Stomach

ANATOMY AND PHYSIOLOGY

Stomach

 It is J shaped dilated portion.

 Situated in the epigastric, umbilical and left
hypochondriac regions of the abdominal
cavity.
Organs associated with the stomach

 Anteriorly- left lobe of liver and anterior

abdominal wall.
 Posteriorly- abdominal aorta, pancreas,
spleen, left kidney and adrenal gland.
 Superiorly- diaphragm, esophagus and left
lobe of liver.
 Inferiorly- transverse colon, small intestine.
Cont.

 To the left lateral- diaphragm and spleen.

 To the right lateral- liver and duodenum
Structure

 The stomach continuous with the esophagus

at the cardiac orifice.
 Continuous with the duodenum at the pyloric
orifice.
 It has two curvatures
- Lesser curvature
- Greater curvature
Cont.

 The stomach is divided into 3 parts :- fundus,

body and pylorus.
 The part of the stomach above the cardiac
orifice is the fundus.
 The main part is the body.
 The lower part is pylorus or pyloric antrum.
Cont.

 At the end of the pyloric antrum there is

pyloric sphincter.
 When stomach is inactive it is relaxed and
open.
 When stomach contain food, it is closed.
Walls of the

 Consist of 4 layers:-
1. Serosa / peritoneum
2. Muscle layer
3. Sub mucosa
4. Mucosa
Peritoneum

 Greater omentum
- The fold of peritoneum attaches the
stomach to the posterior abdominal wall.
Cont.

 Functions
- It stores fat which provides long term
energy
- Secretes peritoneal fluid allows the organ to
glide each other .
- It attaches all the abdominal organs.
- Isolates areas of inflammation.
Muscle layer

 It consist of 3 layers:-
1. Outer layer of longitudinal fibers.
2. Middle layer of circular fibers.
3. Inner layer of oblique fibers.
 This arrangement helps for churning motion
for gastric activity.
Mucosa

 The mucosa lies in large folds called rugae

 The surface is a layer of non ciliated simple
columnar epithelial cells called surface
mucous cells.
 There are gastric glands situated below the
surface in the mucous membrane.
Cont.

 The gastric glands contain 3 types of exocrine

cells that secrete gastric juice.
- mucous neck cells.
- parietal cells.
- chief cells
Cont.

 Both surface mucous and mucous neck cells

secrete mucus.
 The chief cells secrete pepsinogen (inactive
gastric enzyme)
 Parietal cells produces hydrochloric acid
which convert pepsinogen to pepsin.
Cont.

 Parietal cells also secrete intrinsic factor helps

in the absorption of vitamin B12.
 The G cells
- a fourth type of cell in the gastric glands
secrete the hormone gastrin.
Sub mucosa

 Sub mucosa of the stomach is composed of

areolar connective tissue that connects the
mucosa to the muscularis.
Blood and nerve supply

 Blood supply of stomach:

Arterial supply by branches of the celiac artery .
Venous drainage is in to the portal vein.
 Nerve supply:
Sympathetic supply from coeliac plexus.
Parasympathetic supply from vagus nerve.
Gastric juice

 2-3 liters secreted daily.

 It consist of :
- water, mineral salts secreted by gastric
gland.
- mucus secreted by goblet cells
Cont.

 Hydrochloric acid and intrinsic factor secreted

by parietal cells.
 Inactive enzyme precursors (pepsinogen
secreted by chief cells in the glands)
Functions of gastric juice

 Water- liquefies the food swallowed.

 HCL- acidifies the food and stop the action of
salivary amylase
- kills microbes
- provides acid environment for effective
digestion.
Cont.

 Pepsinogen activated to pepsin which digest

protein.
 Intrinsic factor necessary for the absorption
of Vitamin B12.
 Mucus prevents-
- mechanical injury to the stomach wall by
lubrication.
- chemical injury by acting as a barrier.
Secretion of gastric juice

 Three phases of secretion of gastric juice :-

1. Cephalic phases
2. Gastric phases
3. Intestinal phases
Cont.

 Cephalic phases
- this flow occurs before food reaches the
stomach.
- and is due to reflex stimulation of the vagus
nerve initiated by smell, sight or taste of
food.
Cont.

 Gastric phases
Enteroendocrine cells secretes gastrin

Gastrin enters into the blood and stimulates

gastric gland

Produce more gastric juice

Cont.

 Intestinal phases
Partially digested contents

Reach small intestine

Hormone complex enterogastrone

Reduces gastric motility and gastric juice

secretion
Functions of stomach

 Temporary storage
 Chemical digestion- pepsin converts protein
to polypeptides.
 Mechanical digestion- smooth muscle layers
act as a chum and mix the food and gastric
juice.
Cont.

 Limited absorption of water, alcohol and

some lipids soluble drugs.
 Non specific defense againts microbes by
HCL.
 Dissolving out of iron from the food.
 Production of intrinsic factor needed for
absorption of vitamin B12.
Digestion and absorption

 Once the food reach the stomach

 The stomach wall stretched
 The ph of stomach content increase
 Flow of gastric juice
 Initiate peristaltic movements
 Chyme production
Cont.

 Gastric emptying
- each mixing wave forces a small amount of
chyme through the pyloric sphincter into the
duodenum.
- food reach in CHO spend less time in the
stomach
- protein remains longer
- fat- slow gastric emptying
Cont.

 Chemical digestion begins with digestion of

protein by the enzyme pepsin.
 Little absorption of water, irons and fatty
acids.