ANATOMY OF THE STOMACH

BY DR.(MRS) ABDUL-KAREEM
ANA 206
 INTRODUCTION
• The stomach is the first intra-abdominal part
of the gastrointestinal (GI), or digestive tract.
• It is a muscular , J-shaped organ, highly
vascular bag-shaped organ that is distensible
and may take varying shapes, depending on
the build and posture of the person and the
state of fullness of the organ .
• Ridges of muscle tissue called rugae line the
stomach.
 INTRODUCTION CONT.
• The stomach receives food from the esophagus. As
food reaches the end of the esophagus, it enters
the stomach through a muscular valve called the
lower esophageal sphincter.
• The stomach secretes acid and enzymes that digest
food.
• The stomach muscles contract periodically,
churning food to enhance digestion.
• The pyloric sphincter is a muscular valve that
opens to allow food to pass from the stomach to
the small intestine.
 FUNCTIONS
• The stomach has 3 main functions:
1. Temporary storage for food, which passes
from the esophagus to the stomach where it
is held for 2 hours or longer.
2. Mixing and breakdown of food by
contraction and relaxation of the muscle
layers in the stomach.
3. Digestion of food.
 LOCATION
• The stomach lies between the
esophagus and the duodenum
(the first part of the
small intestine).
• It is in the left upper part of the
abdominal cavity.
• The top of the stomach lies against
the diaphragm.
• Lying behind the stomach is the
pancreas.
• A large double fold of visceral
peritoneum called the
greater omentum hangs down
from the greater curvature of the
stomach.
 POSITION OF THE STOMACH
• In adult life , the stomach
is located at the level of
T10 and L3 vertebral
segment.
• Position of the stomach
varies with body habitus
• In general- it is fixed at
two points
– Proximally at the GE juction
– Distally by the
retroperitoneal duodenum
 SPHINCTERS OF THE STOMACH
• Two sphincters keep the contents of the stomach
contained:

1. The lower esophageal sphincter (found in the

cardiac region), at the junction of the oesophagus
and stomach, and
2. The pyloric sphincter at the junction of the stomach
with the duodenum.
 SECTIONS OF THE STOMACH
• Can be divided into
anatomic regions based
on external landmarks
– 4 regions
• Cardia
• Fundus
• Corpus (body)
• Antrum
 PARTS OF THE STOMACH
• Cardia- region just distal to
the GE junction.
• Fundus- portion above and
to the left of the GE junction
• Corpus (body) - region
between fundus and antrum.
• Antrum- bounded distally by
the pylorus
– Which can be appreciated
by palpation of a
thickened ring of smooth
muscle.
 RELATIONS OF THE STOMACH
• Anteriorly-it is in contact
with
 Left hemi-diaphragm,
 left lobe and anterior
segment of right lobe of
the liver and
 the anterior parietal
surface of the abdominal
wall
 RELATIONS
• Posteriorly- it is in
contact with
 Left diaphragm,
 Left kidney,
 Left adrenal gland
 and neck, tail and body
of pancreas
 RELATIONS
• The greater curvature is
near the transverse
colon and transverse
colon mesentery
• The concavity of the
spleen contacts the left
lateral portion of the
stomach
 ARTERIAL SUPPLY
• Arterial flow mainly derived from
Celiac Artery
– 3 Branches
1. Left Gastric Artery- Supplies the
cardia of the stomach and distal
esophagus.
2. Splenic Artery- Gives rise to 2
branches which help supply the
greater curvature of the stomach

