Good morning, today I will talk about the spleen and the stomach. okay I will start by the spleen what should you know about the spleen okay position of the spleen the spleen is located in the left hypochondrium between the stomach and the left colic flexor then we'll talk about the surface anatomy surface anatomy the spleen is parallel to rib number 9 number 10 and number 11 the long axis is parallel to the tenth rib the lateral end of the spleen is at the mid axillary line then we'll talk about the peritoneal covering relations of the spleen arterial supply venous drainage and the lymph drainage of the spleen again spleen is parallel to the tenth to the mines tenth and the eleventh rib long axis opposite number ten and the lateral end is at the mid axillary line now peritoneal covering of the spleen stomach this is the liver this is the spleen this is the kidney left kidney the spleen is completely covered with peritoneum okay and it's really except the hilum and the area related to the tail of the pancreas and it is related to the lesser sac and to the greater sac okay it has two ligaments gastro-spelanic ligament between the spleen and the stomach and the line arena ligament between the spleen and the left kidney again the spleen is related to the lesser sac between the two ligaments and this is the spleenic recess of the lesser sac and to the greater sac outside the two ligaments spleen is related to three ligaments this is the first one between the spleen and the stomach gastro-spleen ligament and this is the second one between the spleen and the left kidney lineal ligament gastro-spinal ligament transmits short gastric arteries to the stomach and the lineal ligament transmits tail of the pancreas and the spleen vessels we have a third ligament here this one pharyngeal collic ligament this pharyngeal collic ligament between the left collic flexure and the diaphragm actually the lateral end of the spleen rests on the pharyngeal collic ligament or actually the lateral end of the spleen is supported by the pharyngeal collic ligament Then we'll talk about the relations of the spleen. The spleen has diaphragmatic surface related to the diaphragm and the visceral surface related to the viscera. The diaphragmatic surface is related to the diaphragm and the diaphragm separates the spleen from the 9th the 10th and the 11th rib the spleen has upper border and the lower border you can know the upper border by the presence of the notches and these notches are close to the lateral end of the spleen the visceral surface of the spleen this is the hilum of the spleen the visceral surface related to four impressions or four organs gastric impression above the hilum related to the stomach renal impression below the hilum related to the left kidney pullic impression related to the left colic fracture at the lateral end of the spleen and the pancreatic impression related to the tail of the pancreas below the end of the hilum this is a visceral surface of the swillin okay you can identify the visceral surface by the presence of the hilum and these are the notches on the upper border and these notches are close to the lateral end so this is the lateral end this is a medium we have four impressions the first one is gastric impression related to the stomach above the hilum of the spleen second one is renal impression related to the left kidney below the hilum third one colic impression at the lateral end of the spleen related the left colic flexure and this one this area below the lateral end of the hilum is related to the tail of the pancreas pancreatic impression again i said that the spleen is completely covered peritoneum except two areas the hilum and the pancreatic area this area splenic vessels spleen has splenic artery and the splenic vein splenic artery arises from the celiac trunk and this splenic artery runs along the upper border of the body of the pancreas in a wavy or in a tortuous course it gives pancreatic branches to the pancreas it gives the spleenic branches to the spleen short gastric branches to the fundus of the stomach and lift gastroepiploic artery to the stomach spleenic vein this is the spleenic vein arises from the hilum enters the anorenal ligament okay then behind the body of the pancreas it unites with the superior mesentric vein to form the portal vein this is the portal vein this is the superior mesentric Ancient Egypt and present Egypt.
Now we talk about the stomach. And what should you know about the stomach? position at the surface anatomy okay this is the stomach this is the stomach this is the epigastrium and this is the left hypochondrium okay so let us draw the stomach this is the stomach this is the cardiac end of the stomach this is the pyloric end this is the midline and this plane here is a transpyloric plane and this plane is the left mid clavicular line okay so this is a midline this is a transpyloric plane and this is the left midclavicular line this is the cardiac end of the stomach and the cardiac end is one inch to the left of the midline or to the left of the median plane opposite t11 this is the pyloric end is one inch to the right of the median plane In the trans-pyloric plane, so it is opposite L1. This is the fundus of the stomach.
and the fundus of the stomach is in the left fifth intercostal space in the mid calvicular line so we have three points cardiac end one inch to the left of the median plane by lorik end one inch to the right of the median plane fundus lift fifth intercostal space mid calvicular line cardiac end is opposite t11 by lurk end is opposite L1 then we'll talk about the shape of the stomach and the divisions of the stomach stomach has two borders okay lesser curvature and the greater curvature has two ends cardiac end and the pyloric end has two surfaces anterior surface and posterior surface then we'll talk about the peritoneal covering of the stomach talk about relations of the stomach arterial supply venous drainage nerve supply and lymph drainage so these are the objectives you should be familiar with regarding the stomach now divisions of the stomach This is the lesser curvature of the stomach and this is the greater curvature of the stomach. The lesser curvature has angular notch. This angular notch divides the stomach into two parts.
