Stomah,Small Intestine

8/8/2019 Stomah,Small Intestine

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Stomach Stomach is the most dilated part of the alimentary tract.

It extends from the cardiac end

( 7th costochondral junction ) to the pyloric end (point 2.5cm to the right of midline on the transpyloric plane)

Upper end continues with esophagus

Lower end continues with the duodenum..


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Shape : pear shaped

Upper part is broader than the lower part It has 2 ends

Cardiac end, pyloric end

two surfaces:

Anterior and posterior

Two curvatures

Lesser curvature and greater curvature


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Sub-divisions

Fundus is the dilated upper part

Body is between the fundus and the incisura

angularis.(Lesser curvature)

Pylorus: the body continues as the pyloric part and it has

pyloric antrum- a proximal dilated portion

Pyloric canal

Pyloric sphincter, the thickened distal end of the canal.


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Stomach


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Relations

Lesser curvature gives attachment to lesser omentum (which stretches

towards the liver.)

It encloses the right and left gastric arteries and formanastomotic channels.

Greater curvature-

It gives attachments to the following peritoneal folds fromabove downwards

1.Gastrophrenic ligament from fundus(cardiac orifice) to

diaphragm 2.Gastrosplenic omentum, from fundus to hilum of

spleenEncloses short gastric arteries from splenic artery.


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3.Greater omentum (from G.C to transverse colon.

Encloses right and left gastroepiploic areteries.

Relations

Anterior surface:

1.left lobe of liver (inferior surface)

2. Diaphragm which separates it from the 7

th

and 8

th

ribsand their costal cartilages.

3. Anterior abdominal wall

4.Gastric area of the spleen(upper left corner of the

anterior surface of the stomach)

Posterior surface

Structures related to the posterior surface is known as

stomach bed.


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Stomach bed structures

1.Head,neck and body of pancreas 2.Root of transverse mesocolon

3.transverse colon

4.upper part pf the anterior surface of the left kidney

5. Anterior surface of the upper of the left suprarenal.

6.splenic artery running along the upper part of the body ofpancreas.

7.diaphragm

8. The gastric surface of spleen

The spleen is separated from the stomach by the greatersac of peritoneum while all the other other structures areseparated by the lesser sac.


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Blood supply

The following arteries supply 1.left gastric artery- a branch from coeliac axis descends

along the lesser curvature between the layers of the lesseromentum.

2.Right gastric artery-branch of hepatic artery run along

lesser omentum. The two arteries anastomose to form a chain.

3. Left gastroepiploic artery- a branch of the splenic arterydescends in between the layers of greater omentum alongthe greater curvature.

4. Right gastroepiploic artery- branch of gastro duodenal-run along greater curvature- between the layers of thegreater omentum.


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blood supply


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5.short gastric arteries- branch from gastro duodenal- run

along the greater curvature between the layers of thegreater omentum.

They reach the stomach through the gastrosplenicomentum.

venous drainage

1. Right and left gastric veins-lesser curvature- ends inportal vein.

2.right and left gastroepiploic veins-greater curvature-

The right vein ends in superior vein and the left ends insplenic vein.

3.Short gastric veins- 4 or 5 drain the fundus of thestomach pass along the gastrosplenic omentum and endsin splenic vein.


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4. Prepyloric vein of Mayo

Cross anterior surface of pylorus and connects the right

gastroepiploic vein with the right gastric vein or portal

vein.

It helps to identify the pylorus in the living.

Lymphatic drainage

There are four lymphatic zones The whole surface is

divided into right and left zones.

The right zone is unequally divided into a larger upper

zone A, and a smaller B zone. The left zone is divided into two equal parts, the upper C

and the lower D


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zone A drains into superior gastric nodes.

Zone B drains into lower hepatic group Zone C drains into splenic nodes

Zone D drains into sub pyloric nodes.

Nerve supply

Sympathetic from T6-10-via coeliac plexus

- are vasomotor, motor to pyloric sphincter, but inhibitoryto other parts of the gastric musculature and carries painimpulses from the stomach

Parasympathetic- gastric nerves- branch from vagus.

Anterior gastric nerve is a branch from left vagus andposterior gastric nerve is a branch from right vagus.

-increase the motility of the stomach and the secretion ofgastric juice rich in pepsin and HCL


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Interior of the stomach

The mucosa of the stomach is thrown into irregular folds

called gastric rugae.

The rugae get flattened when the stomach is distended.

there are 2 longitudinal folds in the gastric mucosa along

the lesser curvature form a canal- the gastric canal

(Magenstrasse)- allow the rapid passage for the fluids

directly to the lower part of the stomach.

Thus the lesser curvature bears the maximum insults of the

swallowed liquids, which makes it vulnerable to ulcers.


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DUODENUM Duodenum is the most fixed part of the small intestine.

It extends from the pylorus to the duodenojejunal flexure.

It is situated in the posterior abdominal wall It is C shaped- the concavity is directed upwards and to the

left.

Length is 25 cm and width 3.75cm.

