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THE STOMACH

The stomach, ventriculus or (gaster) is a sac-like dilatation of the alimentary tract. In the
stomach the food undergoes the first stage of digestion. The main function of the stomach is
chemical treatment of the food in an acid medium.
Two walls anterior and posterior and two curvatures: the lesser and the greater curvature are
distinguished in the stomach.
Four portions of the stomach are distinguished:
• The cardiac portion, pars cardiaca
• The body, corpus ventriculi
• The fundus, or the fornix;
• The pyloric portion, pars pylorica which is divided into the pyloric antrum and the
pyloric canal.
The oesophagus opens into the stomach by the cardiac orifice, and the stomach ends with the
pyloric orifice.
TOPOGRAPHY AND PROJECTION OF THE STOMACH ON ALIVE PERSON
HOLOTOPY
The stomach is situated in the epigastium ( ¾ are situated in the left hypochondriac region and ¼
is situated in the epigastric region).
SKELETOTOPY
The cardiac orifice projects at the level of the X – XIth thoracic vertebrae.
The pyloric orifice projects at the level of the XIIth thoracic or Ist lumbar vertebrae.
The fundus of the stomach is located at the level of the V th rib on the medioclavicular
line.
SINTOPY
When the stomach is full it comes in contact with organs.
• Superiorly (above) – with the diaphragm.
• Inferiorly (down) – with the colon and mesocolon transversum.
• In front - with the left lobe of the liver, with the diaphragm and with the anterior
abdominal wall.
• Behind - with the pancreas, left kidney, left adrenal gland and the spleen. Behind
the stomach is situated the omental bursa.
The capacity of the stomach is 1.5-3 liters.
The stomach has an intraperitoneal position (only at the level of the greater and lesser
curvatures and a small area of the fundus are not covered by the peritoneum).
Ligaments of the stomach
• Gastrofrenic ligament (between the diaphragm and the stomach)
• Gastrolienal ligament (between the spleen and the stomach)
• Gastrocolic ligament (between the transverse colon and the stomach)
• Hepatogastric ligament (between the liver and the stomach)

NB: The hepatogastric and the hepatoduodenal ligaments form the lesser omentum.
From the greater curvature of the stomach towards the tenia omentalis of the transverse colon
passes the greater omentum.
STRUCTURE OF THE STOMACH WALLS
The wall of the stomach consists of four layers:
• The mucous coat, tunica mucosa
• The submucous coat, tunica submucosa
• The muscular coat, tunica muscularis
• The serous coat, tunica serosa

1
The mucous coat – is lined with columnar epithelium. It contains special gastric glands, which
produce gastric juice, that contain hydrochloric acid.
The glands of the stomach are divided into:
• Cardiac glands – are located in the cardiac portion of the stomach and their secretion is
mucous.
• Gastric glands proper (located in the body and in the fundus of the stomach). The gastric
glands produce the gastric juice (it contains HCl, pepsinogen, enzymes, mucous and the
intrinsic Castle's factor). The gastric glands consist of 3 main types of cells:
a) the chief cells – produce pepsinogen.
b) the parietal cells – produce the HCl and in man they are responsible for the secretion of
the intrinsic Castle's factor
c) the auxiliary cells they produce mucous, enzymes, and the intrinsic Castle's factor.
• Pyloric glands – in the pylorus of the stomach. The biggest part of the pyloric glands
cells secret mucous and there are G-cells which produce gastrin.
At the surface of the mucous membrane there are scattered solitary lymph nodules.
The mucous membrane of the stomach forms folds.
• Along the lesser curvature of the stomach – the folds are longitudinal and they form the
“gastric path”, which during contraction of the gastric muscles may transform into a
canal (Waldeyer's gastric canal) through which the fluids (water, salts solutions etc. pass
from the oesophagus into the pylorus of the stomach, by passing the cardiac part.
• Along the greater curvature the folds are zigzag-like.
• In the body and fundus of the stomach the folds are irregular (lake a network).
• In the pyloric part the folds are longitudinal.

NB: In the region of the pyloric orifice there is a circular fold called valvula pylorica, which
has a functional importance because it separates the acid medium of the stomach from the
alkaline medium of the small intestine.
The mucous membrane of the stomach has rounded elevations called gastric areas, area
gastricae, and on their surface the gastric glands open by tiny orifices called gastric pits,
foveolae gastricae. In alive man the mucous membrane of the stomach is of reddish-grey
colour.

The submucous coat, tela submucosa consists of conjunctive and elastic fibres, is rich in
vessels, nervous endings and the submucous nervous plexus is placed here. It is well
developed and due to this coat the mucous membrane forms its folds.
The muscular coat, tunica muscularis consists of three layers of smooth muscle fibres,
which contribute to the mixing and movement of food.
• External longitudinal layer, it is well developed at the level of the lesser and greater
curvatures of the stomach.
• Middle circular layer is the most proportionally developed layer of the stomach. At
the junction of the pylorus and the duodenum the circular layer forms the pyloric
sphincter, musculus sphincter pylori.
• Internal oblique layer, the fibres of this layer have an oblique arrangement and they
look like a loop which surrounds the cardiac orifice and then descend on the anterior
and posterior walls of the stomach.

The pyloric sphincter and the valvula pylorica regulate the passage of the food from the
stomach into the duodenum and prevent the gastroduodenal reflux.
The serous coat of the stomach is called as well the peritoneum and it covers the stomach
almost entirely excepting the lesser and greater curvatures of the stomach.

2
Examination on alive person of the stomach
The stomach of a living man can be examined by clinical and paraclinical methods of
examination.
Clinical methods are: inspection of the epigastric region, palpation and percussion of the
stomach.
Paraclinical methods are: analyses of the gastric juice, X-ray examination of the stomach,
gastroscopy for the spatial inspection of the stomach.

Development of the stomach and abnormalities of the stomach


The stomach develops from a fusiform dilatation of the foregut gut during the fourth
week. The stomach rotates 90 degrees clockwise during its formation, and behind it forms the the
omental bursa.
Abnormalities:
Bilocular stomach, when the stomach has two chambers.
Hypertrophic pyloric stenosis occurs when the external layer of the muscular coat hypertrophies,
narrowing the pyloric lumen.
Forms of the stomach
• Horn-shaped stomach is characteristic for the brachymorphic constitutional type.
• Stomach shaped like a fish hook is characteristic for the mesomorphic constitutional
type.
• Stomach shaped like an elongated hook is characteristic for the dolichomorphic
constitutional type.

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