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Anatomy of stomach and its relations PowerPoint Presentation

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Published on : Jul 10, 2021 | Views : 2588 | Downloads : 12

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Slide 1-

Anatomy of stomach and its relations By Praveen Panicker
Slide 2-

Most dilated part of GIT Occupies in the epigastric, umbilical &left hypochondral areas Occupying a recess bounded by upper abdominal viscera, completed above& anterolateraly by anterior abd wall &diaphragm STOMACH(ventriculus/gaster)
Slide 3-

Parts of stomach
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Roughly J Shaped at rest Size and Shape varies with a) Volume of food or fluid it contains b) Position of body c) Phase of respiration High and transverse in obese and short persons Elongated in thin persons Stomach
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Mean capacity 30ml at birth 1000ml at puberty 1500ml at adult 2 OPENINGS 2SURFACES 2BORDERS
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Gastric orifices Cardiac orifices Situated to the left of midline behind 7th costal cartilage 2.5cm from its sternal junction at the level of T11 10 cm from ant abd wall 40 cm from incisor teeth
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Pyloric orifice Can be identified by prepyloric vein crossing its anterior surface vertically 1.2cm to right of midline in trans pyloric plane provided the body is supine & stomach is empty
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Gastric curvatures Lesser curvature Extends b/w cardiac & pyloric orifice forming right border Incisura angularis is a notch in the most dependent part ,its position varies with gastric distension Gives attachment to lesser omentum
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4 to 5 times longer than lesser curvature Starts at cardiac incisure Arches upwards & postero laterally & to Lt Highest convexity is fundus Lt 5th ICS Finally turns right to end at the pylorus Attachments Lt of fundus & adjoining body - gastrosplenic lig. Beyond this - greater omentum Greater curvature
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Gastric surfaces Antero superior Postero inferior Antero superior surface Lt part of this surface is posterior to Lt costal margin & in contact with diaphragm. It is related to costal attachments of upper fibers of transverse abdominis which separate it from7th to 9th costal margin
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Upper &Left part of this surface becomes postero lateral & is in contact with spleen’s gastric surface Rt half of this surface is related to Lt & quadrate lobe of liver & ant abd wall Whole of the surface is covered by peritoneum. part of greater sac separate it from above structures
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Postero inferior surface Related to STOMACH BED diaphragm Lt suprarenal gland upper part of front of left kidney splenic artery anterior pancreatic surface colic flexure together with transverse mesocolon
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This surface is also covered by peritoneum except near the cardiac orifice where a small triangular area contacts diaphragmatic crus
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INTERIOR OF STOMACH A large globular Lt part & a narrow tubular Rt part
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Gastric micro structure Mucosa Sub mucosa Muscularis externa Serosa Mucosa Thick, smooth surface, velvetty Reddish brown to pink in colour
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In contracted state mucosa is folded to form RUGAE. They are Longitudinal & more marked towards pyloric & greater curvature Actually they are large folds in sub mucosal connective tissue Obliterated when stomach is distended
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MUCOSA Epithelium Lamina propia Muscularis mucosa
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Epithelium Appears as honey combed due to small gastric pits (foveola). Base of gastric pits (foveola) receives gastric glands which extend deep into lam propria Epithelium simple columnar mucous cells
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Gastric glands cardiac Principal pyloric Principal Found In body & fundus Cardiac glands Situated near the cardia Pyloric glands numerous mucous & entero endocrine cells predominate
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Principal Highly differentiated Found In body & fundus Are made of different types of cells Chief Parietal Mucous Stem Entero endocrine
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these cells undergo constant replacement (3 to 7 days)
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Cardiac glands Situated near the cardia Mucous secreting cells predominate Pyloric glands numerous mucous & entero endocrine cells predominate
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Lamina propria Found in b/w the glands Contain gastric follicles which are aggregations of lymphoid tissue A periglandular vascular plexus is also present
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Muscularis mucosa Inner circular Outer longitudinal Ext circular in some places Sub mucosa Loose connective tissue Collagen, elastin,sub mucosal plexus of stomach
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Muscularis externa From within outwards layers are Oblique fibres Circular longitudinal
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Oblique fibres Limited to gastric body Most developed near the cardiac orifice Circular fibres Form a uniform layer external to oblique fibres At the pylorus form annular pyloric sphincter
Slide 30-

Longitudinal fibres Arranged in 2 groups 1st set radiates from cardiac orifice, best developed along the curvatures 2nd set commence in the body, passes to right, some fibres pass to duodenum, deeper fibres interlace with pyloric sphincter Muscle action upper region of stomach forms an area of storage, lower region has a pump like axn mixing & delivering the contents to duodenum
Slide 31-

Gastric vessels Left gastric artery Rt gastric artery Lt & Rt gastro epiploic artery Short gastric artery
Slide 32-

