Stomach: Embryology and anatomy

Question 1

What is the stomach?

Answer 1

Most dilated portion of alimentary canal, part of foregut interposed between oesophagus and duodenum

The stomach plays a crucial role in digestion.

Question 2

From which embryonic layer does the stomach develop?

Answer 2

Endoderm of the foregut

This development occurs on the dorsal mesogastrium.

Question 3

During which week of embryonic development does the stomach tube begin to dilate?

Answer 3

4th week

Question 4

What happens to the dorsal border of the stomach during development?

Answer 4

Grows faster than ventral, forming the greater curvature

This differential growth is essential for stomach shape.

Question 5

In which direction does the stomach swing during development?

Answer 5

To the left

This movement is part of the stomach’s rotation and orientation.

Question 6

What type of rotation occurs to establish the adult orientation of the stomach?

Answer 6

90° rotation on the longitudinal axis

This rotation is crucial for the proper positioning of the stomach.

Question 7

What happens to the duodenal part of the gut during development?

Answer 7

Elongates into a loop which swings to the right

This process is important for the formation of the duodenum.

Question 8

What initially fills the duodenal lumen during embryonic development?

Answer 8

An epithelial plug

This plug is later vacuolized and recanalized.

Question 9

What is the process that occurs in the duodenal lumen at 8 weeks?

Answer 9

Recanalization

This process restores the lumen for digestive function.

Question 10

What are the three muscle layers of the stomach?

Answer 10

Outer longitudinal, Inner circular, Innermost oblique

These muscle layers assist in the movement and processing of food within the stomach.

Question 11

What is the Cardia in relation to the stomach?

Answer 11

Gastro-oesophageal junction; most fixed portion of stomach; lies 2.5cm to left of midline at left of T10; 40cm from teeth

The Cardia is the entry point of the esophagus into the stomach.

Question 12

What is the Fundus of the stomach?

Answer 12

Part that projects above cardia; lies in contact with diaphragm; usually full of swallowed air

The Fundus is the uppermost part of the stomach, important for gas accumulation.

Question 13

What is the Body of the stomach?

Answer 13

Largest portion of stomach; extends from fundus to the angularis notch at the lower part of the lesser curvature

The Body is crucial for the mixing and digestion of food.

Question 14

What does the Pyloric portion of the stomach include?

Answer 14

From angular incisure to gastroduodenal junction; includes Antrum (pyloric antrum) and Pyloric canal

The Pyloric portion regulates the passage of food into the duodenum.

Question 15

What is the function of the pyloric sphincter?

Answer 15

Thickened circular muscle at distal end of pyloric canal

The pyloric sphincter controls the release of stomach contents into the small intestine.

Question 16

What structures make up the stomach bed?

Answer 16

Lesser sacs posterior wall, left crus, dome of diaphragm, splenic artery, body of pancreas, transverse mesocolon, upper part of left kidney, left adrenal gland, spleen, splenic flexure of colon

The stomach bed supports the stomach and contains important vascular and organ structures.

Question 17

What lies medially to the stomach?

Answer 17

Coeliac trunk, coeliac plexus and ganglia, coeliac lymph nodes

These structures are significant for blood supply and innervation to the abdominal organs.

Question 18

What supplies the arterial blood to the stomach?

Answer 18

Branches of coeliac trunk

Question 19

Which artery runs along the lesser curvature of the stomach?

Answer 19

Left gastric artery, anastomosing with right gastric artery

Question 20

Which artery is a branch of the common hepatic artery that contributes to the stomach’s blood supply?

Answer 20

Right gastric artery

The right gastric artery supplies the lesser curvature of the stomach.

Question 21

What artery gives rise to the right gastroepiploic artery? What does this arise from?

Answer 21

Gastroduodenal artery, which arises from the CHA

The right gastroepiploic artery runs closer to the stomach than the left gastroepiploic artery.

Question 22

Which artery supplies the spleen and contributes to the blood supply of the stomach?

Answer 22

Splenic artery

The splenic artery branches off the coeliac trunk and supplies the spleen and parts of the stomach.

Question 23

What are the short gastrics?

Answer 23

Branches of the splenic artery that supply the stomach

The short gastrics specifically supply the upper part of the greater curvature of the stomach.

Question 24

Which artery supplies the left gastroepiploic area of the stomach?

Answer 24

Left gastroepiploic artery

The left gastroepiploic artery is a branch of the splenic artery.

Question 25

What is the primary source of arterial supply to the stomach?

Answer 25

Branches of the coeliac trunk ## Footnote The coeliac trunk is a major artery that supplies blood to the abdominal organs.

Question 26

Which artery supplies the lesser curvature of the stomach?

Answer 26

Left gastric artery ## Footnote The left gastric artery runs along the lesser curvature providing essential blood supply.

