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 of food 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: major 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
of the pyrloric part. It is a marked
thickening of the circular layer of
smooth muscle that controls discharge
of the stomach contents through the
pyloric orifice into the 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 gastric
arteries.
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 vein empties
in the SMV.
 A prepyloric vein ascends over the
pylorus to the right gastric vein
GASTRIC 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 of
the stomach, where it gives off
hepatic and duodenal branches. The
rest of the anterior vagal trunk
continues along the lesser
curvature, giving rise to anterior
gastric branches
 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 gastric branches.
 SYMPATHETIC NERVE
SUPPLY OF THE STOMACH

 From the T6- T9 segments of the

spinal cord passes to the celiac
plexus through the greater
splanchnic nerve and is
distributed through the plexuses
around the gastric and gastro-
omental arteries.
 DUODENUM:
 First & shortest part of the
small intestine
 Widest and fixed part
 C – shaped, about 10
inches long ( 25 cm )
 Begins at the pylorus on
the R side and ends at the
duodenojejunal junction on
the left side ( L2 vertebra)
 DIVISIONS:
 Superior ( 1st ) part – 5cm &
lies anterolat. to the body of L1
 Descending ( 2nd ) – 7 to
10cm & descends along the R
sides of L1 through L3
 Horizontal ( 3rd ) – 6 to 8cm &
crosses L3
 Ascending ( 4th ) – 5cm &
begins at the L of L3 and
rises superiorly as far as
superior border of L2
 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 major 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 jejunum 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:
 Upper part –
superior
pancreaticoduod
enal from
gastroduodenal
 Lower part –
inferior
pancreaticoduod
enal from superior
mesenteric
 VENOUS DRAINAGE
 Superior
pancreaticoduod
enal vein drains
into portal vein
 Inferior
pancreaticoduod
enal joins the
superior
mesenteric vein
 VENOUS
DRAINAGE:
 Superior
mesenteric vein
w/c lies anterior and
to the right of the
SMA in the root of
mesentery; ends
posterior to the
neck of pancreas
where it unites w/
splenic vein to
form the 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
VESSELS from the duodenal
lymph nodes drain into the
celiac lymph nodes
 NERVE SUPPLY
 Derive from the VAGUS and GREATER
and LESSER(ABDOMINOPELVIC)
SPLANCHNIC NERVES by way of the
celiac and superiormesenteric
plexuses.

 They are next conveyed to the

duodenum via periarterial plexuses
extending to the pancreaticoduodenal
arteries.
 HAVE A
NICE DAY !