LESSON-2 PDF: Anatomía del Sistema Digestivo

LESSON-2.pdf user_1680833 Anatomía: sistema renal, reproductor, digestivo, endocrino y metabólico 2º Grado en Medicina Facultad de Ciencias de la Salud. Campus de Alfara Universidad CEU Cardenal Herrera Reserv...

LESSON-2.pdf user_1680833 Anatomía: sistema renal, reproductor, digestivo, endocrino y metabólico 2º Grado en Medicina Facultad de Ciencias de la Salud. Campus de Alfara Universidad CEU Cardenal Herrera Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  Lesson 2: Esophagus and stomach Overview of the abdominal Overviewviscera of the abdominal viscera Abdominal viscera 4 The major part of the digestive system is located in the abdomen: A small piece of esophagus Stomach Intestines Pancreas Liver Gallbladder And also non-digestive organs: Spleen Kidneys Suprarenal glands When we open the abdominal cavity in the cadaver we can see that: Liver, stomach and spleen are almost completely covered by the ribs The falciform ligament of the liver is attached to the anterior wall and it divides the liver into right and left lobes The greater omentum covers the major part of the intestine The gallbladder appears in the inferior border of the liver a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  Arterial supply of digestive tube Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. The digestive abdominal viscera are irrigated by the aorta through three branches: Celiac trunk: for the foregut, from esophagus to a line below the duodenal major papilla Superior mesenteric artery: for the midgut, from the descending duodenum to the left colic flexure Inferior mesenteric artery: for the hindgut, from the left colic flexure to the anal pectinate line Celiac trunk It arises from the aorta immediately after the aortic hiatus of diaphragm Main branches: left gastric, splenic and common hepatic 1. Left gastric artery: for the esophagus and lesser curvature of stomach. It has many anastomosis Esophageal branches that anastomose with the esophageal branches of thoracic aorta Anastomosis of the left and the right gastric artery a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Fiesta del Cine 2024: del 3 al 6 de junio. ENTRADAS 3,50€! Anatomía: sistema renal, rep... Banco de apuntes de la  2. Splenic: big branch with a tortuous path along the superior border of pancreas and splenorenal ligament It irrigates the pancreas, spleen and the stomach thanks to: Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Short gastric arteries Left gastro-omental arteries Posterior gastric artery 3. Common hepatic: it gives these branches: Right gastric artery: for lesser curvature of stomach Cystic artery: for gallbladder Proper hepatic artery: for the liver Gastroduodenal artery, that gives: o Right gastro-omental artery o Supraduodenal artery, which gives the PSPD or posterior superior pancreaticoduodenal artery o ASPD or anterior superior pancreaticoduodenal artery Superior mesenteric artery Anteriorly it has: – Splenic vein – Neck of the pancreas Posteriorly it has: – Uncinate process of pancreas – Inferior horizontal portion of duodenum Branches: Inferior pancreaticoduodenal artery: it will anastomose with ASPD and PSPD and irrigates the duodenum and parts of pancreas Jejunal and ileal arteries: a lot of branches for jejunum and most of ileum that cross between the two layers of mesentery forming arcades and vasa recta a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Fiesta del Cine 2024: del 3 al 6 de junio. ENTRADAS 3,50€!  Middle colic artery: for traverse colon crossing through the transverse mesocolon. It can anastomose with the left colic artery from inferior mesenteric artery Right colic artery: for ascending colon. It can anastomose with the neighboring branches: middle and ileocolic arteries Ileocolic artery: for ileum, cecum, appendix and ascending colon, they are Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. called respectively colic, cecal, appendicular and ileal branches Inferior mesenteric artery Main vessel of the hindgut, it gives these branches: Left colic artery: it travels through the transverse mesocolon for achieve the distal part of transverse colon and descending colon – It anastomoses with the neighboring branches: middle colic and sigmoid arteries Sigmoid arteries: for sigmoid colon Superior rectal artery: for the proximal part of rectum The inferior mesenteric artery does not irrigate the distal part of the rectum, which vessels are: Middle rectal artery: from internal iliac artery Inferior rectal artery: from internal pudendal artery, from internal iliac artery Venous return Behind the neck of pancreas, the superior mesenteric and splenic vein form the hepatic portal vein, that goes to the liver They receive the blood from: – Digestive tube – Spleen – Pancreas – Gallbladder The only exceptions are called portal- systemic anastomosis a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Fiesta del Cine 2024: del 3 al 6 de junio. ENTRADAS 3,50€!  