Question 27

Name the artery that gives rise to the right gastroepiploic artery.

Answer 27

Gastroduodenal artery ## Footnote The right gastroepiploic artery runs closer to the stomach than the left gastroepiploic artery.

Question 28

Which artery is involved in the blood supply to the stomach and also branches off from the common hepatic artery?

Answer 28

Right gastric artery ## Footnote The right gastric artery helps supply the greater curvature of the stomach.

Question 29

What are the short gastric arteries responsible for?

Answer 29

Supplying the fundus of the stomach ## Footnote The short gastric arteries branch from the splenic artery.

Question 30

True or False: The splenic artery contributes to the arterial supply of the stomach.

Answer 30

True ## Footnote The splenic artery provides short gastric arteries and the left gastroepiploic artery.

Question 31

Fill in the blank: The _______ artery runs along the greater curvature of the stomach.

Answer 31

gastroepiploic artery

Question 32

What is the final destination of lymph drainage from the stomach?

Answer 32

Coeliac trunk ## Footnote All lymph drainage from the stomach eventually terminates in the coeliac trunk

Question 33

How do lymph nodes in the stomach wall interact?

Answer 33

They anastomose freely ## Footnote Lymph nodes in the stomach wall are interconnected

Question 34

What are gastric lymph nodes stations 1, 2, and 3

Answer 34

Right of pylorus Left of pylorus Lesser curvature

Question 35

What are gastric lymph nodes stations 4s and 4d, 5, and 6

Answer 35

Left gastroepiploic artery distrubution Right gastroepiploic artery distribution Between CHA and D1 Overlying pancreatic head/within the duodenal c

Question 36

What are gastric lymph nodes stations 7,8,9

Answer 36

Origin of left gastric artery origin of right gastric artery coeliac trunk

Question 37

What are gastric lymph nodes stations 10,11,12

Answer 37

Splenic hilum Along splenic artery pars flaccida?

Question 38

What are gastric lymph nodes stations 13,14,15 and 16

Answer 38

?posterior superior pancreaticoduodenal arteries Origin of SMA Middle colic ?distal sma

Question 39

What constitutes a D1 lymph node dissection for gastric cancer

Answer 39

Upper 1/3 cancer 1,2,3,4s Middle 1/3 cancer 1,3,4s-mid, 4d,5,6 distal 1/3 cancer 3,4d,5,6

Question 40

What constitutes a D2 dissection for gastric cancer

Answer 40

proximal 1/3 4d,7,8 ant, 9, 10,11 Middle 1/3 7,8a,9,11prox, 12 left Distal 1/3 1,7,8,9,11prox, 12 left, 14

Question 41

What is the role of sympathetic fibres in the stomach?

Answer 41

Sympathetic fibres run with arteries, vasomotor, and cause pyloric constriction ## Footnote Sympathetic fibres are accompanied by afferent pain fibres.

Question 42

What is the source of parasympathetic supply to the stomach?

Answer 42

Parasympathetic supply comes from the vagus nerve ## Footnote It controls motility and secretion.

Question 43

Where does the anterior trunk of the vagus nerve lie?

Answer 43

In contact with the anterior oesophagus, near the right margin ## Footnote It gives off the hepatic branch and gastric branches.

Question 44

What does the hepatic branch of the anterior trunk of the vagus nerve do?

Answer 44

Travels in the lesser omentum and gives off the pyloric branch ## Footnote It reaches the sphincter.

Question 45

What are the gastric branches of the anterior trunk responsible for?

Answer 45

Supplying the fundus and body of the stomach ## Footnote Includes a large branch known as the ant nerve of Latarget.

Question 46

What does the posterior trunk of the vagus nerve give off?

Answer 46

Coeliac branch that runs to the coeliac plexus ## Footnote Also includes the posterior nerve of Latarget.

Question 47

What is truncal vagotomy?

Answer 47

Cutting the trunks at the level of the abdominal oesophagus ## Footnote This procedure causes gastric stasis.

Question 48

What are the consequences of truncal vagotomy?

Answer 48

Causes gastric stasis and may require drainage procedures ## Footnote These procedures include pyloroplasty or gastrojejunostomy.

Question 49

What is a potential complication of truncal vagotomy?

Answer 49

Can lead to dumping and post vagotomy diarrhoea ## Footnote These are common complications after the procedure.

Question 50

What is selective vagotomy?

Answer 50

Cutting vagal trunks distal to the hepatic branch of the anterior vagus and coeliac branch of the posterior vagus ## Footnote It can also cause stasis and require drainage procedures.

Question 51

What is the difference between selective vagotomy and highly selective vagotomy?

Answer 51

Selective vagotomy cuts vagal trunks distal to the hepatic branch of the anterior vagus, while highly selective cuts only branches to fundus and body ## Footnote Antral and pyloric branches are left intact in highly selective vagotomy.