21825067 Stomach and Duodenum 10 27

8/6/2019 21825067 Stomach and Duodenum 10 27

http://slidepdf.com/reader/full/21825067-stomach-and-duodenum-10-27 1/32

STOMACH

and

DUODENUM

NORMAN V.VALERA,M.D.



STOMACH

The expanded part of the digestive system between the esophagus and the small intestine

Acts as a food blender and reservoir, its chief function is enzymatic digestion. The gastric juice gradually converts a mass offood into a semi-liquid mixture, CHYME,which passes fairly quickly into duodenum.Can hold 2-3 liters of food.



PARTS, AND ANATOMY OF

STOMACH CARDIA: the part surrounding the cardial

orifice, the superior opening or inlet of the stomach.

FUNDUS: the dilated superior part that is related to the left dome of the diaphragm and is limited inferiorly by the horizontal plane of the cardial orifice. The cardial notch is between the esophagus and the fundus. The fundus usually lies posterior to the left 6th rib in the plane of MCL.



BODY: ma jor part of the stomach between the fundus and the pyloric antrum.

PYLORIC PART: The funnel-shaped outflow part of the stomach; its wider part, the pyloric antrum, leads into the pyloric canal, its narrower part. The pylorus is the distal, sphincteric region ofthe pyrloric part. It is a marked thickening of the circular layer of smooth muscle that co

ntro

ls dis

charge

ofthe

st

oma

ch

contents through the pyloric orifice intothe duodenum.



STOMACH CURVATURES

LESSER CURVATURE: forms the shorter concave right border of the

stomach. The angular incisure, the most inferior part of the curvature,indicates the junction of the body and the pyloric part of the stomach.

The angular incisure lies just to the left of the midline.



GREATER CURVATURE: forms the longer convex left border of the

stomach. It passes inferiorly to the left from the junction of the 5th

interostal spce and MCL, then curves to the right,passing deep to the 9th

or10th left cartilage as it continues medially to reach the pyloric antrum.



SURFACE ANATOMY OF THE

STOMACH



INTERIOR OF THE STOMACH



ARTERIAL SUPPLY OF THE

STOMACH



Arterial supply of the stomach arises from the celiac trunk and its branches.

Most blood is supplied by anastomoses

formed along the lesser curvarture by the right and left gastric arteries, and along the greater curvature by the right and left gastro-omental ( gastro-epiploic) arteries.The fundus and the upper body receive blood from the short and posterior gastricarteries.



VEINS OF THE STOMACH



The veins of the stomach paralleled the arteries in position and course.

The right and left gastric veins drain into the hepatic portal vein; the short gstric veins and left gastro-omental

veins drain into the splenic vein.

The right gastro-omental veinempties in the SMV.

A prepyloric vein ascends over the pylorus to the right gastric vein



ASTRIC LYMPHATIC VESSELS



Lymph from the superior two thirds of the stomach drains along the right and left gastric vessel to the gastric

lymph node; lymph from the fundus and superior part of the body of the stomach also drains along the short

gastric arteries and left gastro-omental vessels to the pancreaticosplenic lymph node



Lymph from the right two thirds of

the inferior third of the stomach drains along the right gastro-omental vessels to the pyloric lymph nodes.

Lymph from the left one third of the greater curvature drains to the pancreaticoduodenal lymph nodes,

which are located along th short gastric and splenic vessels



PARASYMPATHETIC NERVE

SUPPLY OF THE STOMACH

Anterior vagal trunk, derived mainly from the left vagus nerve (CN X). It runs toward the lesser curvature ofthe stomach, where it gives offhepatic and duodenal branches. The rest of the anterior vagal trunk

continues along the lesser curvature,giving rise to anterior gastricbranches



Posterior vagal trunk, derived mainly from the right vagus. It 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 gastricbranches.



SYMPATHETIC NERVE

SUPPLY OF THE STOMACH

From the T6- T9 segments of the

spinal cord passes to the celiacplexus through the greater splanchnic nerve and is distributed

through the plexuses around the gastric and gastro-omental arteries.