Tributaries of portal vein Splenic vein: from the spleen, through the splenorenal ligament. It receives: – Short gastric veins from fundus and greater curvature – Left gastro-omental vein from greater curvature – Pancreatic veins – Inferior mesenteric vein: it receives the superior rectal, sigmoid and left colic veins Superior mesenteric vein: receives the homonym veins from the SMA: jejunal, ileal, ileocolic, right colic, and middle colic veins – Right gastro-omental vein: from the greater curvature, it also receives the ASPD or Anterior Superior Pancreaticoduodenal vein – AIPD and PIPD: Anterior/Posterior Inferior Pancreaticoduodenal veins Once the splenic vein and superior mesenteric vein form the hepatic portal vein, it receives these veins: Right and left gastric veins: they drain the lesser curvature of stomach and esophagus Cystic veins from gallbladder Para-umbilical veins: related to the obliterated umbilical vein PSPD: Posterior superior pancreaticoduodenal vein Portal-systemic anastomoses Places where the blood from digestive tube can cross directly to the systemic circulation – They can provide a parallel path in case of hepatic obstruction: A: the esophageal blood can be drained to the azygos (systemic) or the left gastric vein (portal). When they are dilated, they form esophageal varices B: the rectus blood can be drained to the superior rectal vein (portal) or to the middle/inferior rectal veins (systemic). When they are dilated they form hemorrhoids C At the anterior abdominal wall may anastomose the paraumbilical veins (portal) with epigastric veins (systemic). When they are dilated they cause caput medusae a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  D on the posterior surface of the secondarily retroperitoneal viscera like Portal-systemic the colic vein (portal)anastomoses may anastomose with the posterior abdominal wall Places where the blood from digestive veins such lumbar veins(systemic) tube can cross directly to the systemic circulation Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. They can provide a parallel path Examples Examples indilation of of dilation case ofofhepatic obstruction: porto-systemic of porto-systemic anastomosis anastomosis Esophageal varices A: the esophageal Hemorrhoids blood can be Caput medusae drained to the azygos (systemic) or the left gastric vein (portal). When they are dilated, they form esophageal varices B: the rectus blood can be drained to the superior rectal vein (portal) or to the middle/inferior rectal veins (systemic). When they are dilated they form hemorrhoids 20 Innervation of digestive system 18 The innervation of the abdominal viscera consists of: Extrinsic innervation: – It receives motor impulses from the central nervous system – It sends reflex and pain information to the central nervous system Intrinsic innervation: the enteric nervous system regulates the digestive tract thanks to a self-sufficient network of sensory and motor neurons – These neurons are located in two interconnected plexuses in the walls of the digestive tube – These neurons control the synchronized contraction/relaxation of the intestinal smooth muscle, gastric secretion and blood flow General innervation of Abdominal Viscera Presynaptic fibers: – Sympathetic: abdominopelvic splanchnic nerves – Parasympathetic: X Vagus nerve and pelvic splanchnic nerves Synapsis: – Sympathetic: synapsis takes place at the prevertebral sympathetic ganglia of the abdominal aortic plexuses – Parasympathetic: synapsis takes place at the abdominal viscera a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Fiesta del Cine 2024: del 3 al 6 de junio. ENTRADAS 3,50€!  Postsynaptic fibers: – Sympathetic: Periarterial extensions to the viscera – Parasympathetic: very short neurons inside the digestive tube The two plexus of the digestive tube Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Auerbach plexus: also called myenteric plexus Located between the two muscular layers, from esophagus to anus, but it has more presence in the intestine Its main function is the peristaltism Meissner plexus: also called submucosal plexus Located in the submucosa, from esophagus to anus Its main function is the secretion of the content of the glands (secretomotor) Sympathetic system The sympathetic innervation is provided by: 1. Abdominopelvic splanchnic nerves, that comes from the thoracic and abdominal sympathetic trunks 2. Prevertebral sympathetic ganglia 3 Cervical, 11-12 thoracic, 4 lumbar, 4-5 sacral The last ganglia is the ganglion impar, where the two chains merge in the midline 3. Abdominal aortic plexus and its periarterial plexuses Abdominopelvic splanchnic nerves They are the greater, lesser, least and lumbar splanchnic nerves They bring presynaptic sympathetic fibers to the abdominal and pelvic viscera Origin: the cell bodies are located in the intermediolateral nucleus or the spinal cord (T5-L3) a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Fiesta del Cine 2024: del 3 al 6 de junio. ENTRADAS 3,50€!  