Stomach Anatomy and Ligaments

Stomach - Anatomy

• The stomach is the dilated part of the digestive tract connecting the esophagus and small intestine.
• It lies in the left hypochondrium, epigastrium, and umbilical regions.
• It is J-shaped and very distensible, with a capacity of 30 mL at birth and 1.5-2 liters in adults.
• It has two orifices: the cardiac and pyloric openings.
• The cardiac orifice is at the junction with the esophagus.
• The pyloric orifice is at the junction between the stomach and the small intestine.
• It has two borders or curvatures: the lesser and greater curvatures.
• It has two surfaces: the anterior and posterior surfaces.
• It is completely covered by peritoneum except for a small area on its posterior surface near the cardiac orifice, called the bare area of the stomach.
• The peritoneum covering the anterior and posterior surfaces of the stomach meet at the curvatures to form ligaments.

Stomach Ligaments

• The lesser omentum connects the lesser curvature and the first inch of the duodenum with the porta hepatis (hilum of the liver).
• The greater omentum connects the right two thirds of the greater curvature and the first inch of the duodenum with the transverse colon and the anterior border of the body of the pancreas.
• The gastrosplenic ligament connects the upper left one third of the greater curvature with the hilum of the spleen.
• The gastrophrenic ligament connects the fundus of the stomach with the diaphragm.

Stomach Blood Supply

• The stomach receives a rich arterial supply from the celiac trunk and its branches.
• The lesser curvature is supplied by the left gastric artery (from the celiac trunk) and the right gastric artery (from the hepatic artery).
• The greater curvature is supplied by the short gastric arteries (from the splenic artery), the left gastroepiploic artery (from the splenic artery), and the right gastroepiploic artery (from the gastroduodenal artery).

Stomach Venous Drainage

• The venous drainage of the stomach is by veins that end either in the portal vein or one of its tributaries.
• The left and right gastric veins drain into the portal vein.
• The short gastric veins, left gastroepiploic vein, and the right gastroepiploic vein drain into the splenic vein, with the right gastroepiploic vein also draining into the superior mesenteric vein.

Stomach Lymphatic Drainage

• The lymphatic vessels of the stomach accompany the arteries and drain into lymph nodes.
• The lymph nodes are divided into groups: paracardial, left gastric, pyloric, hepatic, right gastroduodenal, pancreaticosplenic.
• From these nodes, efferent vessels drain into the celiac group of lymph nodes.

Stomach Nerve Supply

• The sympathetic nerve supply comes from the spinal cord segments T6 to T10 via the celiac plexus.
• The parasympathetic nerve supply comes from both vagus nerves, through the anterior and posterior gastric vagal nerves.
• The sympathetic nerves are motor to the pyloric sphincter and inhibitory to the rest of the stomach musculature.
• The parasympathetic nerves are motor to the muscle wall, increasing stomach motility, and secretory to the glands of the stomach.

Applied Anatomy

• The left gastric and short gastric veins connect to the esophageal veins draining the abdominal part of the esophagus (portal).
• These anastomose with the esophageal veins draining the thoracic part of the esophagus (systemic).
• In portal hypertension, this porta-systemic anastomosis can lead to gastric and esophageal varices.