1. Left
Gastroepiploic
2. Short Gastric
Arteries

3. Common Hepatic or Proper

Hepatic Artery.
 ARTERIAL SUPPLY
• Common Hepatic or
Proper Hepatic Artery-
-Gives 2 main branches-
1. Right Gastric- supplies a
portion of the lesser
curvature.
2. Gastroduodenal artery-
gives rise to right
gastroepiploic artery
which helps to supply the
greater curvature in
conjunction with left
gastro-epiploic artery.
 VENOUS SUPPLY
• In general, the
venous supply
parallel arterial
supply .
• Rt & left gastric
vein drain to the
portal vein.
• Rt gastroepiploic
drain to the SMV.
• Left gastroepiploic
drain to the splenic
vein.
 LYMPHATIC DRAINAGE
– Lymph from the
proximal portion of
the stomach drains
along the lesser
curvature first drains
into superior gastric
lymph nodes
surrounding the Left
Gastric Artery
– Distal portion of lesser
curvature drains
through the
suprapyloric nodes
 LYMPHATIC DRAINAGE
– Proximal portion of
the greater curvature
is supplied by the
lymphatic vessels that
traverse the
pancreaticosplenic
nodes
– Antral portion of the
greater curvature
drains into the
subpyloric and
omental nodal groups
 INNERVATION
 The main innervations are
the right & left vagus
nerves.
 Left and Right Vagus Nerves
descend parallel to the
esophagus within the
thorax before forming a
peri-esophageal plexus
between the tracheal
bifurcation and the
diaphragm
 From this plexus, two vagal
trunks coalesce before
passing through the
esophageal hiatus of the
diaphragm
 NERVE SUPPLY
• Left (anterior) Vagus
Nerve
– Left of the esophagus • Right (posterior) Vagus
• Branches Nerve
– Hepatic Branch – Right of the
» Supplies liver esophagus
and Biliary • Branches
Tract – Celiac
– Anterior gastric – Posterior
or Ant. Nerve of Latarget
Latarget
» Innervates
posterior
gastric wall
 INNERVATION
• Parasympathetic
innervation of Stomach-
Vagus Nerve
– 90% of fiber in vagal trunk
is afferent (info
transmitting from
stomach to CNS)
• Sympathetic innervation
of Stomach- Splanchnic
Nerve, mainly from the
coeliac ganglia
– Derived from spinal
segement T5-T10
 CLINICAL SIGNIFICANCE
• Gastroesophageal reflux: Stomach contents, including acid, can
travel backward up the esophagus. There may be no symptoms, or
reflux may cause heartburn or coughing.
• Gastroesophageal reflux disease (GERD): When symptoms of reflux
become bothersome or occur frequently, they’re called GERD.
• Dyspepsia: Another name for stomach upset or indigestion.
• Gastric ulcer (stomach ulcer): An erosion in the lining of the
stomach, often causing pain and/or bleeding. Gastric ulcers are
most often caused by NSAIDs or H. pylori infection.
• Peptic ulcer disease: Doctors consider ulcers in either the stomach
or the duodenum (the first part of the small intestine) peptic ulcer
disease.
• Gastritis: Inflammation of the stomach, often causing nausea
and/or pain. Gastritis can be caused by alcohol, certain
medications, H. pylori infection, or other factors.
 CLINICAL SIGNIFICANCE
• Gastric cancer :Gastric cancer is an uncommon form of cancer in
the U.S. Adenocarcinoma and lymphoma make up most of the
cases of stomach cancer.
• Zollinger-Ellison syndrome (ZES): One or more tumors that
secrete hormones that lead to increased acid production. Severe
GERD and peptic ulcer disease result from this rare disorder.
• Gastric varices: In people with severe liver disease, veins in the
stomach may swell and bulge under increased pressure called
varices, these veins are at high risk for bleeding, although less so
than esophageal varices are.
• Stomach bleeding: Gastritis, ulcers, or gastric cancers may bleed.
• Gastroparesis (delayed gastric emptying): Nerve damage from
diabetes or other conditions may impair the stomach’s muscle
contractions. Nausea and vomiting are the usual symptoms.
 HISTOLOGY OF THE STOMACH
• Like other part of the
GIT , the stomach consist
of 4 layers:
1. An outer mucosa
2. Inner submucosa
3. Muscularis external and
4. Serosa.
 OUTER MUCOSA
• Compose of
 Epithelium (simple
columnal)for
absorption/secretion.
 Laminal propria
compose of L.C.T of thin
layer of smooth muscle
called muscularis
mucosa separating it
from the submucosa
and glands which differ
in each histological
region of the stomach.
 SUBMUCOSA LAYER
• Lies under the
mucosa
• Consists of fibrous
C.T separating the
mucosa from the
next layer.
• Present here also is
the Meisner’s
plexus.
 MUSCULARIS EXTERNA
• Lies beneath the submucosa
• Consists of 3 layers:
1. Inner oblique
2. Middle circular
3. Outer longitudinal.
• Auerbach’s plexus (AKA
myenteric plexus) is found
between the outer
longitudinal and middle
circular and is responsible
for the innervation of both
layers causing peristalsis and
mixing.
MUCOSA OF THE STOMACH
 SEROSA
• Consist of C.T
continuous with the
peritoneum.
LAYERS OF STOMACH
 GASTRIC CELLS
• Different glands with different
types of cells are found at
different regions of the
stomach.
• E.g :
1. Enteroendocrine cells(APUD)
cells are found at
cardia,fundic & pyloric region
2. Chief(zymogenic cells) are
found at cardiac region only.
3. Parietal(oxyntic) cells are
found at at fundic regon.
4. Foveolar cells are found at
fundic ,cardiac & pyloric
region.
 GASTRIC CELLS
• All these cells stain
differently & secretes
different hormones e.g.
1. Parietal cells are
acidophilic and
secretes gastric acids
and intrinsic factors.
2. Chief cells are
basophilic and
secretes pepsinogen
and gastric lipase.
THANK U FOR YOUR ATTENTION