Stomach

stomach it is the first portion of in abdomen, excluding the small portion from esophagus abdominal. Functionally it could be described like reservorio temporary of the swallowed nutritional skittle until it is come to its intestinal transit, once mixed well in the stomach.

Table of contents

Embryology of the stomach:

Its form and disposition it is necessary to understand considering them its embryonic development. The stomach in the second month of embryonic life begins like a simple expansion of the previous intestine. Soon it undergoes a rotation on a longitudinal axis in such a way that the left face of the stomach becomes previous, and the right part becomes later. Therefore vague nerve of the left side, that in descends by the left side of the esophagus, happens to a previous location, whereas the right is located in the stomach in the later part. The stomach has in addition another rotation on an anteroposterior axis, in such a way that the inferior part, by which it is continued with the duodeno, ascends and it is placed to the right, under . It is necessary to have present that the stomach has in this phase of the life I pull in the later part (mesogastrio dorsal) and another one in the forcebody (mesogastrio ventral) that reaches to the first portion of duodeno. Both mesos also undergo the previous rotations in such a way that they determine a series of you fold in the visceral peritoneo that covers them. Mesogastrio dorsal forms the omento (epiplón) greater (after megring with I pull of the colon transverso), which determines the closing by the inferior part of the transcavidad of epiplones. Mesogastrio ventral gives origin to the omento (epiplón) smaller, than it extends between the right edge of the stomach and the first portion of the duodeno until the liver and hilio hepático. All these relations have their costory in the adult.

Anatomy of the stomach

Form and relations of the stomach:

The stomach is located in the high part of abdomen (epigastrio). The cardia (extreme by where it penetrates the esophagus) is located to level of the T11 vertebra, whereas píloro does at level of L1. Nevertheless, there is considerable variation from individuals to others. The esophagus determines the cardial incisura, that it serves as valve to prevent the gastroesofágico ebb tide. Towards the left and above (underneath the diafragmática cupola) fundus extends (occupied by visible air and in the simple x-rays), that it is continued with the body, extended portion that can to hang more or less in the abdomen, soon progressively it follows a more or less horizontal passage and towards the right, to continue with the pilórica portion, that consists of the pilórico cavern and the pilórico conduit whose pilórico sphincter separates it of the duodeno. In this point the wall thickens of considerable way by the circular fiber presence abundant of the muscular layer that forms the pilórico sphincter.

The flattened form of the stomach in rest determines the presence of a previous, visible face in situs abdominis, and a later face that watches at the transcavidad of epiplones (omental cavity), located behind. Also, it determines the presence of an inferior edge (greater bending) than down watches and the left, and a superior edge (smaller bending) than above watches and the right. As a result of the turns of the stomach in embryonic period, by the greater bending it is continued the stomach with the omento (epiplón) greater, and the minor with the omento (epiplón) smaller.

The light of the stomach has the presence of you fold of mucosa longitudinal, of which most important they are two parallels and next to the bending smaller than they form the channel of the stomach or gastric street. You fold them diminish in fundus and the pilórica portion.

The gastric wall consists of a serosa that it covers to three muscular layers (longitudinal, circular and it cants, mentioned from the surface towards the depth). Layer submucous gives anchorage to mucosa itself, that consists of cells that produce snot, hydrochlorate acid and digestive enzymes. The stomach has systems of fixation in its two ends, which are united by the smaller bending through the omento (epiplón) smaller. At level of the cardia the gastrofrénico ligament by the later part exists, that unites it to the diaphragm. By the pilórica part it is united to the inferior face of the liver by the gastrohepático ligament, leaves from the omento (epiplón) smaller. These systems of fixation determine their relations with other abdominal organs. Nevertheless, and had not only to the turns of the stomach, but also to the embryonic development of the liver, the relations of the stomach settle down through a space that is behind, the omental cavity or transcavidad of epiplones.

Arterial irrigation of the stomach:

The irrigation is the responsibility of branches of the abdominal aorta. The celíaco trunk gives rise to the left gastric artery, that crosses the smaller cruvatura until anastomosar itself with the right gastric artery, branch of the common hepática artery (that it leaves also the celíaco trunk as well); these two arteries get to form what is the coronary superior gastrica. From this common hepática artery the gastrodudodenal artery also arises, which it gives rise to the gastroepiploica artery that crosses the greater curvature until anastomosar itself with the left artery gastroepiploica, branch of the artery esplénica(que comes from the celíaco trunk); these form what is the coronary inferior gastrica. This irrigation comes complemented by the short gastric arteries that, coming from the esplénica artery, reach fundus of the stomach.

