Dr.

Nurzarina Abdul Rahman

Faculty of Medicine and Health Sciences

USIM

At the end of the lecture, the student should be able to:

describe the surface marking of the stomach
identify the parts of the stomach and name of its borders
describe the relation of the stomach to the peritoneal
cavity and the name of the peritoneal folds ligament
attach to the organ
describe the relation of the stomach to the other organs
including the structures present at the stomach bed
mention the blood supply of the stomach

Muscular bag forming the

widest and most
distensible part of
digestive tract
Connected above to lower
end of the oesophagus
and below to duodenum
Function reservoir of
food and prepares food for
digestion

Developmentally related to
the foregut
Position :
upper left quadrant epigastrium, left
hypochondrium and
umbilical region
Lies under cover of left
costal margin and ribs
Shape : J-shape (empty)
or pyriform (partially
distended)
Capacity : 1000-1500 ml

Midline of the abdomen

25 cm long

Relatively fixed at both

ends

Upper end

T10

cardio-oesophageal
junction
left of mid line (T10)
40 cm from incisor teeth

Lower end

pylorus
right of the mid line (L1)

L1

4 parts

Cardia
Fundus
Body
Pylorus

Surfaces and borders

2 ends : cardiac end and

pyloric end
2 borders : right lesser
curvature and left greater
curvature
2 surfaces : anterior and
posterior

1. Cardia
The part surrounding the cardial orifice

1. Cardia
Also known as
Oesophagogastric (OG)
junction
40cm from incisor teeth
Lower oesophageal
sphincter, distal 1-4 cm of
the oesophagus
not an anatomical
sphincter
zone of high intraluminal
resting pressure (higher
than the pressure in the
fundus)

2. Fundus
Dilated superior part, related to left dome of diaphragm
Above level of cardia
Superior part reaches level of left 5th Intercostal space
Cardial notch between esophagus and fundus

3. Body
Major part between fundus
and pylorus
From fundus to incisura
angularis
Incisura angularis
separates body from the
pyloric part

4. Pyloric part
Funnel-shaped outflow
region of stomach
Incisura angularis
separates body from the
pyloric part

4. Pyloric part (pyloros = gateguard)

Three parts:

Pyloric part

Duodenum

Pyloric
sphinter

Pyloric antrum
Pyloric canal

Lesser curvature

Concave to right
For attachment of lesser
omentum
Has angular notch (incisura
angularis) between body
and pylorus

Greater curvature

Convex to left
For attachment of greater
omentum
Has cardiac notch between
esophagus and fundus

Stomach is completely covered by peritoneum

(intraperitoneum organ)

Area where the stomach is not

covered with peritoneum :
A bare area at the back of
cardial orifice
Where blood vessels run
along its curvatures
Stomach has peritoneal folds:
lesser omentum
greater omentum
gastrophrenic ligaments
gastro- splenic ligaments

Gastrophrenic ligament
from the fundus to the
diaphragm
Gastrosplenic ligament
from the greater curvature
to the hilum of spleen
Greater omentum
from the greater curvature
to the transverse colon
(gastro-colic ligament)
Lesser omentum
from lesser curvature to
the liver porta hepatis and
fissure for ligamentum
venosum
(gastro-hepatic ligament)

Anteriorly related to:

diaphragm
left lobe of the liver
anterior abdominal
wall

Posteriorly related to:

Anterior

Lesser sac (Omental

bursa)
Pancreas

Posterior surface of
stomach forms most
of the anterior wall
of the omental bursa

Posterior

Posteriorly related to:

Anterior

Lesser sac (Omental

bursa)
Pancreas

Posterior surface of
stomach forms most
of the anterior wall
of the omental bursa

Posterior

Definition : the bed on which the stomach rests

on SUPINE position

Structures at the stomach bed form the

posterior wall of Lesser sac (omental bursa)

Structures at the stomach bed THAT are

separated from the stomach by the cavity of
lesser sac

1.
2.
3.
4.
5.
6.
7.
8.

Structures at the stomach bed THAT are

separated from the stomach by the cavity of
lesser sac:
(From superior to inferior)
left crus of diaphram - related to the bare area at the
back of the cardiac end of the stomach
spleen separated from stomach by cavity of greater
sac
left suprarenal gland
left kidney
splenic artery along upper border of PANCREAS
pancreas
left colic flexure
transverse mesocolon and colon

From coeliac artery

A) along lesser curvature two arteries
1. left gastric artery and
2. right gastric artery
B) along the greater
curvature - three arteries
1. short gastric arteries from
splenic artery to fundus
2. left gastro-epiploic artery
(from the splenic artery)
3. right gastro-epiploic artery
(from the branches of
hepatic artery)

the veins accompany

the arteries
empty into portal
circulation

Stomach lymphatic drainage

A : Pancreaticosplenic area
drains into pancreaticosplenic
nodes along splenic artery to
the coeliac nodes
B : Drains into left gastric nodes
to the coeliac nodes
C : Drains into right
gastroepiploic nodes, into
hepatic nodes then into coeliac
nodes
D : into plyloric, hepatic and left
gatric nodes, then all into
coeliac nodes

C
D

anterior ulcers perforate

posterior ulcer erode (GIT bleeding) or
penetrate

gastric ulcer erodes pancreas, splenic artery

Protrusion of part of stomach (cardia and part of

fundus) into the mediastinum through the
oesophageal hiatus of the diaphragm
Occurs in people after middle age (due to
weakening of the muscular part of diaphragm)

nurzarina@usim.edu.my