- Cardiac end of stomach where oesophagus continues as stomach
- It is 40cm from incisor teeth
- Cardiac end of stomach lies on the left 7th costal cartilage.
- Pyloric End corresponds to transpyloric plane i.e., L1
- This is the pyloric end which is very thick where you can see the star shaped sphincter inside- due to circular smooth muscles.
- It continues as D1
- 2 curvatures- lesser and greater
- 2 surfaces-
- anterosuperior –
- Related to liver
- Posteroinferior-
- Related to stomach bed structures-
- Pancreas
- Splenic artery over the superior border of the pancreas
- Spleen
- Transverse and mesocolon
- Splenic flexure
- Left kidney
- Left supra renal gland
- Diaphragm
- Related to stomach bed structures-
- anterosuperior –
- Parts of stomach-
- Fundus
- Body
- Pylorus-
- Pyloric antrum
- Pyloric canal
- Pyloric sphincter
- Incisura angularis- along the lesser curvature a turn/flexure present.
- Blood supply-
- Lesser curvature-
- Left and right gastric arteries
- Greater curvature-
- Lower part- Left and right gastro epiploic arteries
- Near fundus- short gastric arteries
- Lesser curvature-
- Venous drainage-
- All lesser curvature veins go to portal vein
- Greater curvature-
- Left gastroepiploic vein-> splenic vein-> portal vein
- Lymphatic drainage-
- Left- pancreatico splenic nodes
- Lower part- pyloric nodes and gastric nodes
- Upper nodes- hepatic nodes
- All drain into- coeliac nodes->
- cysterna chyli-
- a lymph trunk in the posterior abdominal wall
- Enters into the abdomen as thoracic duct-
- Thoracic duct further drains in between->
- Left internal jugular vein
- Left subclavian vein
- Thoracic duct further drains in between->
- pre-aortic nodes
- cysterna chyli-
- Gastric tumor/carcinoma path-
- Coeliac node -> cysterna chyli -> thoracic duct ->enlarged nodes in the left supraclavicular region(Virchow’s Node), and the enlarged sinus is called Trousseaus Sign
- Nerve supply-
- Anterior and posterior vagal trunk
- Parasympathetic supply- vagus
- Sympathetic- T4 to T7 nerves
- Anterior vagal trunk branches-
- Branch to liver- Hepatic branch
- Body of stomach to produce acid- Gastric branch
- Pyloric End- Nerve of Latarjet
- Posterior vagal Trunk-
- Celiac branch to Celiac trunk-
- Largest nerve of this branch- Criminal Nerve of Grassi
- Body of stomach for acid secretion
- Minimal branches to Pylorus of stomach
- Celiac branch to Celiac trunk-
- To decrease gastric secretion-
- Don’t cut main vagal trunk-
- Will also disturb bile secretion through hepatic branch
- Only cut Gastric branch- Highly selective Vagotomy
- Don’t cut pyloric trunk as well
- Don’t cut main vagal trunk-
- Along lesser curvature-
- Gastric canal, more prone for ulcer.