Path: anterior roots→anterior rami→thoracic and lumbar spinal nerves → white communicating branches → sympathetic trunks → paravertebral ganglia (bypassed without synapsis) → abdominopelvic splanchnic nerves →prevertebral ganglia (synapsis) The suprarenal medulla is an exception, it has a different innervation system Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Sympathetic system 27 Abdominopelvic splanchnic nerves Thoracic splanchnic nerves: originated at the thoracic part of the sympathetic trunks Greater splanchnic nerve (T5-T9) that makes synapsis at the celiac sympathetic ganglia Lesser splanchnic nerve (T10-T11) that makes synapsis at the aorticorenal ganglia Least splanchnic nerve (T12) that can make synapsys at the superior mesenteric, inferior mesenteric, or intermesenteric ganglia Lumbar splanchnic nerves: 3 nerves originated at the abdominal part of the sympathetic trunks. They make synapsis at the prevertebral ganglia: superior mesenteric, inferior mesenteric, intermesenteric or superior hypogastric ganglia We will see in the lesson about pelvis the sacral splanchnic nerves: from the sacral part of the sympathetic trunk to pelvic prevertebral ganglia and the inferior hypogastric plexus a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Este examen te lo sacas con un croissant y fucking Colacao Batidos.  Splanchnic nerves Splanchnic Group Kind of fibers Origin Ending (synapsis) nerve Greater T5-T9 Celiac ganglion Lesser T10-T11 Aorticorenal Least T12 Other prevertebral ganglia: Abdomino- Abdominal Superior mesenteric pelvic Presynaptic Lumbar sympathetic Inferior mesenteric splanchnic Sympathetic fibers trunk Intermesenteric nerves Sacral Sacral sympathetic Pelvic prevertebral ganglia trunk Pelvic Presynaptic Intrinsic ganglia after the left splanchnic Pelvic S2-S4 Parasympathetic fibers colic flexure nerves 29 Check the thoracic splanchnic nerves and their synaptic ganglia: Thoracic part of the Check the thoracic splanchnic nerves and their synaptic ganglia: sympathetic trunks Thoracic part of the sympathetic trunks Greater splanchnic: celiac ganglia Greater splanchnic: celiac ganglia Lesser splanchnic: aorticorenal ganglia Lesser splanchnic: aorticorenal ganglia Least splanchnic: superior mesenteric, inferior mesenteric, or intermesenteric Least splanchnic: superior mesenteric, inferior mesenteric, or ganglia intermesenteric ganglia Check the three plexuses of the 30 lumbar splanchnic nerves 31 a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  Postsynaptic sympathetic fibers Synapsis at the prevertebral ganglia → Periarterial plexuses → Plexuses of Meissner and Auerbach Actions: Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. – Vasoconstriction – Inhibition of peristalsis Parasympathetic system The parasympathetic innervation consists of: Vagal trunks: Anterior and posterior Pelvic splanchnic nerves Abdominal paraaortic plexuses and their periarterial extensions Intrinsic enteric parasympathetic ganglia Vagal trunks: Anterior and posterior They are continuation of the vagus nerves after crossing the esophageal plexus and entering into the abdomen through the esophageal hiatus They have presynaptic fibers, not only parasympathetic, but also visceral afferent fibers for some reflexes They run through the abdominal aortic plexuses and periarterial plexuses They end at the intrinsic ganglia of: – Inferior esophagus and stomach – Small intestine – Ascending colon and most of the transverse colon a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Esperemos que el próximo haul que nos hagas sea el de tus notas. Atentamente, Colacao Batidos.  Pelvic splanchnic nerves: Don’t confuse them with greater, lesser, least and lumbar splanchnic nerves which are sympathetic They derive from the anterior rami of S2-S4 spinal nerves They send presynaptic parasympathetic fibers to the inferior hypogastric Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. plexus The synapsis take place at the Plexuses of Meissner and Auerbach of the: Sigmoid colon Rectum So remember: Pelvic organs Vagus nerves Vagus nerves until the left colic until the left flexure (in red) colic flexure (in red) Pelvic splanchnic nerves from the left colic flexure (in purple) Pelvic splanchnic nerves from the left colic flexure (in purple) 37 Pain visceral sensory innervation Don’t confuse it with the visceral afferent fibers that produce unconscious reflexes, they go through the parasympathetic fibers The pain fibers normally accompany the sympathetic fibers but in the opposite direction Viscera→Splanchnic nerves→Sympathetic trunk→White rami communicanti→Anterior rami of spinal nerves→Posterior sensory ganglia→Spinal cord The spinal level of each viscera is shown in the next slide: Foregut: Stomach, liver, pancreas: T6-T9 level Midgut: Small intestine, ascending and transverse colon: T8-T12 Hindgut: Descending colon: T12-L2 Exception: the sigmoid colon pain fibers go through the parasympathetic fibers to the S2-S4 sensory ganglia a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Esperemos que el próximo haul que nos hagas sea el de tus notas. Atentamente, Colacao Batidos.  