Sitg: Left hypochondrium, epigastrium and umbilical regions.
J-shaped (vertical): COMMONEST.
Steer-horn (horizontal): less common.
The stomach has 2 orifices, 2 borders & 2 surfaces:
o At the junction of the esophagus.
o At the level of T10, l inch to the left of
o At the junction with the duodenum.
o At the level of L1,yz inch to the right of the midline.
o ldentified at operation by: {F
1. Pre-pyloric vein of Mayo between Rt. gastric and Rt.
Lesser curvature & greater curvature (4 times long as the lesser curvature).
A-Anterior: related to the liver, diaphragm, & ant abdominalwall
B- Posterior: (The Stomach neA)f
4- Spleen (separated by greater sac).
N.B. atl are separated from the stomach by lesser sac
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1 . Fundus: above the level of cardiac notch.
2. Bodv: between the fundus & the pyloric portion.
o Distal to imaginary line between incisura angularis to corresponding
bulge in the greater curvature.
i- Pyloric antrum ) proximal dilated part.
ti- Pyloric canal ) distal narrow part.
i-i-Pyloric sphincter ) at the end of the stomach.
peritoneal covering: {* lgrrsnrnlum
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- completelv covered with peritoneum
o Lesser omentum attached to the lesser curvature.
o Liqaments attached to qreater curuature ) Greater omentum, includinq:
3. Gastro-colic (the name greater omentum is commonly used for this):
- ls a 4-layered serous structure.
- Acts as a plug in acute abdominal inflammation (Policeman of the
- lt occasionally has congenital openings.
- lt is mainly supplied by gastro-epiploic artery.
- Lies anterior to the transverse colon.
Supplied by branches of celiac trunk (foregut)
Superior pancreaticoduodenal a,
i. Rt. gastric (from hepatic artery).
ii. Lt. gastric (from celiac trunk).
i. Rt. gastro-epiploic (from gastro-duodenal artery).
ii. Lt. gastro-epiploic (from splenic artery).
tr Short gastric arteries (from splenic artery passing through gastrosplenic ligament).
ln subtotal gastrectomy, the land mark is the upper border of descending branch of lt.
gastric a. & the last short gastric a.
(Poftal + anastomosis with esophageat veins)
Rt. & Lt. gastric veins ) portal vein.
Rt. gastro-epiploic vein ) superior mesenteric vein.
Lt. gastro-epiploic vein & short gastric veins ) splenic vein.
LN on the lesser curve LN in gastrosplenic ligament
The lvmoh vessels are in the stomach itself
A- Sympathetic: from celiac plexus (Greater Splanchnic Nerve).
B- Parasympathetic (secretomotor):
is the shortest, widest & most fixed portion of the small intestine.
It is usually the breadth of 12 fingers.
It forms a c - shaped curve around the head of the pancreas.
- Duodenum has no mesentery (it is the fixed portion of small intestine
retroperitoneal) except for the 1't part.
- lt lies anterior to the structures of posterior abdominal wall.
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PartS Of The DuOdenUm: ft is subdivided into 4 pafts
- lt is 2 inches long & begins at the level of the L1 vertebra.
- lt is the only mobile part of the duodenum (specially the 1't inch).
- lt is covered anteriorly by peritoneum of greater sac.
- lt is covered posteriorly by peritoneum of the lesser sac.
o Posteriorlv: Gastro-duodenal artery, CBD, portal vein & IVC (from anterior to
. @fly.: quadrate lobe of liver & neck of GB.
- lt is 3 inches long desceA.ling vertically from L1 to L3.
- The bile duct opens in its postero-medial aspect.
- The bile duct usually unites with the main pancreatic duct to form the ampulla of
.Vater & opens at the major duodenal papilla.
The accessory pancreatic duct opens separate]y at the minor duodenal
papilla 1 inch dncive the major duodehal papilla. {F
Anterior: the liver & the transverse colon.
Posterior: the Rt. kidney & Rt. psoas major.
- lt is 4 inches in'length at the level of L3 vertebra.
- lt is covered by peritoneum anteriorly & inferiorly.
oAnterior: superior mesenteric vessels at root of mesentry.
