverse mesocolon
• The stomach is J-shaped, baglike organ that
expands to store food. Typical of that of the
entire digestive tract, the wall of the stomach
contains four layers.
 The first main layer. This consists of an epithelium, the lamina
propria composed of loose connective tissue and which has
mucosa
gastric glands in it underneath, and a thin layer of smooth
muscle called the muscularis mucosae.

This layer lies over the mucosa and consists of fibrous

submucosa connective tissue, separating the mucosa from the next layer.
The Meissner's plexus is in this layer.

Over the submucosa, the muscularis externa in the stomach

differs from that of other GI organs in that it has three layers
of smooth muscle instead of two.
 inner oblique layer: This layer is responsible for creating
the motion that churns and physically breaks down the
food. It is the only layer of the three which is not seen in
other parts of the digestive system. The antrum has
thicker skin cells in its walls and performs more forceful
contractions than the fundus.
muscularis externa
 middle circular layer: At this layer, the pylorus is
surrounded by a thick circular muscular wall which is
normally tonically constricted forming a functional (if not
anatomically discrete) pyloric sphincter, which controls
the movement of chyme into the duodenum. This layer is
concentric to the longitudinal axis of the stomach.

 outer longitudinal layer: Auerbach's plexus is found

between this layer and the middle circular layer.

This layer is over the muscularis externa, consisting of layers

serosa
of connective tissue continuous with the peritoneum.
Cross section of gastric wall. Nerve plexi provide the interface between
the mucosa and the muscularis, as well as between the longitudinal and
circular layers of the muscularis
Glands
The epithelium of the stomach forms deep pits. The glands at these
locations are named for the corresponding part of the stomach:

Layer of Name Secretion Region of Staining

stomach stomach
Isthmus of Mucous neck mucus gel layer Fundic, cardiac, Clear
gland cells pyloric

Body of gland parietal (oxyntic) gastric acid and Fundic, cardiac, Acidophilic
cells intrinsic factor pyloric

Base of gland chief pepsinogen Fundic only Basophilic

(zymogenic)
cells
Base of gland enteroendocrine hormones Fundic, cardiac, -
(APUD) cells gastrin, pyloric
histamine,
endorphins,
serotonin,
cholecystokinin
and
somatostatin
 Arterial supply
• The rich arterial supply of the stomach arises
from the celiac trunk and its branches. Most
blood is supplied by anastomoses formed
along the lesser curvature by the right and left
gastric arteries, and along the greater
curvature by the right and left gastro-omental
(gastroepiploic) arteries. The fundus and
upper body receive blood from the short and
posterior gastric arteries.
Artery Origin Branches Vascularize Observation

gastric left celiac a. esophageal brs. superior part of the left gastric a.
stomach near the lesser anastomoses with
curvature the right gastric a.
on the lesser
curvature of the
stomach; it also
anastomoses with
the esophageal brs.
of the thoracic aorta

gastric, right proper hepatic a. no named branches inferior part of the right gastric a.
stomach near the lesser anastomoses with
curvature the left gastric a. on
the lesser curvature
of the stomach

gastric, short splenic a. no named branches fundus and upper part short gastric aa.
of the stomach near the reach the stomach
greater curvature by passing through
the gastrosplenic
ligament; they are
usually 4-5 in
number
Artery Origin Branches Vascularize Observation
Left gastro-omental splenic a. gastric brs., omental mid-part of the stomach left gastro-omental a.
brs. near the greater anastomoses with the
curvature; greater right gastro-omental a.
omentum near the greater
curvature of the
stomach; also known
as: left gastroepiploic a.

Right gastro-omental gastroduodenal a. gastric brs., omental lower part of the pyloric right gastro-omental a
brs. region of the stomach, anastomoses with the
right part of greater left gastro-omental a.
curvature of the near the greater
stomach, greater curvature of the
omentum stomach; also known
as: right gastroepiploic
a.

Gastroduodenal common hepatic a. supraduodenal aa., upper duodenum, upper gastroduodenal a.

retroduodenal aa., part of the head of the supplies the lowest
posterior superior pancreas; greater portion of the foregut
pancreaticoduodenal a., curvature of the and its derivatives
anterior superior stomach on the right (Latin, duodeni = 12
pancreaticoduodenal a., each, the duodenum is
right gastro-omental a. about 12 finger breadths
long)
 Venous drainage from the stomach
Vein Branches Origin Dreinage Observation
gastric, left esophageal vv.; portal v. lesser curvature of left gastric v.
gastric brs. the stomach, lower communicates with
part of the the esophageal vv.,
esophagus forming a portal-
caval venous
anastomosis
(esophageal varices
when enlarged); the
left gastric v. and
right gastric v. are
together called the
coronary v. because
they form a circle

gastric, right gastric brs. portal v. lesser curvature of the left gastric v.
the stomach and right gastric v.
are together called
the coronary v.
because they form a
circle
the short gastric veins the splenic vein the splenic vein joins
left gastro-omental the splenic vein the superior
mesenteric vein (SMV)
to form the hepatic
portal vein
right gastro-omental the superior
mesenteric vein
prepyloric the right gastric vein Ascends over the
pylorus to the right
gastric vein. Because
this vein is obvious in
living persons,
surgeons use it for
identifying the pylorus.
 Lymph vessels and nodes of stomach

The stomach can be divided into three drainage zones

Area I the superior two-thirds drain along the left and
of the stomach right gastric vessels to
the aortic nodes
Area II the right two-thirds of drain along the right
the inferior one-third of gastro-epiploic vessels
the stomach to the subpyloric
nodes and
thence to the aortic
nodes
Area III the left one-third of the drains along the short
greater curvature of gastric and splenic
the stomach vessels lying in the
gastrosplenic
and lienorenal
ligaments, then, via the
suprapancreatic
nodes, to the aortic
group.
 NERVES OF STOMACH
The parasympathetic nerve supply of the stomach
is from the anterior and posterior vagal trunks and
their branches, which enter the abdomen through the
esophageal hiatus.
The anterior vagal trunk, derived mainly from the
left vagus nerve (CN X), usually enters the abdomen as
a single branch that lies on the anterior surface of the
esophagus. It runs toward the lesser curvature of the
stomach, where it gives off hepatic and duodenal
branches and the rest of the anterior vagal trunk
continues along the lesser curvature, giving rise to
anterior gastric branches.
 The larger posterior vagal trunk, derived
mainly from the right vagus nerve, enters the
abdomen on the posterior surface of the
esophagus and passes toward the lesser
curvature of the stomach. The posterior vagal
trunk supplies branches to the anterior and
posterior surfaces of the stomach. It gives off a
celiac branch, which passes to the celiac plexus,
and then continues along the lesser curvature,
giving rise to posterior gastric branches.
 The sympathetic nerve supply of the
stomach from the T6 through T9 segments of
the spinal cord passes to the celiac plexus
through the greater splanchnic nerve and is
distributed through the plexuses around the
gastric and gastroomental arteries.
Differences between gastric ulcer
and gastric cancer
Gastric ulcer
Gastric cancer