Lecture Notes - Stomach & Spleen

Foregut Structures (supplied by the celiac trunk): abdominal esophagus, stomach, spleen, proximal half of duodenum, pancreas, liver and biliary system.

1. Review of the Developmental Anatomy and Peritoneal Relationships:
   1. Dorsal mesentery: greater omentum (gastrophrenic, gastrosplenic, gastrocolic ligaments and omental apron)
   2. Ventral mesentery: lesser omentum (gastrohepatic and gastroduodenal ligaments)
   3. Omental bursa (lesser sac) and epiploic foramen (of Winslow)
   4. Relationship to transverse mesocolon
2. Abdominal Esophagus - Descends through the esophageal hiatus of the diaphragm.
3. Stomach - fixed at T11 and L1 or L2
   1. Nerves
      1. Sympathetic: postganglionic fibers from the celiac ganglia (preganglionic fibers from the greater thoracic splanchnic nerve, T5 - T9 or 10)
      2. Parasympathetic: from the vagus (X)
         1. Anterior vagal trunk (continuation of the left vagus)
            • gastric branches
            • hepatic branch
         2. Posterior vagal trunk (continuation of the right vagus)
            • gastric branches
            • celiac branch
   2. Parts: cardia, fundus, body, and pylorus (pyloric antrum, canal, and sphincter)
   3. Blood Vessels:
      1. Arteries - Celiac trunk (axis)
         1. Left gastric artery:
            • gastric branches
            • esophageal and hepatic branches
         2. Splenic artery:
            • splenic branches
            • short gastric branches
            • left gastro-omental (gastroepiploic) a.
         3. Common hepatic artery:
            • proper hepatic a. - right gastric a.
            • gastroduodenal a. - right gastro-omental (gastroepiploic) a.
      2. Veins - Portal Vein: venous blood from the abdominal digestive organs.
         1. Directly into the portal vein:
            • left gastric v. (plus esophageal v.) and right gastric v.
         2. Via superior mesenteric vein: right gastro-omental v.
         3. Via splenic vein:
            • splenic branches
            • short gastric branches
            • left gastro-omental v.
            • inferior mesenteric v.
   4. Lymphatic Drainage: four regions drain into the celiac nodes near the celiac trunk.
4. Spleen
   1. Projection on ribs, 9th, 10th and 11th.
   2. Visceral surface - contact stomach, kidney, pancreas, and left colic flexure.
   3. Hilum - site of entrance of the splenic vessels.
   4. Costal (diaphragmatic) surface
   5. Internal structure: no regular segmentation.
   6. Capsule: thin and easily ruptured, difficult to repair.