Al.B; Superior mesenteric vein lies on the right side of superior
.-terrol: the aorta, IVC, origin of the inferior mesenteric artery, Rt. ureter and
- lt is covered by peritoneum anteriorly & to the Lt.
.r- - lt ends at the D-J flexure which is supported by Iigament of Treitz from the Rt.
- ,.4, border of Lt. psoits major muscle.
Medial relations (and to the Rt.):
- Uncinate process of the pancreas.
2 parts, probably neither attached to crura
1. Slip of striated muscle from diaphragm at esophageal opening, ending in
connective tissue of celiac prtery.
2. Fibro-muscular (non-striated) band from region of cetiac a. to D-J, 3'd and 4th parts
Bleeding above this ligament ) hematemesis + melena, while below this ligament )
melena & if massive, bleeding per rectum occurs.
Bleeding per rectum & not melena occurs if bleeding is from the beginning of the
The small gut is suspended by its mesentery which extends from the left side of the 2nd
Iumbar vertebra to the Rt. iliac fossa crossing the 3'd part of the duodenum, aorta, lVC,
Supplied by branches of both celiac trunk & sup mesenteric a (foregut + midgut)
a- Superior pancreatico-duodenal aftery ) from the gastro-duodenal artery.
b- lnferior pancreatico-duodenal artery ) from superior mesenteric artery.
Both of them supply the head of pancreas & the duodenum.
c- Supra-duodenal aftery ) from hepatic artery.
Common hepratic ertery Grealer
Herhr lnlerior pancreaticoduodenal artery
Points of Suroica! Imoortance:
1) Obstruction of 3'd part of the duodenum may be caused by:
o Pressure by superior rnesenteric artery"
o Contraction of the ligament of Trietz.
. Widening of C-curve of the duodenum ) cancer head of pancreas.
. lnverted figure J ---+ peri-ampullary carcinoma.
o Trifoliate deformity ---+ duodenal ulcer.
. Root: 6 inches long and is attached to the posterior abdominal wall crossing 6
1) 4th part of duodenum 2) 3t part of duodenum 3) Aorta.
4) rvc 5) Rt. Psoas major muscle 6) Rt. ureter
. Blg4lgg5. lt extends from left side of L2 to Rt. sacroiliac joint.
2) Superior mesenteric artery.
Large amount of mesenteric fats.
- Small amount of mesenteric fats.
- Has 1 or 2 arterial arcades in the
i ns: at the end of the ileum, at the ileo-caecal valve.
EndS: at the anal canal (recto-analjunction).
Related tcl anterior er"tu olF srri+eii
Supplied by left colic vessels of
Supported by phrenico-colic ligament
Lies higher than right colic flexure.
o Reiated to right lobe of liver.
Supplied by superior mesenteric
Haustrations: due to the presence of taenia
coli which is shorter than the length of the
intestine (in ulcerative colitis, the large
intestine is fibrosed ) loss of haustrations).
Appendices epiploicae (more in the left).
. Transverse colon is the longest segment of the colon,
, Sigmoid colon makes an S-shaped course.
, By endoscopy, the promontory of the sacrum might be clinical landmark
between cancer rectum & sigmoid colon.
. By endoscopy, recto-sigmoid junction is 15 cm from the anal verge.
l.Ascending & descending colons are covered on the front and sides by
peritoneum, not from behind (retro-peritoneal- no mesentery).
N.B: A mesentery for the ascending colon & descending colon might be abnormally
present & this may lead to volvulus of the caecum & rnfussusception.
-;]-.Transverse colon has a transverse mesocolon (mobile segment), which is
Storred of 2 layers attached to the anterior border of'the pancreaZ.
3. Sigmoid colon has a sigmoid mesocolon. This mesocolon:
. lt has 2 limbs, meeting each other to form inverted V-shaped mesentery.
. lts apex is directed upwards (lies near the division of left common iliac artery).
MIEU,T: SuPerior mesenteric artery
HINDGUT: lnferior mesenteric artery
1- Proximal Group: situated on the main blood vessels as superior mesenteric,
inferior mesenteiic, ilio-colic, right colic. "etc'
2- Intermediate Group: along the smaller branches (e'g' ascending & descending
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