Stomach

Stomach diagram.svg
The stomach is located centre left in the human body.
Illu stomach.jpg
1. Body of stomach 2. Fundus 3. Anterior wall 4. Greater curvature 5. Lesser cur
vature 6. Cardia 9. Pyloric sphincter 10. Pyloric antrum 11. Pyloric canal 12. A
ngular incisure 13. Gastric canal 14. Rugae[1]
Details
Latin Ventriculus
Greek Gaster
Precursor
Foregut
System Digestive system
Artery
Right gastric artery, left gastric artery, right gastro-omental artery, left gas
tro-omental artery, short gastric arteries
Vein
Right gastric vein, left gastric vein, right gastroepiploic vein, left gastroepi
ploic vein, short gastric veins
Nerve
Celiac ganglia, vagus nerve[2]
Lymph
Celiac lymph nodes[3]
Identifiers
Gray's p.1161
MeSH
A03.556.875.875
Dorlands
/Elsevier
Stomach
TA
A05.5.01.001
FMA
7148
Anatomical terminology
The stomach is a muscular, hollow, dilated part of the digestive system which fu
nctions as an important organ of the digestive tract in many animals, including
vertebrates, echinoderms, insects (mid-gut), and molluscs. It is involved in the
second phase of digestion, following mastication (chewing).
In most vertebrates, the stomach is located between the esophagus and the small
intestine. It secretes protein-digesting enzymes called proteases and gastric ac
id to aid in food digestion, (sent to it via esophageal peristalsis) through smo
oth muscular contractions before sending partially digested food (chyme) to the
small intestines.
Contents [hide]
1 Structure
1.1 Sections
1.2 Blood supply
1.3 Histology
2 Function
2.1 Digestion
2.2 Absorption
2.3 Control of secretion and motility
2.4 Stomach acid
2.5 Stomach as nutrition sensor
3 Clinical significance
3.1 Diseases
3.2 Surgery
4 History
4.1 Etymology
5 Other animals
6 Additional Images

7 See also
8 References
9 External links
Structure[edit]
Sections of the stomach
The stomach lies between the esophagus and the duodenum (the first part of the s
mall intestine). It is in the left upper part of the abdominal cavity. The top o
f the stomach lies against the diaphragm. Lying behind the stomach is the pancre
as. The greater omentum hangs down from the greater curvature.
Two sphincters keep the contents of the stomach contained; the lower esophageal
sphincter (found in the cardiac region), at the junction of the oesophagus and s
tomach, and the pyloric sphincter at the junction of the stomach with the duoden
um.
The stomach is surrounded by parasympathetic (stimulant) and orthosympathetic (i
nhibitor) plexuses (networks of blood vessels and nerves in the anterior gastric
, posterior, superior and inferior, celiac and myenteric), which regulate both t
he secretions activity and the motor (motion) activity of its muscles.
In adult humans, the stomach has a relaxed, near empty volume of about 45 to 75
milliliters.[4] Because it is a distensible organ, it normally expands to hold a
bout one litre of food.[5] The stomach of a newborn human baby will only be able
to retain about 30 milliliters.
Sections[edit]
In classical anatomy, the stomach is divided into four sections, beginning at th
e cardia,[6] each of which has different cells and functions.
The cardia is where the contents of the esophagus empty into the stomach. The ca
rdia is defined as the region following the "z-line" of the gastroesophageal jun
ction, the point at which the epithelium changes from stratified squamous to col
umnar. Near the cardia is the lower esophageal sphincter.[7]
The fundus is formed by the upper curvature of the organ.
The body is the main, central region.
The pylorus is the lower section of the organ that facilitates emptying the cont
ents into the small intestine.
Blood supply[edit]
Schematic image of the blood supply to the stomach: left and right gastric arter
y, left and right gastro-omental artery and short gastric artery.[8]
The lesser curvature of the stomach is supplied by the right gastric artery infe
riorly, and the left gastric artery superiorly, which also supplies the cardiac
region. The greater curvature is supplied by the right gastro-omental artery inf
eriorly and the left gastro-omental artery superiorly. The fundus of the stomach
, and also the upper portion of the greater curvature, is supplied by the short
gastric artery which arises from the splenic artery.
Histology[edit]
Micrograph showing a cross section of the stomach wall, in the body portion of t
he stomach. H&E stain.
Main article: Gastrointestinal wall
Like the other parts of the gastrointestinal tract, the stomach walls consist of
an outer mucosa, and inner submucosa, muscularis externa, and serosa.
The gastric mucosa of the stomach consists of the epithelium and the lamina prop
ria (composed of loose connective tissue), with a thin layer of smooth muscle ca
lled the muscularis mucosae separating it from the submucosa beneath. The submuc