These form anastomosis in all layers, forming sub serosal, intramuscular & sub mucosal plexus ;from these anterior & posterior branches arise Mucosal arteries usually arise from sub mucosal plexus. But along the curvatures they arise directly from sub serosal arteries without anastomosing with other plexus. So that these are more vulnerable to ischemic injury
Slide 33-

pyloric region is supplied by pyloric arteries (br of rt gastric & gastroepiploic) where they form a submucosal plexus. They also anstomose with Duodenal & gastric arteries Arterioles from Submucosal arterial plexus penetrate the mucosa & branch to form capillary beds which drain to sub mucosal venous plexus
Slide 34-

This rich lumen directed blood flow enablesHCO3- generated basally by the parietal cells as a counterpart of their secretion of acid to be carried into apical part in order to protect the cells from acid damage Fenestrated capillaries also facilitate delivery of HCO3- In antrum where HCO3- secreting parietal cells are few blood supply is increased in order to facilitate removal of acid
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Gastric nerves Parasympathetic sympathetic [ vagus] Anterior br Posterior br (frm rt vagus) ( frm Lt vagus)
Slide 36-

Gastric Anterior nerve Pyloric Gastric nerve radiates on anterior surface of body &fundus One br which is larger near lesser curvature is called greater anterior gastric N (anterior nerve of latarjet)
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Pyloric br 2 in no: one which traverses the lesser omentum almost horizontally to Rt, then turns down on the left side of hepatic artery to reach pylorus Other arises from greater anterior gastric nerve & passes obliqly to pylorus
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Posterior Gastric coeliac Gastric Radiate over the posterior surface of body & fundus upto pyloric antrum Largest pass along lesser curvature Greater posterior gastric nerve Coeliac Pass to coelic plexus
Slide 40-

Sympathetic supply From Coeliac plexus Hepatic plexus Lt phrenic plexus Inconstant brs Lt thorasic nerve, thorasic & lumbar trunks Form Sub mucosal plexus of Meissner Myentric plexus of Auerbach
Slide 41-

Lymphatics are continous with that of oesophagus & duodenum Arranged in 4 groups 1st gp accompany Lt gastric artery. Receives a large area on both gastric surface. They end in Lt gastric nodes 2nd gp short gastric & Lt gastro epiploic arteries. Drains Left of the vertical from oesophagus. End in pancreaticosplenicnode
Slide 42-

3rd gp drains Rt half of grtr curvature as far as pylorus. End in Rt gastro epiploic nodes which drain to pyloric nodes 4th gp Pylorus Drains to hepatic, pyloric & Lt gastric nodes
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LYMPH NODES ON POTERIOR SURFACE
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Although these vessels communicate, their valves direct lymph from Rt part of stomach towards lesser curvature. From Lt side to greater curvature
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Important Lymph node stations-(Japanese)
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PHYSIOLOGY Parietal cells HCL & IF Chief cells pepsinogen ECL histamine
Slide 49-

Gastric secretions 2500 ml/day Contents cations Na,K,Mg,H+ anions Cl,HPO2,so4 pepsin lipase Mucus IF
Slide 50-

MUCOSAL BARRIER Formed by mucous & HCO3- Mucous made of glycoprotein forms a flexible gel coat They also protect duodenal mucosa Their stimulation is augmented by prostaglandin Trefoid peptides also provide protection
Slide 51-

HCL SECRETION H+ -K+ ATPase in the apical membrane of parietal cells pumps H+ against concentration gradient. When stimulated tubulo vesicular structures inside the parietal cell move to apical membrane & fuse with it thus inserting more H+ -K+ ATPase (which are present in the walls of tubulo vesicular structures )
Slide 52-

Regulation of acid secretion H+ -K+ ATPase is activated by Histamine Ach secretogouges Gastrin which act through their receptors Histamine play the dominant role Ach & Gastrin act partly directly & partly indirectly by releasing histamine
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Slide 54-

Regulation of gastric secretion Cephalic influence Gastric influence Intestinal influence
Slide 55-

Gastric motility & emptying The pacemaker of gastric muscle action is called gastric pacemaker cells of Cajal situated in the FUNDUS of the stomach They are located in the outer circular muscle layer near the myentric plexus They initiate the basic electrical rhythm
Slide 56-

Gastric motility & emptying When food enters the stomach fundus & upper part of body relax & accommodate the food called receptive relaxation This is vagally mediated & triggered by movement of pharynx & oesophagus Soon after, peristaltic waves settle in distal stomach, mixing & grinding the food permitting semi liquid portion to enter the duodenum
Slide 57-

The contraction of distal stomach caused by each peristaltic waves is called antral systole & can last upto 10 seconds. In regulation of gastric emptying antrum, pylorus & upper duodenum act as a single unit. In antrum partial contraction ahead of advancing gastric contents prevent solid masses from entering duodenum
Slide 58-

Regurgitation from duodenum will not occur because contraction of pyloric segment tends to persist longer than that of duodenum Hunger contractions Gastric contractions in b/w meals sometimes be felt, sometimes mildly painful
Slide 59-

Rate at which stomach empties into duodenum depends on Type of food Oncotic pressure of food Type of food food rich in carbohydrate leaves the stomach in few hrs, protien rich food leaves more slowly, slowest for fat. Oncotic pressure of food Hyperosmolarity of duodenal contents gastric emptying
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Thank you