扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 24. Stomach and Duodenum Diseases Part I

Chapter 24.Stomach and Duodenum Diseases

Chapter 24. Stomach and Duodenum Diseases

Sections.Section 1. Anatomy.1.1GrossAnatomy:1.2 Blood Supply★★★· 1.3 Nerve Supply ★★:1.4Lymphatic Drainage·Section 2. Physiology:2.1Motility.2.2Gastric Juice:2.3MucosalResistance

Sections • Section 1. Anatomy • 1.1 Gross Anatomy • 1.2 Blood Supply ★★★ • 1.3 Nerve Supply ★★ • 1.4 Lymphatic Drainage • Section 2. Physiology • 2.1 Motility • 2.2 Gastric Juice • 2.3 Mucosal Resistance

1.1GROSS ANATOMY·The Cardia islocated at theEsophagusgastroesophagealjunction.Fundus.TheFundus istheportionofthestomachCardiathat lies cephaladtothegastroesophagealjunction.LesserTheCorpus/BodyisthecapaciouscentralcurvatureBodypart; division of the corpus from the pyloricPylorusantrumismarkedapproximatelybytheGreaterangularincisure,acreaseonthelessercurvaturecurvature just proximalto the"crow's-foot"Duodenumterminations ofthe nerves of LatarjetPyloricThePylorusistheboundarybetweenthestomachandtheduodenum.antrum

1.1 GROSS ANATOMY • The Cardia is located at the gastroesophageal junction. • The Fundus is the portion of the stomach that lies cephalad to the gastroesophageal junction. • The Corpus / Body is the capacious central part; division of the corpus from the pyloric antrum is marked approximately by the angular incisure, a crease on the lesser curvature just proximal to the "crow's-foot" terminations of the nerves of Latarjet. • The Pylorus is the boundary between the stomach and the duodenum

1.1 GROSS ANATOMYThecardiacglandarealocatesattheGastric pitgastroesophagealjunction.ItcontainsprincipallySurfacemucouscellsmucus-secretingcells,thoughafewparietal cellsaresometimespresent.Parietal cellsIsthmusTheoxynticglandareaistheportioncontainingparietal (oxyntic)cells and chief cellsMucousneckcellsNeckThepyloricglandareaconstitutesthedistal30%ofthestomachandcontainstheGcellsthatArgentaffincellsmanufacturegastrin.MucouscellsarecommonintheBaseoxynticandpyloricglandareas.ChiefcellsGastricgland

1.1 GROSS ANATOMY • The cardiac gland area locates at the gastroesophageal junction. It contains principally mucus-secreting cells, though a few parietal cells are sometimes present. • The oxyntic gland area is the portion containing parietal (oxyntic) cells and chief cells. • The pyloric gland area constitutes the distal 30% of the stomach and contains the G cells that manufacture gastrin. Mucous cells are common in the oxyntic and pyloric gland areas

1.1 GROSS ANATOMYCELLTYPELOCATIONFUNCTIONSurfaceepitheliumBodyParietalSecretionof acidandintrinsicfactorGastricpitsMucusBody,antrumMucusChiefBodyPepsinSurface epithelialDiffuseMucus,bicarbonate,prostaglandins)BodyEnterochromaffin-likeHistamineGAntrumGastrinDBody,antrumSomatostatinLymphoidGastricmucosalBody,antrumGastrin-releasingnoduleinterneuronspeptideGastricglandsSubmucosaDiffuseCalcitonin gene-relatedEntericneuronsLaminaMuscularispeptide,otherspropriamucosaeSerosaBodyGhrelinEndocrinemucosaeSmoothmusclelayers

1.1 GROSS ANATOMY

LeftgastricBranchesto1.2 Blood Supply ★★★greateromentumarteryHepaticStomacharteryRightgastroepiploicLeft gastroepiploic·The Left GastricArtery suppliesarteryarterythe lesser curvature and connectsRightgastricShort gastricarteryarteries(vasabrevia)with theRight GastricArtery,aPortalveinPylorusSpleenbranchofthe commonHepaticGastroduodenalCeliacarteryarteryandveinArtery.PancreasSplenic arteryand veinSuperiopancreaticoduodenalTransversearterycolonDescendingcolonPancreatic ductJejunumDuodenumSuperiormesentericlleocolicartery and veinInferiorarteryInferiorpancreaticoduodenalmesentericAbdominalarteryarteryaorta