It is the widest part of the small intestine. Subdivisions

It is subdivided into 4 parts


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First part- 5 cm, extends from the pyloric junction,

to the right side and form a superior duodenalflexure

Second part-7.5 cm in length, extends verticallydownwards on the right side of the vertebral

column from the superior duodenal flexure to thelevel of the third lumbar vertebra

Third part-10cm, extends transverse fromL3 tothe left side of the vertebra.

Fourth part 2.5 cm, ascends up vertically on theleft side from the level of L2 and continuous withjejunum.


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Relations

Relations

1stpart- first 2.5 cm is completely covered by peritoneum.

Post.surf related to lesser sac which separates the head ofpancreas.

2nd 2.5 cm is anteriorly covered with peritoneum

Above and anteriorly- quadrate lobe of liver

Above and posteriorly opening of lesser sac.

Posteriorly

Gastroduodenal trunk, bile duct, portal vein and IVC

Below head of pancreas


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II part

Anteriorly-covered with peritoneum except where it is

crossed by transverse mesocolon.

Right lobe of liver

Coils of small intestine

Posteriorly: covered by peritoneum

Hilum and anterior surface of right kidney Structures entering and leaving the hilum (right renal

vessels and pelvic part of ureter.

Laterally:rt.kidney, right colic flexure.

Medially:Head of pancreas, ampulla of vater pierces thewall of the 2ndpart of duodenum-major duodenal papilla. Itis guarded by a valve called as hood of monk.

Opening of accessory pancreatic duct in the minorduodenal papilla, if it is present.


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Opening of bile duct


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III part:

Peritoneum covers except where it is crossed by and its

contents(superior mesenteric vessels and nerves)

Coils of small intestine

Posteriorly:

It crosses the following structures from right to left.

1.right ureter

2.right psoas major

3.IVC

4.right testicular or ovarian vessels. 5.abdominal aorta

6.Inferior mesenteric artery


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Above: lower border of head of pancreas, uncinate process

Below; peritoneum, small intestine IV part:

Right side: abdominal aorta

Left side: left kidney and ureter

Anteriorly: peritoneum,coils of jejunum. Posteriorly

Left psoas muscle

Left renal artery

Inferior mesenteric vein

Left testicular or ovarian vessels

Left sympathetic chain


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Suspensory muscle of the duodenum(ligament of Treitz)

From right crus of diaphragm to the duodenojejunalflexure.

It runs behind the head of the pancreas but in front of theaorta and encircle the coeliac axis.

Duodenojejunal flexure, where the fourth part of

duodenum continuous as jejunum It is at the L2 level.

Superiorly: root of transverse mesocolon and body ofpancreas

Posteriorly:inferior mesenteric vein

Medially: abdominal aorta, root of mesentery

Anteriorly:continuous as jejunum


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Blood supply:

Supraduodenal Retro duodenal

Recurrent duodenal branches of gastro duodenal artery

Supra duodenal artery branches are end arteries necrosisof the mucosa- ulcer formation.

Most common part of ulcer formation is the 1st part.

II,III,IV parts are supplied by superior and inferiorpancreatico duodenal arteries , superior mesenteric artery.

Venous drainage: corresponding veins-splenic,superior

mesenteric and portal veins Nerve supply:sympathetic- from T1-9 and parasympathetic

by vagus.

Lymphatic drainage

Pancreatico duodenal nodes


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Small intestine

The coils of jejunum and ileum are suspended by mesentryfrom the posterior abdominal wall and are freely movable

Extent:jejunum starts from duodeno jejunal flexure L2 and

forms 3/5 of small intestine

and 2/5 form the ileum. It ends in the ileocaecal junction.


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intestine


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FATTY ABSORPTION


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DIFFERNCE BETWEEN JEJUNUM AND

ILEUM

colour

Thickness of

wall

JEJUNUMred

thick

ILEUMpale

thin

Mesentry

1.presence of fat

2.presence of

lymph nodes

less

less

more

more

arteries larger vasa

rectae arteries

window spaces-

lar e

shorter vasa

rectae arteries

window spaces-

smaller


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DIFFERENCE BETWEEN SMALL AND

LARGE INTESTINE

LARGE INTESTINE

1. APPENDICES

EPIPLOICAE PRESENT 2.3 TAENIA COLI

PRESENT

3.COLON IS FIXED

EXCEPT TRANSVERSE

& PELVIC COLON

SMALL INTESTINE

ABSENT

ABSENT

FREE EXCEPTDUODENUM


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Meckls diverticulum or diverticulum ilei.

short, 2(5 cm) in length occurs in 2% of individuals

It is persisting proximal part of the vitellointetinal duct.

it may give rise to umbilical fistula, umbilical sinus, orcysts

mucosa of gastric or pancreatic in nature-lead to ulcerformation,perforation or diverticulitis

blood supply

12-15 branches from superior mesentric artery.

each branch divide into 2 and anastomose with each other.-to form one chain, from which series of straight arteriesarise called vasa rectae


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nerve- sympathetic from T9-10

parasympathetic-vagai lymphatics

mesentric nodes-aortic nodes


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Documents

Stomah,Small Intestine