osa lies under the mucosa and consists of fibrous connective tissue, separating
the mucosa from the next layer. Meissner's plexus is in this layer. The muscular
is externa lies beneath the submucosa, and is unique from other organs of the ga
strointestinal tract, consisting of three layers:
The inner oblique layer: This layer is responsible for creating the motion that
churns and physically breaks down the food. It is the only layer of the three wh
ich is not seen in other parts of the digestive system. The antrum has thicker s
kin cells in its walls and performs more forceful contractions than the fundus.
The middle circular layer: At this layer, the pylorus is surrounded by a thick c
ircular muscular wall which is normally tonically constricted forming a function
al (if not anatomically discrete) pyloric sphincter, which controls the movement
of chyme into the duodenum. This layer is concentric to the longitudinal axis o
f the stomach.
Auerbach's plexus (AKA myenteric plexus) is found between the outer longitundina
l and the middle circular layer and is responsible for the innervation of both (
causing peristalsis and mixing)
The outer longitudinal layer
The stomach also possesses a serosa, consisting of layers of connective tissue c
ontinuous with the peritoneum.
Different types of cells are found at the different layers of these glands:
Layer of stomach
Name
Secretion
Region of stomach
Staining
Isthmus of gland
Foveolar cells mucus gel layer Fundic, cardiac, pyloric
Clear
Body of gland parietal (oxyntic) cells
gastric acid and intrinsic facto
r
Fundic only
Acidophilic
Base of gland chief (zymogenic) cells pepsinogen and gastric lipase Fundic o
nly
Basophilic
Base of gland enteroendocrine (APUD) cells
hormones gastrin, histamine, end
orphins, serotonin, cholecystokinin and somatostatin
Fundic, cardiac, pyloric
Cardiac glands (at cardia)
Pyloric glands (at pylorus)
Fundic glands (at fundus)
Function[edit]
Digestion[edit]
Main article: Digestion
Bolus (masticated food) enters the stomach through the esophagus via the lower e
sophageal sphincter. The stomach releases proteases (protein-digesting enzymes s
uch as pepsin) and hydrochloric acid, which kills or inhibits bacteria and provi
des the acidic pH of two for the proteases to work. Food is churned by the stoma
ch through muscular contractions of the wall called peristalsis
reducing the vol
ume of the fundus, before looping around the fundus[9] and the body of stomach a
s the boluses are converted into chyme (partially digested food). Chyme slowly p
asses through the pyloric sphincter and into the duodenum of the small intestine
, where the extraction of nutrients begins. Depending on the quantity and conten
ts of the meal, the stomach will digest the food into chyme anywhere between for
ty minutes and a few hours. The average human stomach can comfortably hold about
a litre of food.
Gastric juice in the stomach also contains pepsinogen and prorennin. Hydrochlori
c acid activates these inactive forms of enzymes into active forms which are pep
sin and rennin (proteases). Rennin digests the milk protein caseinogen (soluble)

into casein (insoluble) thus curdling the milk. Pepsin breaks down proteins int
o polypeptides.
Absorption[edit]
Although the absorption is mainly a function of the small intestine, some absorp
tion of certain small molecules nevertheless does occur in the stomach through i
ts lining. This includes:
Water, if the body is dehydrated
Medication, like aspirin
Amino acids[10]
10 20% of ingested ethanol (e.g. from alcoholic beverages)[11]
Caffeine[12]
The parietal cells of the stomach are responsible for producing intrinsic factor
, which is necessary for the absorption of vitamin B12. B12 is used in cellular
metabolism and is necessary for the production of red blood cells, and the funct
ioning of the nervous system.
Control of secretion and motility[edit]
The movement and the flow of chemicals into the stomach are controlled by both t
he autonomic nervous system and by the various digestive system hormones:
Gastrin The hormone gastrin causes an increase in the secretion of HCl from the
parietal cells, and pepsinogen from chief cells in the stomach. It also causes i
ncreased motility in the stomach. Gastrin is released by G-cells in the stomach
in response to distension of the antrum, and digestive products (especially larg
e quantities of incompletely digested proteins). It is inhibited by a pH normall
y less than 4 (high acid), as well as the hormone somatostatin.
Cholecystokinin Cholecystokinin (CCK) has most effect on the gall bladder, causi
ng gall bladder contractions, but it also decreases gastric emptying and increas
es release of pancreatic juice which is alkaline and neutralizes the chyme. CCK
is synthesized by I-cells in the mucosal epithelium of the small intestine.
Secretin
In a different and rare manner, secretin, produced in the small
intestine, has most effects on the pancreas, but will also diminish acid secreti
on in the stomach.
Gastric inhibitory peptide
Gastric inhibitory peptide (GIP) decreases both
gastric acid release and motility.
Enteroglucagon enteroglucagon decreases both gastric acid and motility.
Other than gastrin, these hormones all act to turn off the stomach action. This
is in response to food products in the liver and gall bladder, which have not ye
t been absorbed. The stomach needs to push food into the small intestine only wh
en the intestine is not busy. While the intestine is full and still digesting fo
od, the stomach acts as storage for food.
Stomach acid[edit]
Epidermal growth factor (EGF) results in cellular proliferation, differentiation
, and survival.[13] EGF is a low-molecular-weight polypeptide first purified fro
m the mouse submandibular gland, but since then found in many human tissues incl
uding submandibular gland, parotid gland. Salivary EGF, which seems also regulat
ed by dietary inorganic iodine, plays also an important physiological role in th
e maintenance of oro-oesophageal and gastric tissue integrity. The biological ef
fects of salivary EGF include healing of oral and gastroesophageal ulcers, inhib
ition of gastric acid secretion, stimulation of DNA synthesis as well as mucosal
protection from intraluminal injurious factors such as gastric acid, bile acids
, pepsin, and trypsin and to physical, chemical and bacterial agents.[14]
Sequence of 123-iodide total-body scintiscans of a woman after intravenous injec
tion of 123-iodide (half-life: 13 hours); (from left) respectively at 30 minutes
, and at 6, 20 and 48 hours. High and rapid concentration of radio-iodide (in wh