1.2 Blood Supply ★★★ • The Left Gastric Artery supplies the lesser curvature and connects with the Right Gastric Artery, a branch of the common Hepatic Artery

BranchestoLeftgastricPosteriorgastricartery1.2 Blood Supply ★★★greateromentumarteryHepaticarterymachRightgastroepiploicLeft gastroepiploic.In60%ofpersons,aPosteriorarteryarteryGastric Artery arises off the middleRightgastricShort gastricarteryarteries(vasabrevia)third of the Splenic Artery andPortalveinSpleenPylorusterminatesinbranchesontheGastroduodenalCeliac arteryarteryandveinposterior surface of the body andPancreasSplenic arteryand veinthe fundus.SuperiopancreaticoduodenalTransversearterycolonDescendingcolonPancreatic ductJejunumDuodenumSuperiormesentericlleocolicartery and veinInferiorarteryInferiorpancreaticoduodenalmesentericAbdominalarteryarteryaorta

1.2 Blood Supply ★★★ • In 60% of persons, a Posterior Gastric Artery arises off the middle third of the Splenic Artery and terminates in branches on the posterior surface of the body and the fundus. Posterior gastric artery

BranchestoLeft gastric1.2 Blood Supply ★★★greateromentumarteryHepaticStomacharteryRightgastroepiploic·The greater curvature is suppliedLeft gastroepiploicarteryarterybytheRightGastroepiploicArteryRightgastricShort gastricarteryarteries(vasabrevia)(abranchoftheGastroduodenalPortalveinSpleenPylorusArtery)andtheLeftGastroduodenalCeliacarteryarteryandveinGastroepiploic Artery (a branch ofPancreasSplenic arteryandveinthe Splenic Artery)SuperiopancreaticoduodenalTransversearterycolon.The mid portion of the greaterDescendingcolonPancreatic ductcurvature correspondstoapoint atejunumwhichthegastricbranchesofthisDuodenumSuperiormesentericlleocolicvasculararcadechangedirectionartery and veinInferiorarteryInferiormesentericpancreaticoduodenalAbdominalarteryarteryaorta

1.2 Blood Supply ★★★ • The greater curvature is supplied by the Right Gastroepiploic Artery (a branch of the Gastroduodenal Artery) and the Left Gastroepiploic Artery (a branch of the Splenic Artery). • The mid portion of the greater curvature corresponds to a point at which the gastric branches of this vascular arcade change direction

BranchestoLeftgastric1.2 Blood Supply ★★★greateromentumarteryHepaticStomachartery.Thefundus ofthe stomachalongRightgastroepiploicLeftgastroepiploicarteryarterythegreatercurvature issuppliedRightgastricShortgastricarterybytheShortGastricArteries(vasaarteries(vasabrevia)Portalveinbrevia),branchesoftheSplenicSpleenPylorusGastroduodenalCeliac arteryandLeftGastroepiploicArteriesarteryandveinPancreasSplenic arteryand veinSuperiopancreaticoduodenalTransversearterycolonDescendingcolonPancreatic ductJejunumDuodenumSuperiormesentericlleocolicartery and veinInferiorarteryInferiorpancreaticoduodenalmesentericAbdominalarteryarteryaorta

1.2 Blood Supply ★★★ • The fundus of the stomach along the greater curvature is supplied by the Short Gastric Arteries (vasa brevia), branches of the Splenic and Left Gastroepiploic Arteries

BranchestoLeft gastric1.2 Blood Supply ★★★greateromentumarteryHepaticStomachartery? The blood supply to theRightgastroepiploicLeft gastroepiploicarteryarteryduodenum is from the SuperiorRightgastricShort gastricarteryPancreaticoduodenal Arteriesarteries(vasabrevia)Portalveinand InferiorSpleenPylorusGastroduodenalCeliac arteryPancreaticoduodenalArteriesarteryandveinPancreasSplenic arterywhicharebranchesoftheand veinSuperioGastroduodenalArtery(GDA）pancreaticoduodenalTransversearterycolonandtheSuperiorMesentericDescendingcolonPancreatic ductArtery(SMA),respectively.lejunumDuodenumSuperiormesentericleocolicartery and veinInferiorarteryInferiormesentericpancreaticoduodenalAbdominalarteryarteryaorta

1.2 Blood Supply ★★★ • The blood supply to the duodenum is from the Superior Pancreaticoduodenal Arteries and Inferior Pancreaticoduodenal Arteries, which are branches of the Gastroduodenal Artery (GDA) and the Superior Mesenteric Artery (SMA), respectively