sheet no . 35

*The Stomach*
it is the upper dilated part of the GI tube.
Located in the epigastric, umbilical & left hypochondriac regions.
Its normal shape is (J) shape.
It's size small when empty, larger when filled--->it's size & shape depends on habits of eating.
It is a completely intraperitoneal organ with the following parts:
two ends:

→ cardiac end which receives Esophagus.
→ pyloric end which controls evacuation of stomach & continue as duodenum.

*between these two ends stomach is relatively fixed (like a plastic bag filled with water between 2 hands), the rest of it is mobile(expandable).

two surfaces:
→ anterior parietal surface (related to anterior abdominal wall).
→ posterior visceral surface (related to viscera).
SO after eating if you want to lie you should lie on the RIGHT side because when lying on your face you will push the anterior abdominal wall & when lying on back you will push the viscera.
3.two curves:
-Greater curvature: attached with large double layer of peritoneum called GREATER OMENTUM.
-Lesser curvature: it is indented at its bottom forming (Angular notch), attached with double layer of peritoneum called LESSER OMENTUM.
Stomach is attached to its neighbors through Greater & Lesser omentums.



*Parts of Stomach:

Fundus:

Highest (upper) part of stomach, always filled with gas.
Note: If you eat large amount of food the gas will push the diaphragm then to the left lung so you cannot breathe properly.

Body (main part):
Largest part of stomach, it is the blender & mixer of food with gastric juices like HCl.

Pylorus:

Start at Angular notch THAT'S WHY angular notch is a good clinical landmark to separate Pylorus from Body of stomach.
it has 3 parts:
1.Pyloric Antrum
2.Pyloric Canal → through which food transferred from stomach to duodenum.
3.Pyloric Sphincter → control evacuation of stomach.
Note: when the milk return back in new born baby that's because the Sphincter is closed (the stomach will appear soup-dish like → stomach dilation will cause feed back).

*The wall of stomach formed of the following layers: (from in to out)

I. Mucosa: thrown into longitudinal folds called RUGAE to increase the surface area for efficient absorption & digestion.

*Opposite lesser curvature there are 2 permanent longitudinal folds having a canal between them called (Gastric Canal) which is the common site of Gastric Ulcer. BECAUSE the 1st sip of food is passing through gastric canal so we should begin eating with water or anything that soothes mucosa (milk, salad…) & the other food then will go without causing Gasteritis.

II. Submucosa
III. Muscolosa: (Muscular layer)
Formed of 3 layers:
→ outer longitudinal
→ middle circular to form Sphincter
→ inner oblique
IV. Serousa
-Arterial Supply: stomach supplied through branches from Celiac artery.
-Venous Drainage: stomach drainage from GI tube is carried through Portal Vein loaded with products of digestion & foreign substances to be carried to the liver then to inferior vena cava for filtration from harmful substances absorbed.

*Duodenum*

-(G) shaped tube, about 10 inches in length
-extending from stomach at Pyloroduodenal junction & end at small intestine in Duodenojejunal junction.
-surrounding(embracing/framing) the head of Pancreas.
-Divided into 4 parts:
The 1st part
- Crossing L1
- horizontal part
- 2 inches in length → the 1st inch is intraperitoneal
→ the 2nd inch is retroperitoneal
The 2nd part
- Parallel to right side of L1,L2,L3
- descending part
- 3 inches in length, retroperitoneal
- it is important part because receives CBD (Common Bile Duct) & Pancreatic Duct.
- site of digestion of Protein & Fat.
*Site of interance of CBD divides the duodenum into:
1. Proximal part developed by Foregut → supplied by Celiac A.
2. Distal part developed by Midgut → supplied by SMA (superior mesenteric artery).
The 3rd part
- Crossing L3
- horizontal part
- 3 inches in length, retroperitoneal
- crossed by superior mesenteric vessels.
The 4th part
- extending from L3,L2 above (parallel to them)
- ascending part
- 2 inches in length
→ proximal inch is retroperitoneal
→ distal(last) inch is intraperitoneal (due to connection with small intestine to be in mobility)
THUS, all duodenum is retroperitoneal except the 1st & the last inches.
**the lengths of the 4 parts from 1st to 4th are (2-3-3-2)
Arterial Supply:
- Celiac Artery for proximal part.
- Superior Mesentric Artery (SMA) for distal part.



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Finally, I want to dedicate this sheet to all medical students especially:
Nesreen Abu Osba(zoro is the best), Amal Al7elo(You're the best) ,Sawsan Tabaza(snsn thanks), Sondos Al5teeb(tararara!!), Heba Nemer(miss purple), Heba Abu 5eran, Lama Jamal(twirl!), Ruba Almo7tseb(wd3k bel7yah), Aya Bni Kenanah, Rawan Alrajbi, Rawan Sale7, Rawan Ghazal, Ala2 3bd Elr2of, Do3a2 Abu Jame3,Byan 5door, Zein Njada, W3d Swylmeen,Suzan Mbydeen, Jamela, Rasha Jabra, Nadia, Dima, Ala2 7jazi, As7ar,Rand Abu Lubdeh ,Lubna, Samar Taqatqa, Muna, Do3a2 jra7,Do3a2 Al3antri, Najd AlQur3an, Aseel ,Ruba Halaseh, Nuha.
"الزهور كائن هش جداً .. وحتى لا تتكسر أثناء الأمطار يجب أن تكون مغطاة .. كما أنها أيضاً تحتاج إلى ضوء الشمس حتى لا تذبل .. وإذا هبت العاصفة فلا فائدة من الغطاء..."
Best Wishes, *SSRH*
Samar Al-Rahmeh
ملاحظة: لقد تم تغيير موعد الامتحان النهائي لمادة الثقافة الاسلامية لطلاب الطب بحيث أصبح 4/6/2008 بدلا من 7/6/2008 الساعة 11:30 في مبنى ال
IT