Chapter 49 – Stomach

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1、CHAPTER49STOMACHDavidM.MahviandSethB.Krantzdiaphragmaticesophagealhiatusinthehorizontalplaneoftheanatomyseventhchondrosternalarticulation,aplaneonlyslightlycepha-physiologyladtothatcontainingthepylorus.Thegastrosplenicligamentppepticulcerdiseaseattachestheproximalgreate

2、rcurvaturetothespleen.stressgastritispostgastrectomysyndromesBloodSupplygastriccancerTheceliacarteryprovidesmostofthebloodsupplytotheothergastriclesionsstomach(Fig.49-2).Therearefourmainarteries—theleftandrightgastricarteriesalongthelessercurvatureandtheleftandrightgast

3、roepiploicarteriesalongthegreatercurvature.Inaddi-tion,asubstantialquantityofbloodmaybesuppliedtotheANATOMYproximalstomachbytheinferiorphrenicarteriesandbytheshortgastricarteriesfromthespleen.ThelargestarterytoGrossAnatomythestomachistheleftgastricartery,anditisnotuncom

4、mon(15%to20%)foranaberrantlefthepaticarterytooriginateDivisionsfromit.Consequently,proximalligationoftheleftgastricarteryThestomachbeginsasadilationinthetubularembryonicoccasionallyresultsinacuteleft-sidedhepaticischemia.Theforegutduringthefifthweekofgestation.Bytheseve

5、nthweek,rightgastricarteryarisesfromthehepaticartery(orthegastro-itdescends,rotates,andfurtherdilateswithadisproportionateduodenalartery).Theleftgastroepiploicarteryoriginatesfromelongationofthegreatercurvatureintoitsnormalanatomicthesplenicarteryandtherightgastroepiplo

6、icoriginatesfromshapeandposition.Followingbirth,itisthemostproximalthegastroduodenalartery.Theextensiveanastomoticconnec-abdominalorganofthealimentarytract.Themostproximaltionbetweenthesemajorvesselsensuresthatinmostcases,theregionofthestomachiscalledthecardia,whichatta

7、chestothestomachwillsurviveifthreeoutoffourarteriesareligated,esophagus.Immediatelyproximaltothecardiaisaphysiologi-providedthatthearcadesalongthegreaterandlessercurvaturescallycompetentloweresophagealsphincter.Distally,thepylorusarenotdisturbed.Ingeneral,theveinsofthes

8、tomachparallelconnectsthedistalstomach(antrum)totheproximalduode-thearteries.Theleftgastric(coronary)andrightg