Venous return of the stomach:

The venous return is enough parallel to the arterial one, with gastric veins right and left, in addition to the prepilórica vein, that drain in the vein carries; short gastric veins and gastroepiploica left that drains in the esplénica vein; right gastroepiploica vein that finishes in the superior mesentérica. Through the short gastric veins an anastomosis between the system of the vein settles down carries and of the vein it digs superior by means of the veins of the submucosa of the esophagus. In cases of hypertension vestibule (the blood that penetrates in the liver by means of the vein carries cannot reach the inferior digging, reason why it is accumulated ratrógradamente in the veins which they drain and they form the vein carries), the very small blood expands these anastomosis normally, giving rise to the esofágicas varices. If these varices are broken they can give a mortal hemorrhage.

Lymphatic drainage of the stomach:

The lymphatic drainage comes given by ganglionary chains that cross the greater bending (right and left gastroepiploicos nodules and gastric nodules and straight left). They are complemented with the celíacos and pilóricos lymphatic ganglia. These ganglia have great importance in gastric cancer, and it is necessary to extirpate them in case of entensión of . The extirpation becomes according to the ganglionary barriers, exist 15 ganglionary groups that are:

  • Barrier 1 (N1): It corresponds to the perigástricos ganglia.
Group 1: right cardial
Group 2: left cardial

Group 3: smaller curvature

Group 4: greater curvature
Group 5: suprapilóricos
Group 6: infrapilóricos
  • Barrier 2 (N2): It corresponds to the ganglia located in main the arterial trunks of the stomach.
Group 7: estomáquica or gastric coronary artery izq.
Group 8: hepática artery
Group 9: celíaco trunk
Group 10: hilio esplénico
Group 11: esplénica artery
  • Barrier 3 (N3): It corresponds to the moved away ganglia of the stomach.
Group 12: hepatoduodenal ligament
Group 13: retropancreáticos
Group 14: superior mesentérica artery
Group 15: cólica artery average

The oncológica extirpation always must obtain the last free ganglionary barrier.

Inervación of the stomach

inervación from the stomach it comes from vague nerve, parasimpático and of the likeable nerves that accompany the arterial glasses.

The branches of the left vague nerve go to the previous face and they divide in a previous branch a hepática branch and previous nerve of Latarjet.

The branches of the vague nerve straight go to the later face and they are divided in later gastric branch, celiaca branch and later nerve of Latarjet.

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Histología of the stomach

The wall of the stomach is formed by the layers characteristic of all the alimentary canal: the mucosa, the submucosa, muscular and the serosa.

The gastric mucosa

The mucosa of the stomach presents/displays manifold you fold, crests and fosillas, formed by:

  • Superficial Epitelio: It is cylindrical simple, that it appears abruptly in the cardia, after epitelio flat stratified of the esophagus. In the apical pole of these cells it appears a heavy layer of gastric snot that serves as protection against the ingested substances and acid and gastric.
  • Cardiac glands: They are located around the gastroesofágica union. The cells endocrinas that it has in his bottom produce gastrina.
  • Oxínticas, gastric or fúndicas glands: They are mainly located at heart and body of the stomach and produce most of the volume of the gastric juice. They are very together with others, have a very narrow light and they are very deep. Esteem that the stomach has 15 oxínticas million of glángulas, which they are composed by four types of cells: main or zimógenas, oxínticas or paritales, mucous of the neck and endocrinas.
  • Pilóricas glands: They are located near píloro. It secretes viscous secretion mainly and it thickens that it is the mucus to lubricate the interior of the cavity of the stomach so that the food can happen through the stomach and it is mixed with them, therefore it protects the walls of the stomach.
  • Own lamina:
  • Muscular layer of the mucosa:

Lás cells that compose epitelio gastric is:

  • Mucous cells of the neck:
  • Oxínticas or parietales cells: They are the cells that they secrete hydrochlorate acid and gastric intrinsic factor.
  • Zimógenas main cells or: They are the cells that produce the pepsinógeno.
  • Cells endocrinas:

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Submucous layer === formed by conjuntivo weave (woven of support which it connects or it unites the diverse parts of the body), in which are numerous blood vessels, lymphatic and nervous completions.

External muscular layer

The muscular layer is formed of inside outwards by muscular fibers oblícuas, circular and longitudinal. The gastric muscular layer can be considered like gastric muscle because thanks to its contractions, the nutritional skittle is mixed with the gastric juice and it moves towards píloro with the peristálticos movements. tyj6jkm, o654 <34<w4tmkyui p9´ñ

Serosa layer

The serosa or peritoneal layer surrounds to the stomach in all its extension, expanding in its curvatures to form epiplon smaller or gastrohepático, epiplon greater or gastrocólico and epiplon gastroesplénico that finishes in the frenogástrico ligamiento.

Gastric physiology

The stomach is controlled by , being vague nerve the main component of . The acidity of the stomach is controlled by three molecules that are acetilcolina, histamina and gastrina.

Diseases of the stomach


Mouth - Pharynx - Esophagus - Stomach - Páncreas - Biliary vesicle - - Thin intestine (duodeno, yeyuno, íleon) - - Blind person - Rectum - Anus

Bibliography

Approached information thanks to Bethlehem S.

 

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