ite) in extra-thyroidal organs is evident in gastric mucosa of the stomach, epid

ermis, salivary glands, periencephalic and cerebro-spinal fluid, choroid plexus
and oral mucosa. In gastric mucosa 131-iodide (half-life: 8 days) persists in sc
intiscans for more than 72 hours. In the thyroid, iodide-concentration is more p
rogressive, as in a reservoir [from 1% (after 30 minutes) to 5.8% (after 48 hour
s) of the total injected dose]. High iodide-concentration by the mammary gland i
s evident only in pregnancy and lactation. High excretion of radio-iodide is obs
erved in the urine. (Venturi, 2009)
Stomach as nutrition sensor[edit]
The stomach can "taste" sodium glutamate using glutamate receptors[15] and this
information is passed to the lateral hypothalamus and limbic system in the brain
as a palatability signal through the vagus nerve.[16] The stomach can also sens
e, independently to tongue and oral taste receptors, glucose,[17] carbohydrates,
[18] proteins,[18] and fats.[19] This allows the brain to link nutritional value
of foods to their tastes.[17]
Clinical significance[edit]
An endoscopy of a normal stomach of a healthy 65-year-old woman.
Diseases[edit]
Main article: Stomach disease
A large number of studies have indicated that most cases of peptic ulcers, gastr
itis, and stomach cancer are caused by Helicobacter pylori infection. The stomac
h has to regenerate a new layer of mucus every two weeks, or else damage to the
epithelium may result.
Surgery[edit]
Many bariatric surgery procedures involve the stomach, in order to lose weight.
A gastric band may be placed around the cardia area, which can adjust to limit i
ntake. The anatomy of the stomach may be modified, or the stomach may be bypasse
d entirely.
Surgical removal of the stomach is called a Gastrectomy, and removal of the card
ia area is a called a "cardiactomy". "Cardiectomy" is a term that is also used t
o describe removal of the heart.[20][21][22] The former procedure may be carried
out because of gastric cancer or severe perforation of the stomach wall.
History[edit]
There were previously conflicting statements in the academic anatomy community[2
3][24][25] over whether the cardia is part of the stomach, part of the esophagus
or a distinct entity. Modern surgical and medical textbooks have agreed that "T
he gastric cardia is now clearly considered to be part of the stomach."[26][27]
Etymology[edit]
The word stomach is derived from the Latin stomachus which is derived from the G
reek word stomachos (st?a???), ultimately from stoma (st?a), "mouth".[28] The word
s gastro- and gastric (meaning related to the stomach) are both derived from the
Greek word gaster (?ast??, meaning "belly"[29][30]).[31]
Other animals[edit]
Although the precise shape and size of the stomach varies widely among different
vertebrates, the relative positions of the esophageal and duodenal openings rem
ain relatively constant. As a result, the organ always curves somewhat to the le
ft before curving back to meet the pyloric sphincter. However, lampreys, hagfish
es, chimaeras, lungfishes, and some teleost fish have no stomach at all, with th
e esophagus opening directly into the intestine. These animals all consume diets
that either require little storage of food, or no pre-digestion with gastric ju
ices, or both.[32]
The gastric lining is usually divided into two regions, an anterior portion line

d by fundic glands, and a posterior with pyloric glands. Cardiac glands are uniq
ue to mammals, and even then are absent in a number of species. The distribution
s of these glands vary between species, and do not always correspond with the sa
me regions as in man. Furthermore, in many non-human mammals, a portion of the s
tomach anterior to the cardiac glands is lined with epithelium essentially ident
ical to that of the esophagus. Ruminants, in particular, have a complex stomach,
the first three chambers of which are all lined with esophageal mucosa.[32]
In birds and crocodilians, the stomach is divided into two regions. Anteriorly i
s a narrow tubular region, the proventriculus, lined by fundic glands, and conne
cting the true stomach to the crop. Beyond lies the powerful muscular gizzard, l
ined by pyloric glands, and, in some species, containing stones that the animal
swallows to help grind up food.[32]
Comparison of stomach glandular regions from several mammalian species. Yellow:
esophagus; green: glandular epithelium; purple: cardiac glands; red: gastric gla
nds; blue: pyloric glands; dark blue: duodenum. Frequency of glands may vary mor
e smoothly between regions than is diagrammed here. Asterisk (ruminant) represen
ts the omasum, which is absent in Tylopoda (Tylopoda also has some cardiac gland
s opening onto ventral reticulum and rumen[33]) Many other variations exist amon
g the mammals.[34][35]