STOMACH

*Site: In the left hypochondrium , epigastric &

umbilical regions.

*Shape: It has 2 ends, 2 borders and 2 surfaces:

)Ends: a
1 - C ardiac end : At the junction with oesophagus. It does
not have an anatomical sphincter (only physiological). It
lies at the level of left 7th c.c. 1 inch to left side of rnidline,
45 cm from incisors, 10 cm deep to ant. abdominal wall.
The lower esophageal sphincter & the cardia are
controlled by many physiological factors :
 The valve like action of the acute gastro-oesophageal angle
( angle of His ).
 Pinch like action of the right crus of the diaphragm.
  The mucosal rossette of the upper end of the stomach
forming a plug to the lower end of the oesophagus.
 The abdominal part of the oesophagus is subjected to high
positive intra-abdominal pressure.
 The circular muscle fibres of the fundus of the stomach
encircle the lower end of the oesophagus. During gastric
contraction, these fibres prevent gastro-oesophageal reflux.
2- Pyloric end: It has an anatomical sphincter (thick circular
muscle layer ) . It lie at the level of Ll vertebra ( trans-pyloric
plane ) 1 inch to right of midline. It can be detected during
operation by pyloric constriction , prepyloric vein of Mayo &
feeling the thickened pyloric sphincter.
b)Borders:
1. Lesser curvature: Is the right concave border of stomach. It
presents a notch known as angular notch or incisura angularis.
It gives attachment to the lesser omentum.
2. Greater curvature: Is the left convex border of stomach. It
presents a notch at the gastro-esophogeal junction known as
cardiac notch or incisura cardia. It gives attachment to greater
omentum, gastro-splenic & gastro-phrenic ligaments.
c) Surfaces :
1. Antero-superior surface: Related to liver, diaphragm &
anterior abdominal wall.
 *Relations of Stomach*
Pericardiu
m & heart
Diaphrag
.m

Fundus
of
stomac
h
Costal
margin

Left
lobe of
liver
Stoma
ch

Relations of antero-superior surface

2. Postero-inferior surface: Structures related to this surface
form "stomach bed" which include left crus of diaphragm,
left suprarenal gland , left kidney, splenic artery , spleen ,
anterior surface of body of pancreas, transverse colon and
mesocolon. The lesser sac separates between the stomach &
its bed.

STOMACH BED
* Subdivisions:
a) Fundus : Above level of cardiac orifice.
b) Body : Between level of cardiac opening & imaginary vertical
line between angular notch & the corresponding point on the
greater curvature.
c) Pyloric portion: 3 parts:
1. Pyloric antrum: Is a dilated part below the body.
2. Pyloric canal: Is the terminal 1 inch of stomach.
3. Pyloric sphincter.
* Blood supply:
a) Arteries:
1. Along greater curvature: right gastroepiploic (from
gastroduodenal artery), left gastroepiploic & short gastric
arteries (from spelenic artery )
2. Along lesser curvature: right gastric artery (from hepatic
artery ) & Lt. gastric artery (from coeliac trunk).

Abdominal Oesophageal branch

Aorta .of Lt. gastricA
coliac trunk .Lt. gastric A
.Hepatic A
Short gastric arteries
.Rt. gastric A
Spleen
Gastro-
.duodenal A
Splenic A. &
its terminal
branches

Left gastro-
.epiploic A
Rt. gastro-
Superior pancreatico- .epiploic A
.duodenal A

.Arterial Supply of the Stomach

b) Veins:
1. Right & left gastric veins: Drained into portal vein.
2. Left gastro-epiploic vein & short gastric veins: Drained into
splenic vein.
3. Right gastro-epiploic vein: Drained into superior mesenteric
vein.
 Applied Anatomy:
1) Left gastric and short gastric veins receiving oesophageal
veins draining abdominal part of oesophagus (portal)
which anastomose with oesophegeal
.Rt. gastric V .Oesophagealveins
V (tributaries of
azygos veinsV) draining thoracic partShort
.Left gastric of oesophagus
gastric
(systemic). In portal hypertension, opening vein of this porta-
.Portal V
systemic anastomosis results in gastric and oesophageal
Spleen
varices.
2) The stomach has very rich blood supply and it is found
that it can depend only on right gastro-epiploic vessels.
This is the principle of poro-systemic disconnection
operations to treat oesophageal varices.
Left gastro-
.epiploic V

