Stomach and duodenum

Stomach and duodenum
Objectives
?To understand the gross anatomy and pathophysiology of stomach disease
?To be able to recognize and manage peptic ulcer complications
?To be able to recognize gastric cancer presentations and understand the principles of management
Surgical anatomy
Blood supply to stomach are through
1- lt. gastric artery which is a branch of celiac axis
2- Rt. gastric artery which is a branch of hepatic artery
3 – Rt. gastro epiploic artery branch of hepatic artery
4- lt. gastro-epiploic artery and
5- short gastric artery ,branch of splenic artery

Innervation
The vagus nerve is the main motor &sensory nerve supply to stomach . The vagus is of two trunks Anterior &posterior, these give branches through lesser omentum to the stomach .
Nerve of Grassia; are the branches from ant. Vagal trunk to the stomach
The stomach also has intrinsic innervation
1- myentric plexus( Aurbach)&
2- submucosal plexus (miessners)
these give branches through lesser omentum
Peptic ulcer
?Acute peptic ulcer
?Chronic peptic ulcer
Peptic ulcer
?These are either
? Duodenal ulcer ,affecting 1st part of duodenum
? Gastric ulcer , affecting stomach
?These are induced by helicobacter pylori infection or NSAID ingestion
complications
1 –perforation
2-deformity a-gastric outlet obstruction
b-hourglass deformity
c-tea-pot deformity
3-bleeding
4-malignant changes
Perforated peptic ulcer
?It was affect male more than female ,now affect female more than male
?Usually was middle age group, now elderly patient
?Most of patient has history of dyspepsia
?These patient present in two forms