د. عصام طارق. Objectives:

Transcription

1 GI anatomy Lecture: 5 د. عصام طارق Objectives: To describe anatomy of stomach, duodenum & pancreas. To list their main relations. To define their blood & nerve supply. To list their lymph drainage. To relate to some clinical conditions like peptic ulcer.

2 The stomach is an Elongated, distensible muscular sac Epigastrium Left Hypochondrium Although it undergoes considerable variation Volume of its content Position of the body Phase of respiration J- shaped Umbilical Region

3 Cardiac Notch Fundus To The Greater Curvature Angular Notch Body To The Greater Curvature

4 The stomach possesses: 1- Two orifices (cardiac & pyloric) 2- Two borders (greater & lesser curvatures) 3- And two surfaces (anterior & posterior)

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7 Median Plane Cardiac Sphincter Cardiac end of stomach 1 inch

8 Median Plane Pyloric end of Stomach 1/2 inch Transpyloric plane Pyloric sphincter

9 Angular Notch

10 Cardiac Notch Fundus of The Stomach

11 Greater Omentum Gastrosplenic F

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13 Ant. Relation of stomach 4- Diaphragm 3- Liver 7 th 2- Left costal margin 8 th 9 th 1- Anterior abdominal wall

14 Post. Relation of stomach 6- Left crus of diaphragm 5- Left Kidney & suprarenal gland 4- Spleen & splenic Artery 3- The Pancreas 2- omental bursa 1- Transverse colon & mesocolon

15 Arterial supply 1- Left gastric artery 3- Short gastric arteries 2- Right gastric artery 4- Left gastroepiploic artery 5- Right gastroepiploic artery

16 1- Left Gastric Vein Venous drainage Splenic Vein 3- Short Gastric Veins 2- Right Gastric Vein Superior Mesenteric Vein 5- Rt. Gastroepiploic v. 4- Lt. Gastroepiploic v.

17 Lymphatics drain into LN along the courses of the arteries supplying the stomach & ultimately drain into celiac group of lymph nodes 5- Coeliac LN 1- Left gastric LN 3- Splenic & Pancraticosplenic LN 2- Pyloric LN 4- Right gastroepiploic LN

18 Anterior vagal trunk Coeliac Plexus Hepatic branch Pyloric branch

19 Median Plane C-shaped,25cm Pyloric end of stomach Widest & most fixed 1 ST Duodenojejunal flexure Root of T. meso. 2 nd Head 3 rd 4 th I.V.C. Aorta

20 1- Anteriorly: quadrate lobe of liver 2- Superiorly: Lesser omentum 1- Anteriorly: Quadrate lobe & GB 1- Superiorly: Epiploic foramen 1 st Inch 2- Inferiorly: Neck of pancreas 4- Posteriorly: Neck of pancreas 3- Inferiorly: Greater omentum

21 4- Posteriorly: 4) Bile Duct 3) Gastroduodenal artery 2) Portal Vein 1) I.V.C.

22 Descending part A) Anteriorly: 1- Right Lobe of Liver 2- Transverse Colon & root of mesocolon 3- Loops of Jejunum

23 B) Posteriorly: 1- Hilum of Rt. kidney 2- Renal Vv. 3- Psoas Major

24 C) Laterally: D) Medially: 1- Fat on Rt. kidney 2- Rt. colic flexure 1- CBD 2- Head of pancreas 3- sup. Pancreatico duodenal artery

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26 B) Superiorly: 1- Head of pancreas 2- Inf. Pancreaticoduodenal artery A) Anteriorly: 1- Transverse colon & mesocolon. 2- Sup. mesenteric Vs in the root of mesentery 3 rd Part 3- Root of mesentery 4- Coils of jejunum

27 B) Posteriorly: 1- Right Ureter 2- Right psoas 3- Right gonadal Vessels 4- I.V.C. 5- Aorta & origin of Inf. Mesenteric Artery

28 A) anteriorly: 2- The Transverse Mesocolon Duodenojejunal Flexure Jejunum 1- The Transverse Colon 4 th Part

29 B) Posteriorly: 1- Left Psoas Major Muscle 2- Left gonadal Vs 3- Inferior mesenteric Vein 4- Left Sympathetic Chain

30 1- Right gastric Artery 2- Supra-duodenal 3- Right gastroepiploic 4- Superior Pancreatico -duodenal 5- Inferior pancreaticoduodenal

31 Lymphatics drain into a series of LN along courses of arteries supplying duodenum & drain ultimately into celiac & sup. mesenteric LN. 1- Celiac LN 2- Superior mesenteric LN

32 Head

33 1- It lies in concavity of duodenum 2- Pancreaticoduodenal Vv in the groove between head and duodenum Head Sup. mesenteric Vs Aorta Uncinate Process

34 Anterior relations: 2- Cavity of lesser sac 1- Stomach 3- Transverse colon & mesocolon

35 6- Lt. Suprarena Post. relation 1- Descending Abdominal Aorta 2- Origin of Inferior Mesenteric a. 3- Left Crus of Diaphragm 4- Lt Sympathetic Chain 5- Lt. Psoas Muscle 7- Lt Kidney 8- Lt Renal Vv. 9- Splenic V. 10- Lt. Renal V.

36 2- Superior pancreaticoduodenal 1- Pancreatic branches of splenic artery 3- Inferior pancreaticoduodenal

37 Venous blood ultimately end in the portal & superior mesenteric veins 1- Portal vein 2- sup. mesenteric vein.

38 Lymphatics drain into a series of LN along courses of arteries supplying pancreas & drain ultimately into celiac & sup. mesenteric LN. 1- Celiac LN 2- Sup. mesenteric LN

39 Gastric ulcer: Occur on or close to lesser curvature of stomach. Invades muscular coat & with time invades peritoneum. Ulcer on posterior wall may perforate into lesser sac resulting in diffused peritonitis & air under diaphragm It may become adherent to pancreas resulting in referred backache. A perforated anterior ulcer may result in diffused peritonitis due to leakage of gastric content into greater sac. Sensation of pain is caused by stretching of smooth muscle fibers in stomach wall & it is felt in epigastrium. Air under diaphragm is visualized in erect plane abdominal radiography.

40 Summary: The stomach has two: orifices, curvatures & surfaces. Duodenum lies retroperitoneally close to the midline between transpyloric & subcostal planes & divided into four parts. Pancreas lies retroperitoneally & extends from the midline to the spleen crossing the transpyloric plane.

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