Endoscopic signs of a normal stomach

The stomach is located in the epigastrium. The small curvature of the stomach, appearing as a continuation of the esophagus, descends to the left of the midline, along the XI and XII thoracic vertebrae, then, rounding to the right, crosses the aorta and passes into the gatekeeper. The greater curvature rises above the esophagus by 4-5 cm. When it reaches the diaphragm, it repeats its dome, and then, curving bent, goes down and to the right towards the doorman.

The larger stomach is located to the left of the middle line, and only the gatekeeper goes 2-3 cm to the right. Only the entrance to the stomach and the gatekeeper are firmly fixed. The position of the bottom and the large curvature varies depending on the filling of the stomach. When lowering the stomach can reach the navel and below.

Forms of the stomach

1. Horny.
2. Hook-shaped - the most frequent.
3. A long stomach (the shape of a stocking).

In the stomach, distinguish the front and back walls, large and small curvature. The front wall is always more elongated than the posterior wall. The entrance to the stomach is cardia, the exit is the gatekeeper.

Stomach departments.

• Cardiac.
• The bottom (arch).
• Body of the stomach:
  • upper third,
  • middle third,
  • lower third.
• Pyloric:
  • antrum,
  • channel of the gatekeeper.

The cardiac department is 4 cm around the cardia. It begins with a hole through which the stomach communicates with the esophagus, a cardiac opening.

The bottom (arch) is the uppermost part of the stomach with a height of 2 to 7 cm. It is located directly to the left of the cardial part.

The body is the largest part of the stomach, which extends to the bottom without sharp boundaries, and to the right, gradually narrowing, passes into the pyloric part. The boundary between the pyloric part and the body of the stomach passes along the intermediate groove, which corresponds to the angular notch (incisura angularis) on the small curvature.

The peloric section directly adjoins the orifice of the gatekeeper , through which the lumen of the stomach communicates with the lumen of the duodenum. The peloric department is divided into the cave of the gatekeeper, the antrum pyloricum, and the canal's channel, the canalis of the rotoricus, equal in diameter to the adjacent duodenum, and the pylorus himself .

Separately, the angle of the stomach at the border of the body and the pyloric part is distinguished according to the small curvature, and also the angle of the Gysa is the angle at which the esophagus flows into the stomach. The latter is usually 90 ° (81 °), and in 19% it is 90 ° to 180 °.

The shape of the stomach and its size vary depending on the amount of content, functional state, diet. The shape and position of the stomach is also affected by constitutional and age factors, pathological processes in the abdominal cavity and the standing of the diaphragm. The length of the stomach is on the average 14-30 cm (usually 20-25 cm), width 10-16 (12-24) cm, length of small curvature 10.5-24.5 (18-19) cm, length of large curvature 32-64 (45-56) cm. The capacity of the stomach is from 1.5 to 2.5 liters, in men the capacity is greater than that of women.

Histological structure:

• Mucous membrane:
  • single-layered cylindrical epithelium,
  • own plate of the mucosa (loose connective tissue),
  • muscular plate of the mucous membrane.
• Submucoid layer.
• Muscular layer.
• Serous membrane.

The mucous membrane of the stomach is a continuation of the mucosa of the esophagus. A well-defined strip of dentate form represents the boundary between the epithelium of the mucosa of the esophagus and stomach. At the level of the gatekeeper according to the position of the pulp, the mucosa forms a permanent fold. The mucous membrane of the stomach has a thickness of 1.5-2 mm; it forms numerous folds, mainly on the back wall of the stomach. The folds have different length and different directions: near the small curvature there are long longitudinal folds that delineate the smooth portion of the mucous membrane in the region of small curvature - the canal of the stomach, canalis ventricularis, which mechanically directs the food lump into the pyloric cave. On the remaining sections of the stomach wall, the folds have a diverse direction, and longer folds are distinguished, connected with each other by a shorter one. The direction and number of longitudinal folds are more or less constant. When the stomach is stretched, the folds of the mucosa are smoothed out.

The mucous membrane of the stomach has its own muscular plate, which is separated from the muscle layer of the stomach by a well-developed, loose submucosal layer . Together with his own muscular plate, he causes the formation of folds.