Prepyloric Right gastro-

Superior V. of Mayo .epiploic V
.Mesenteric V

Venous Drainage of the Stomach

 Lymphatic drainage:
* Afferent lymphatics communicate freely in the stomach wall.
* Lymphatics from the anterior and posterior surfaces of the
stomach pass towards its curvatures where lymph nodes are
located along the arteries supplying the stomach and have the
same names.
* The cardia is drained by the paracardiac (Para-oesophageal)
lymph nodes which lie around the cardia and lower end of the
oesophagus.
* Fundus of the stomach is drained by splenic lymph nodes
( which lie in the gastrasplenic ligament and hilum of the spleen) &.
left gastroepiploic .Efferent lymphatics from these lymph nodes
pass to the pancreatico- splenic lymph nodes along the splenic
artery and upper border of the pancreas.
 hpmyl citroa -erP fo puorg caileoC (
loop lanif) sedon
()
cirolyP *puorg caidrac -araP
thgiR *
puorg. cirtsag puorg cirtsag .tL. *
-arpuS puorg
cirolyp
puorg

-ocitaercnaP *
puorg cinelps
-ortsag tfeL
-ortsag .tR *
puorg ciolpipe
cirolyp -buS puorg ciolpipe
puorg caidrac -araP
hpmyl caileoC sedon hpmyl.
sedon
* Lymph Drainage of the Stomach *
-ocitaercnaP
cirtsag .tL & .tR hpmyl cinelps
sedon hpmyl sedon

neelpS
hpmyl cirolyP -ortsag tfeL
sedon puorg ciolpipe
-ortsag .tR
hpmyl ciolpipe
sedon
* The remaining part of the greater curvature and adjoining part
of the stomach are drained into the left and right gastroepiploic
lymph nodes which lie on the left and right gastroepiploic arteries
respectively between the anterior 2 layers of the greater omentum.
* The lesser curvature and adjoining part of the stomach are
drained by the left and right gastric lymph nodes which lie along
the left and right gastric vessels respectively between the 2 layers
of the lesser omentum.
* The pyloric region is drained by right gastric, right
gastroepipoic, subpyloric, retropyloic and suprapyloic lymph
nodes. The later nodes are related to the pyloric end of the
stomach and beginning of the duodenum along gastoduodenal
artery.
* From the previously mentioned groups, lymphatics converge
more proximally to end mainly in the coeliac lymph nodes. Some
lymphatics may also pass to the superior mesenteric lymph
nodes.
* Applied anatomy:
1) A sound knowledge of the lymphatic drainage of the stomach is
essential for proper treatment of its cancer.
2) From coeliac lymph nodes, malignant cells can spread to
cysterna chyli  thoracic duct  retrograde lymphatic
permeation may spread to left supraclavicular lymph nodes
(Virchow's glands).
3) From coeliac lymph nodes, retrograde spread of malignant cells
in the lymphatic around the hepatic artery leading to
enlargement of lymph nodes in the porta hepatis.
4) Retrograde spread of malignant cells from lymph nodes in the
porta hepatis may lead to liver metastases or spread in the
lymphatics in the falciform ligament around the ligamentum
teres  malignant nodule in the umbilicus called sister Joseph
nodule.
5) To ensure removal of lymph nodes in gastric malignany,
radical surgery should include removal of lesser and greater
omenta as well as gastro- splenic ligament and spleen.
 Nerve supply:
1. Parasympathetic supply: Anterior & posterior vagi carry
motor parasympathetic & secretory fibres to the stomach.
· The anterior vagus gives a hepatic branch to the liver &
biliary passages which is motor & secretory to G.B.
· The posterior vagus gives coeliac branch which goes to
the coeliac plexus to share in the innervation of the gut to
the right 2/3 of transverse colon.
  Each vagus gives gastric branches to the fundus and body
of the stomach which are responsible for HCl secretion .
· Each vagus end as the nerve of Latarjet which is the
pyloric branch of the vagus nerve which is motor to the
pyloric antrum & relax the pyloric sphincter and
responsible for gastric evacuation.
 The main trunks as well as the nerves of Latarjet provide
the stomach with preganglionic fibres that relay in
ganglia within the stomach wall.
 Applied anatomy:
- Vagotomy may be indicated in cases of peptic ulcer to
diminish gastric acid secretion.
2) Sympathetic nerve supply:
 It is from the greater splanchnic nerves, then the coeliac
ganglion.
 Postganglionic fibres reach the stomach along its arteries.
 Afferent fibres carry visceral pain sensation from the stomach
appear to be carried with sympathetic nerves.