Autonomic plexuses The plexuses have parasympathetic, sympathetic and visceral afferent fibers mixed: – Presynaptic parasympathetic + Reflex visceral afferent fibers from the X Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Vagus nerves – Presynaptic sympathetic + Pain visceral afferent fibers from the thoracic and lumbar splanchnic nerves – Presynaptic parasympathetic fibers from the pelvic splanchnic nerves The prevertebral sympathetic ganglia are located in the Celiac, Superior mesenteric and Inferior mesenteric plexuses There is also a continuity between the Inferior mesenteric plexus, Intermesenteric plexus and Superior hypogastric plexus Autonomic plexuses 41 a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Esperemos que el próximo haul que nos hagas sea el de tus notas. Atentamente, Colacao Batidos.  ESOPHAGUS Esophagus Muscular tube that goes from the pharynx to the stomach with about 25 cm long and 2 cm of diameter It is stretched by some structures during its path: o Cervical constriction, also called upper esophageal sphincter due to the cricopharyngeus muscle o Aortic arch constriction o Left main bronchus constriction o Diaphragmatic constriction: due to the esophageal hiatus of the diaphragm If you pass an instrument through the esophagus you have to be careful with these narrow points, because the esophageal wall is very easy to break The esophagus descends following the curve of the vertebral column The esophageal nervous plexus surrounds the esophagus It crosses to the abdomen through the esophageal hiatus at T10 vertebra level Cardial orifice: it is the end of the esophagus, located at the level of T11, left to the midline Its wall consists from outside to inside of: 1. A serosa made of visceral peritoneum 2. Two layers of muscle (see next slide) 3. Submucosa: loose connective tissue that contains a parasympathetic nervous plexus: submucosal plexus of Meissner 4. Mucosa: plenty of folds and glands. The kind of epithelium is very different from one zone to other a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  The two layers of muscle are: Internal circular layer External longitudinal layer made of striated muscle in its superior third, but it turns into smooth muscle as it descends Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Between both layers we have the intermuscular plexus of Auerbach Abdominal esophagus The abdominal part of the esophagus measures less than 2 cm and it widens and turn left as it approach to the cardial orifice, making a groove on the posterior surface of the liver Anterior surface: covered by the peritoneum of the greater sac, that continues to the anterior surface of the stomach Posterior surface: covered by the peritoneum of the omental bursa that continues to the posterior surface of the stomach Right border: continues with the lesser curvature of the stomach Left border: does not continue smoothly with the fundus of the stomach, because there is a cardial notch Phrenico-esophageal ligament: attaches the esophagus to its diaphragmatic hole Diaphragmatic hiatus: the musculature of the hiatus can work as an sphincter, contracting and relaxing. The barium contrast stops here momentarily before entering the stomach – This is very useful for keep the esophagus collapsed between meals, preventing the reflux of stomach acids Z-line: line where the mucosa suddenly changes histologically from esophageal mucosa to gastric mucosa Vessels of the abdominal esophagus Vessels of the abdominal Arterial supply: esophagus Left gastric artery, from the Arterial supply: celiac trunk Left gastric artery, from Left inferior the celiac phrenic artery trunk Left inferior phrenic artery Venous drainage: Submucosal veins that can follow two paths: Left gastric vein Hepatic portal vein a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Esophageal branch Tu imperio romano será que fuiste a la biblio, estudiaste y te lo sacaste todo! Azygos vein Superior  celiac trunk Left inferior phrenic artery Venous drainage: Submucosal veins that can Venous drainage: follow two paths: Submucosal veinsLeft thatgastric can follow two paths: vein Hepatic portal vein – Left gastric vein→ Hepatic portal vein Esophageal branch Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Azygos – Esophageal branch→ veinvein→ Azygos Superior Superior vena cava vena cava Lymphatic drainage: 50 Lymphatic drainage: Left gastric lymph nodes → Celiac Left lymph gastric lymph nodes nodes Celiac lymph nodes Innervation: Innervation: Parasympathetic: Esophageal plexus, Parasympathetic: formed by branches from the vagus nerve Esophageal plexus, formed by branches Sympathetic: Thoracic sympathetic trunk via from the vagus nerve Greater splanchnic nerve Sympathetic: STOMACH Thoracic sympathetic Stomach trunk via Greater splanchnic nerve It accumulates the food and prepares it for 51 the digestion before crossing through the duodenum Stomach mixes the food with the gastric juice forming a semiliquid mass called chyme Size and position The stomach can expand considerably. The size, position and shape depends mainly on: Diaphragmatic movements during respiration Content of the stomach – Empty is a bit bigger than the large intestine – Full can achieve a capacity of 3 liters of food a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Este examen te lo sacas con un croissant y fucking Colacao Batidos.  Position: – Supine: epigastric, umbilical or left hypochondrium quadrants – Standing: it can descend even to the pelvic region in very thin people (see the picture) Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Parts of the stomach: Cardia: o It surrounds the cardial orifice, the inlet of the stomach o In supine position normally is located at the level of T11 vertebra Body: § The biggest part, located between the fundus and pyloric part § Cylindrical shape Fundus: § The superior part, related to the left dome of the diaphragm due to its dilation caused by gas, liquid or food § In the radiography you can see here the gastric bubble § The cardiac notch marks the limit between esophagus and fundus § Inferiorly is limited by the horizontal plane of the cardial orifice § In supine position it is located at 6th left rib Pyloric part: the exit of the stomach, with the shape of a funnel o Pyloric antrum: the wider part, also known as pyloric vestibule o Pyloric canal: a narrow tunnel from the vestibule to the pylorus o Pylorus: sphincter formed by a thickening of the circular layer of smooth muscle Pylorus It can regulate the outflow of chyme to the duodenum when the intragastric pressure is higher than the resistance of the pylorus It is normally contracted, but the gastric peristalsis pushes the chyme through the canal at irregular intervals It is located about 1cm right to the midline at the level of L1 in supine position In the picture you can see the pylorus watched endoscopically a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Tu imperio romano será que fuiste a la biblio, estudiaste y te lo sacaste todo!  Curvatures of the stomach Lesser curvature: it consists of the right border of the stomach, concave. It ends in the inferior part at the angular notch, where the fundus bounds with the pyloric part, left to the midline Greater curvature: it consists of the left border of the stomach, convex. It passes to the left and then to the right to reach the pyloric antrum Both curvatures have different length, so the shape of the stomach seems a J View of the stomach in situ The liver has been partially removed, but you can see its silhouette represented by a dotted line The lesser omentum extends around the stomach and jump to the greater curvature converted in greater omentum Relations of the stomach Anteriorly: Diaphragm Left lobe of liver Anterior abdominal wall Posteriorly: Omental bursa: the stomach is the anterior wall of the omental bursa Pancreas Inferolaterally: Transverse colon If we cut the omental bursa through the great curvature, we can see the posterior surface of the bursa Check the portal triad inside the hepatoduodenal ligament and the caudate lobe of the liver. Both are limits of the omental foramen a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Bed of the stomach: formed by the structures of the posterior wall of the omental bursa, from superior to inferior: Left dome of the diaphragm Spleen Left kidney Suprarenal gland Splenic artery Pancreas Transverse mesocolon Layers of stomach Mucosa Submucosa: – Here we can find the Meissner plexus Three layers of muscles: instead of the normal two layers of the rest of the digestive tube (the extra layer is the oblique). From internal to external: – Oblique: it originates the churning movement – Circular: It forms the pyloric sphincter a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Tu imperio romano será que fuiste a la biblio, estudiaste y te lo sacaste todo!  