Stomach Knowledge

Parts of the Stomach

The stomach is made up of four parts, the cardial orifice, the Fundus, Body, and pyloric part.  The cardial orifice is on the superior portion of the stomach.  It is the connection point to the esophagus.  The fundus lies also on the superior part of the stomach, and is a dilated portion that also lies to the left of the dome of the diaphragm.  The cardial notch lies in between the esophagus and the fundus.  The body of the stomach is the major portion of the stomach where contents within the stomach reside.  Finally the pyloric part of the stomach has several different divisions.  The pyloric antrum (wider portion of the pyloric part), leads into the pyloric canal.  Leading from the pyloric canal, is the pylorus, which is the sphincter region of smooth muscle within the stomach.  From here the contents of the stomach (known as chyme), discharge out through the pyloric orifice. 

Congenital Hypertrophic Pyloric Stenosis

This particular disease effects 1 of every 750 female infants and 1 of every 150 male infants every year.  It is a thickening of the smooth muscle in the pylorus.  The cause is not yet known as to why this happens, but genetics play a big role in it.  Monozygotic twins are at a high risk for it.  The disease causes the pyloric canal and orifice to become narrow thus not allowing chyme to move out of the stomach. 

Blood Vessels of the Stomach

The stomach is very rich in blood vessels.  The arterial supply of the stomach comes from the celiac trunk.  The right and left gastric arteries run along the lesser curvature, and the right and left gastro-omental arteries run along the greater curvature.  The fundus and upper body of the stomach receives its blood from the short and posterior gastric arteries.  These groups of arteries supply blood to the stomach through anastomoses.  The veins of the stomach are more jumbled up in their organization.  Unlike the arteries, where everything is right and left with the same fitting name, the veins of the stomach are mixed up in how they drain blood from the stomach.  The short gastric, and left gastro-omental veins will drain into the splenic vein that flows into the superior mesenteric and then into the hepatic portal vein.  The right gastro-omental vein empties just into the superior mesenteric vein.  The right and left gastric veins do follow each other into the hepatic portal vein. 

Gastrorectomy

A partial gastrorectomy is a procedure generally performed to remove a carcinoma from a region of the stomach.  Due to anastomoses of the arteries surrounding the stomach, it is possible to remove a part of the stomach without effecting the circulation.  An example is when the pyloric antrum is removed.  The omental branches of the gastro-omental artery are ligated.  However, anastomoses to other arteries allow blood supply to continue.

Lymph Vessels of the stomach

The gastric lymph vessels flow along the greater and lesser curvatures along with the gastric arteries.  The lymph is drained from the anterior and posterior surfaces of the stomach towards the curvatures of the stomach where the gastric and gastro-omental lymph nodes reside.  The pathway of the superior two thirds of the stomach flow through the right and left gastric vessels into the gastric lymph nodes.  The pancreaticosplenic lymph nodes receive lymph drainage from the fundus and superior part of the body of the stomach.  The pyloric lymph nodes handle the right 2/3 of the inferior portion of the stomach and the right gastro-omental vessel does the draining.  The remaining 1/3 of the inferior portion of the stomach drains into the pancreaticoduodenal lymph nodes via the short gastric and splenic vessels. 

Lymph node resectioning

Lymph node removal is also important during a carcinoma situation.  As cancer spreads if any cells are left behind, it is important to remove those nodes that are infected.  The pyloric lymph nodes are most common as far as being removed.  In addition to them are the gastro-omental lymph nodes.  In more advanced cases, dismantling the celiac lymph nodes becomes necessary.  This is the location for which all lymph vessels drain into from the stomach.