DUODENUM:DUODENUM:

First & shortest First & shortest part of part of the small intestinethe small intestine

Widest and fixedWidest and fixed part part

CC shaped,shaped, about about 1010inches long ( 25 cm )inches long ( 25 cm )

BeginsBegins at theat the pyloruspyloruson theon the R sideR side andand endsends

at theat the duodenojejunalduodenojejunal junction junction on theon the left sideleft side(( L2 vertebraL2 vertebra))



DIVISIONS:DIVISIONS:

Superior ( 1Superior ( 1stst ) part) part 5cm5cm& lies anterolat. to the body& lies anterolat. to the bodyof of L1L1

Descending ( 2Descending ( 2ndnd )) 7 to7 to

10cm & descends along the R10cm & descends along the Rsides of sides of L1 throughL1 through L3L3

Horizontal ( 3Horizontal ( 3rdrd )) 6 to6 to8cm & crosses8cm & crosses L3L3

Ascending ( 4 Ascending ( 4

thth

)) 5cm &5cm &begins at the L of begins at the L of L3L3 andand

rises superiorly as far asrises superiorly as far assuperior border of superior border of L2L2



SUPERIOR PART OF THE

DUODENUM

Ascends from the pylorus and is overlapped by the liver and gallbladder

Peritoneum covers its anterior aspecct,bare of peritoneum posteriorly

Proximal part has the hepatoduodenal ligament attached superiorly, and the

greater omentum attached to inferiorly



DESCENDING PART OF THE

DUODENUM

Runs inferiorly, curving around the head of the pancreas.

Bile and main pancreatic ducts enter its posteromedial wall. This duct s usually unite to form the hepatopancreatic ampulla, which opens on an eminence, called ma jor duodenal papilla

Entirely retroperitoneal



INFERIOR PART OF THE

DUODENUM

Runs transversely to the left, passing

over the IVC, aorta and L3 vertebra

Crosses superior mesenteric artery

and vein and the root of the mesentery of the je junum and ileum.



ASCENDING PART OF THE

DUODENUM

Runs superiorrly and along the left side of the aorta to reach the inferior border of the body of the pancreas.

Supported by the attachment of the suspensory muscle of the duodenum(

ligament of Treitz )



BLOOD SUPPLY:BLOOD SUPPLY:

Upper part Upper part superiorsuperiorpancreaticoduodenpancreaticoduoden

alal fromfromgastroduodenalgastroduodenal

Lower part Lower part inferiorinferiorpancreaticoduodenpancreaticoduoden

alal from superiorfrom superiormesentericmesenteric



VENOUS DRAINAGEVENOUS DRAINAGE

Superior Superior pancreaticoduodenpancreaticoduodenalal vein drains intovein drains into

portal veinportal vein Inferior Inferior

pancreaticoduodenpancreaticoduodenalal joins the superior joins the superior

mesenteric veinmesenteric vein



VENOUSVENOUS

DRAINAGE:DRAINAGE:

Superior Superior mesentericmesenteric veinveinw/c lies anterior andw/c lies anterior and

to the right of theto the right of theSMA in the root of SMA in the root of mesentery; endsmesentery; endsposterior to the neckposterior to the neckof pancreas where it of pancreas where it

unitesunites w/w/ splenicsplenicveinvein to form theto form theportal vein.portal vein.



LYMPHATICS

ANTERIOR LYMPHATIC VESSELS- drain into pancreaticoduodenal lymph nodes,located along the superior and inferior

pancreatoduodenal arteries, and into the pyloric lymph node( fig. 2.46)

POSTERIOR LYMPHATIC VESSEL- pass posterior to the head of the pancreas and

drain into the superior mesenteric lymph nodes.



EFFERENT LYMPHATIC VESSELSfrom the duodenal lymph nodes

drain into the celiac lymph nodes



NERVE SUPPLY

Derive from the VAGUS and GREATER and LESSER(ABDOMINOPELVIC) SPLANCHNICNERVES by way of the celiac and

superiormesenteric plexuses.

They are next conveyed to the duodenum via periarterial plexuses extending to the pancreaticoduodenal arteries.



HAV

E ANICE DAY !

Documents

21825067 Stomach and Duodenum 10 27