Between circular and longitudinal we can find the Auerbach plexus – Longitudinal: the external layer Serosa: visceral peritoneum Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Mucosa of the stomach Consists of an epithelium, a lamina propria of connective tissue, and a layer of thin muscle fibers called muscularis mucosae The mucosa protects the surface of the stomach from the gastric acids The mucosa has plenty of folds, most marked at the pylorus and the greater curvature The mucosa has plenty of small holes, the openings of the glandular ducts Color: in living people, the gastric mucosa is brown except the pylorus that is pink Gastric canal or Swiss tie: temporary groove formed between the longitudinal gastric folds of the lesser curvature during swallowing This canal is formed due to the lack of oblique layer of muscle in this site It is visible during endoscopy when the stomach is empty. When the stomach is full the canal almost disappear due to distension Thanks to the canal is easy for the saliva to slide to the pylorus Secretory cells in the mucosa They secrete different substances depending on the location: Cardia: secrete mucus and digestive enzymes Fundus and body: secrete hydrochloric acid and digestive enzymes Pylorus: secrete mucus Argentaffin cells: located in the mucosa of almost the entire digestive tract – They are part of the APUD system (Amine Precursor Uptake Descarboxilase), which secretes hormones and neurotransmitters a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Este examen te lo sacas con un croissant y fucking Colacao Batidos.  Arterial supply of the stomach The oxygenated blood is supplied by the celiac trunk through three branches. Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Celiac trunk: Left gastric: for the abdominal esophagus and lesser curvature of the stomach Splenic: goes to the spleen, but it gives some branches for the stomach: o Posterior gastric artery: posterior wall and fundus o Left gastro-omental artery: left portion of the greater curvature o Some short gastric branches: fundus Common hepatic artery: goes to the liver, but it gives some branches for the stomach: o Right gastric artery: right portion of the lesser curvature (anastomosis) o Gastroduodenal artery: it goes to the duodenus and pancreas, but it gives also one branch for the stomach: Right gastro-omental: right portion of greater curvature of stomach So we have two important anastomoses: Anastomoses from right and left gastric arteries along the lesser curvature Anastomoses by the right and left gastro- omental arteries Remember that the fundus and upper body receive blood from the short and posterior gastric arteries. Veins of the stomach The veins run parallel to the arteries Remember that splenic vein and superior mesenteric vein will form the hepatic portal vein a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Este examen te lo sacas con un croissant y fucking Colacao Batidos.  Right gastric vein: to the hepatic portal vein Left gastric vein: to the hepatic portal vein Short gastric veins: to the splenic vein Right gastroepiploic vein: to the superior mesenteric vein Left gastroepiploic vein: to the splenic vein Prepyloric vein: to the right gastric vein – This vein is useful in surgery because it shows the correct position of the pylorus Lymph drainage of the stomach The main groups of lymph nodes are located along the curvatures: – Gastric lymph nodes: small curvature – Gastro-omental lymph nodes: greater curvature Lymph from the superior 2/3 of the stomach goes to the gastric lymph nodes Lymph from the fundus goes to the pancreatico-splenic lymph nodes and then can go to one of both curvatures Lymph from the right 2/3 and the inferior 1/3 drains first to the gastro-omental lymph nodes and later to the pyloric lymph nodes Lymph from the left 1/3 of greater curvature drains to the pancreatico- duodenal lymph nodes All the lymph vessels from these nodes will meet at the Celiac lymph nodes a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  Sympathetic supply: From T6-T9→ → Greater splanchnic nerve → →Celiac plexus→ → Plexus of the gastric and gastroepiploic arteries Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. ve supply Sympathetic supply: From T6-T9 Nerve supply Parasympathetic supply: from theGreater splanchnic anterior and nerve posterior vagal trunks. They have entered to the abdomen crossing the esophageal hiatus Celiac plexus Anterior vagal trunk: from the left vagus nerve. It goes to the lesser curvature and later through the hepato-duodenal ligament runs to the liver and duodenus Plexus of the gastric and gastroepiploic Posterior vagal trunk: from arteries the right vagus nerve. It goes to the lesser and there gives branches for the anterior and posterior surfaces of the stomach 75 a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885977 1 coin = 1 pdf sin publicidad