Dr. Ágoston Szél
Gross Anatomy of the Stomach and Small Intestines
Institute of Anatomy, Histology and Embryology Semmelweis University 2020. Topography of visceral organs
Lungs Heart
Stomach Liver Duodenum Gall bladder Ascending colon Descending colon Caecum Gross anatomy of stomach Cardial notch Cardial part „J” Esophagus Fundus Body Cardia Lesser curvature
Lesser omentum Angular notch Duodenum
Pylorus (gatekeeper) Pyloric Greater curvature part Greater omentum Pyloric canal Pyloric antrum anterior – posterior wall Stomach (gr. Gaster - sac) Section of stomach
Cardial notch Gastric Cardial orifice fundus
Gastric canal
Pyloric sphincter
Pyloric orifice
Pyloric canal
Pyloric antrum Longitudinal (gastric) folds curved tube Angle of His betwen cardia und fundus (normally: an acute angle of opening)
Relations of stomach
Diaphragm A: hepatic surface
A
B
C Spleen
Liver
Costal arch B: phrenic surface
C: free surface „Gastrostomy” (stomach field) Radiology of stomach Esophagus Fundus (containing air) Lesser curvature 5th intercostal space
Fluid level Angular notch
Corpus Bulbus duodeni
Pylorus Greater curvature
Pyloric antrum Radiology of Diaphragm stomach
Fundus Esophagus
Angular Cardial notch notch
Corpus Bulbus duodeni Greater Pyloric curvature orifice
Pyloric Jejunum canal Pyloric antrum Radiology of stomach
Superior Pyloric orifice part Lesser curvature Superior flexure of duodenum Angular Bulb of notch duodenum Pyloric antrum
Descending Pyloric part of canal duodenum Greater curvature Peristaltic contraction Radiology of stomach Fundus Lesser curvature
Angular notch Corpus
Greater curvature Folds of mucous Pyloric membrane canal Pyloric Inferior antrum pole Variations in the shape of stomach
Steerhorn-shaped stomach (hypertonic Hook-shaped stomach) stomach
Gastroptosis Long stomach Peptic ulcer (sinking of (hypotonic (hour-glass stomach) stomach) shape) Ulcer of stomach (hour-glass) Prepare your smart phone! QR-code will appear for registering your attendance ATTEND-AOKANT674_1A - 2020-02-12 15_10_00 Celiac trunk and blood supply of stomach
Splenic artery Left gastric artery Short gastric arteries Celiac trunk Inferior phrenic artery Right gastric artery Cystic artery Splenic Proper hepatic artery branches Gastroduodenal artery
Superior Left gastroepiploic artery pancreatico- duodenal artery Common hepatic artery Right gastroepiploic artery Abdominal aorta Venous drainage of stomach
Splenic vein Short gastric Left gastric vein vein
Right gastric vein
Portal vein
Prepyloric vein Left gastroepiploic vein Inferior mesenteric Pancreatico- vein duodenal vein Right gastroepiploic vein Superior mesenteric vein Lymph nodes of stomach
Left gastric lymph Pancreatico- nodes lienal lymph nodes
Pyloric lymph nodes
Right gastric and subpyloric lymph nodes Lymphatic drainage of stomach
Gastric lymph nodes
Celiac lymph nodes
Intestinal trunk Left supraclavicular lymph nodes Cisterna chyli
Enlarged lymph Thoracic duct nodes in the left supraclavicular fossa (Virchow) Left venous angle Innervation of stomach
Left vagus nerve Right vagus nerve (anterior trunk) (posterior trunk)
Sympathetic trunk Sympathetic trunk Thoracic splanchnic Esophageal plexus nerve Celiac lymph nodes
Left gastric Greater splanchnic nerve lymph nodes Lesser splanchnic nerve Anterior gastric Hepatic branch of vagus branches Celiaci plexus and ganglia Posterior gastric branches Innervation of the stomach
Vagus nerve : musculature and glands of the stomach
Sympathetic trunk : sphincter muscles
Greater splanchnic nerve – spinal nerves: sensory fibers Left anterior vagal trunk Branches to Total vagotomy corpus and fundus Left vagal branches to stomach Proximal Gastric selective vagotomy vagotomy
Left vagal branches to Pyloric small branches intstines
Vagus nerve Esophageal opening of diaphragm
Suprahiatal Endothoracic phrenico-esophageal fascia ligament Diaphragm
Transversalis fascia Subhiatal phrenico- esophageal ligament
Peritoneum Esophago-gastric junction Cardial orifice (Z-line level with Th11) Sliding (par glissement Paraesophageal hiatus hiatus hernia) hernia Projection of internal organs
Lungs
Heart
Stomach Liver
Duodenum Gall bladder Ascending colon Descending colon Cecum Position of Coils of Free Small Intestines
Duodenum: horseshoe-shaped Jejunum: more vertical
Ileum: more horizontal Longitudinal Section of Human Duodenum
Circular folds (folds of Kerkring)
Topography of the Duodenum
Hepatoduodenal lig. Pylorus Esophageal opening
Superior part L I. Suspensory lig. of duodenum Superior duodenal flexure Duodenojejunal flexure
Descending part Jejunum
Aortic hiatus L III. Inferior duodenal flexure Ascending part
Horizontal part Blood Supply of Duodenum
Splenic artery Left gastric artery Common hepatic artery Coeliac trunk
Proper hepatic artery
Gastroduodenal artery
Superior pancratico- duodenal artery Left gastroepiploic artery Bühler’s anastomosis
Superior mesenteric Inferior pancratico- artery duodenal artery Duct Openings into the Duodenum
Right hepatic duct Left hepatic duct Common hepatic duct Cystic duct
Lesser pancreatic duct Gall bladder Common bile duct Lesser duodenal papilla Greater pancreatic duct
Greater duodenal papilla
Branches of Superior Mesenteric Artery
Superior mesenteric artery Inferior pancratico-duodenal artery
Middle colic Anastomosis with inferior artery mesenteric artery Jejunal arteries Right colic artery Ileocolic artery
Posterior caecal artery Anterior caecal artery Ileal arteries Appendicular artery Topography of Duodenum
Omental tuber Esophagus Inferior phrenic artery Left gastric artery Coeliac ganglion Inferior phrenic artery Portal vein Ganglion coeliacum Suprarenal gland Suprarenal gland Proper hepatic artery Common bile duct Left colic flexure Superior pancreatico- duodenal artery Coeliac trnk Right colic flexure Abd. aorta
Head of pancreas
Superior mesenteric vein Uncinate process Right colic artery Quadratus lumborum Inferior pancreatico- Psoas major duodenal artery Iliacus muscle Superior mesenteric artery Sympathetic trunk Ureter Duodenal Duodenojejunal flexure Probe bulb
Descending part
Colic flexure Jejunum
Ascending colon
Terminal ileum Radiographic Image of the Cecum Intestines
Ileum Sigmoid colon Diaphragm
Fundus Radiology of Duodenum
Pyloric antrum Corpus Duodenal bulb Greater Pyloric curvature orifice Ascending part Pyloric Jejunum canal Horizontal part Bibliography
• Lippert H: Lehrbuch Anatomie, Urban & Fischer, München, 2000 • Mac Kinnon P, Morris J: Oxford Lehrbuch der klinischen Anatomie, Hans Huber, Bern, 1997 • Snell RS, Clinical Anatomy, Little, Brown & Co, Boston, 1995 • Moore KL, Dalley AF: Clinically Oriented Anatomy, Lippincott, 1999