The mucous membrane of the stomach is divided into small, 1-6 mm in diameter, areas - gastric fields. In the margins there are indentations - gastric dimples , having a diameter of 0.2 mm. In each dimple open the openings of 1-2 ducts of the gastric glands located in the lamina propria of the mucous membrane. Distinguish gastric (own) glands, cardiac glands, as well as pyloric. Own glands predominate. They are located in the area of the body and the bottom of the stomach and contain 4 main types of cells:

• the main (glandular),
• parietal (obkladochnye),
• mucous (additional),
• cervical.

The main cells produce pepsinogen. Lining cells are located outside the main, they produce hydrochloric acid. Additional cells produce a mukoid secret. Neck cells are the focus of the regeneration of the glandular secretory system. In their own glands of the stomach contains argentophilic cells, they are related to the development of an internal anti-anemic factor (factor Kastla). Cardiac and pyloric glands produce mucus.

The muscular membrane of the stomach consists of two layers: circular and longitudinal, and also from oblique fibers.

Circular layer, is the continuation of the circular layer of the esophagus. It is a continuous layer that covers the stomach throughout its entire length. A slightly weaker circular layer is expressed in the bottom region; at the level of the gatekeeper, he forms a significant thickening - the sphincter of the pylorus.

The outer, longitudinal, layer representing the continuation of the same-named layer of the esophagus has the largest thickness in the region of low curvature. In the place of the transition of the body into the pyloric part (incisura angularis), its fibers fan out in a fan-like manner along the anterior and posterior walls of the stomach and are weaved into the beams of the next (circular) layer. In the region of great curvature and the bottom of the stomach, the longitudinal muscle bundles form a thinner layer, but occupy a wider area.

Inside the circular layer are oblique fibers. These beams do not represent a continuous layer, but form separate groups; in the area of the entrance to the stomach, bundles of oblique filaments loop around it, passing to the front and back surfaces of the body. The contraction of this muscle loop causes the presence of a cardial notch (angle of His). Near the small curvature, oblique beams take a longitudinal direction.

The serous membrane is the inner sheet of the peritoneum and covers the stomach from all sides.

Blood supply of the stomach. Blood supply of the stomach is carried out by the branches of the celiac trunk - left gastric, hepatic and spleen arteries. The left gastric artery passes along the free right edge of the gastro-pancreatic ligament and is divided into the ascending and descending branches. The descending branch of the left gastric artery on a small curvature is connected to the right gastric artery, which departs from the hepatic artery. The third source of blood supply to the stomach is the spleen artery, from which the short gastric arteries that go in the gastroesophageal ligament to the bottom of the stomach. The final branch of the splenic artery is the left gastro-omental artery, which runs along the large curvature in the gastro-osseous ligament. It connects to a similar branch going to the right of the hepatic artery - with the right gastro-omental artery. Due to a very pronounced arterial collateral network, sufficient gastric blood supply is provided by one large gastric artery.

The veins of the stomach go in the course of the same arteries and flow into the portal vein. In the region of the cardial part, the veins of the stomach are anastomosed with the lower veins of the esophagus. With portal hypertension, these anastomoses are often a source of bleeding.

The innervation of the stomach. The stomach is innervated by sympathetic and parasympathetic fibers, which form the extra-gastric nerves and intramural plexuses. Sympathetic nerves go to the stomach from the celiac plexus and accompany the vessels that drain from the celiac artery. Decrease peristalsis, cause shrinkage of the gatekeeper, narrow the vessels and transmit a sense of pain. Parasympathetic innervation of the stomach is carried out by vagus nerves, as well as by nerves that are part of the celiac plexus. They increase the peristalsis of the stomach, the secretion of glands, relax the pyloric sphincter, transmit a feeling of nausea and hunger. Intramural plexus of the stomach is represented by the musculoskeletal and submucosal plexuses. The musculoskeletal plexus plays an important role in the motor activity of the stomach. The submucosal plexus is involved in the regulation of the secretory activity of the stomach.

[1], [2], [3], [4], [5],