This part is the cardiac part and this part is the pyloric part. So the stomach is divided into cardiac part and pyloric part. the cardiac part is divided by a line from the cardiac notch into fundus above the cardiac notch above this line and the body below this line so the cardiac part is formed off or is divided into fundus and the body then the pyloric part is divided into three parts the dilated part this one is pyloric and trama pyloric antrum then this part is the pyloric canal and then this part the constricted part this one is pyloric sphincter okay again this is the stomach this is the angular notch this is the cardiac notch this is the lesser curvature this is the greater curvature a line from the angular notch to the greater curvature okay this line divides the stomach into cardiac part and pyloric part the cardiac part is divided by this line from the cardiac notch okay into fundus and the body and the pyloric part is divided into three parts the dilated part is the pyloric entrum then pyloric canal then this construction is the pyloric sphincter then peritoneal covering and connections of the stomach The stomach is completely covered with peritoneum, except a very small area behind the cardiac end where the left gastric artery enters between the two layers of the peritoneum.
The lesser curvature gives attachment to the lesser omentum. the greater curvature gives attachment to three ligaments between the fundus and the diaphragm between the fundus and the diaphragm is the gastrofrenic ligament between the greater curvature and the spleen this is the gastro splenic ligament between the greater curvature and the transverse colon this is the greater momentum so the stomach gives attachment to four ligaments lesser momentum along the lesser curvature and the three ligaments along the greater curvature gastrophrenic ligament gastro-spirulina ligament and greater momentum then we'll talk about the relations of the borders we have two borders lesser curvature and the greater curvature relations of the lesser curvature okay of course this is angular notch present on the lesser curvature this is the cardiac notch present on the greater curvature it gives attachment to the lesser momentum the lesser curvature i mean and the greater curvature gives attachment to three ligaments gastrophrenic ligament gastro splenic ligament and the greater momentum the lesser curvature is related to two arteries left gastric artery and right gastric artery the greater curvature is related to two arteries left gastroepiploic artery and right gastroepiploic artery so again relations of the borders lesser curvature and the greater curvature Lesser curvature has angular notch. Greater curvature has cardiac notch.
Lesser curvature gives attachment to lesser omentum. Greater curvature gives attachment to three ligaments. splenic and the greater momentum this curvature is related to two arteries this left gastric and right gastric arteries greater curvature is related to two arteries left gastroepiploic and right gastroepiploic arteries now relations of the surfaces this is the anterior surface of the stomach this is anterior surface of the stomach okay so half the anterior surface is covered by the liver and this part is covered by the diaphragm and this part is covered by the anterior abdominal wall so the anterior surface is related to three structures okay anterior surface related to three structures this part is related to the liver and this part okay this part is related to the liver this part is related to the diaphragm this part is related to the anterior abdominal wall liver diaphragm anterior abdominal wall then the posterior surface of the stomach The structures related to the posterior surface of the stomach are called the stomach bed.
So what are the structures forming the stomach bed? From blue upward. Let us see this one.
This is a transverse column. then this is the transverse mesoculon this one transverse mesoculon then body of the pancreas this one body of the pancreas body of the pancreas splenic vessels along the upper border okay then lift kidney then lift the suprarenal gland then the spleen and the diaphragm all these structures are separated from the stomach by this cavity and this is the cavity of the lesser sac again structures forming the stomach bed from blue upward number one transverse colon okay and then transverse mesocolon and then body of the pancreas splenic vessels splenic artery along the upper border of the pancreas lift kidney okay lift suprarenal spleen above the hilum and this one lift kidney and the number seven is the diaphragm transverse colon transverse mesocolon body of the pancreas splenic artery left suprarenal spleen left kidney and diaphragm we discussed this before arterial supply of the stomach the stomach is supplied by five arteries two arteries along the lesser curvature and the three arteries along the greater curvature along the lesser curvature this is number one left gastric artery from the splenic from the celiac trunk directly left gastric from the splenic and this is number two right gastric artery from the hepatic artery along the greater curvature three arteries these are the short gastric arteries from the splenic left gastroepiploic artery from the splenic artery right gastroepiploic artery from the gastro duodenal artery which arises from the hepatic artery so we have five arteries two along the lesser curvature and the three along the greater curvature regarding the venous drainage of the stomach stomach drains into the portal circulation you see this left gastric vein and this is the right gastric vein they drain directly into the portal vein okay so lift the gastric and right gastric veins drain into the portal vein you see short gastric veins lift the gastroepiploic vein of course they drain into the splenic vein which drain into the portal vein so lift the gastroepiploic and the short gastric veins drain into the splenic vein and then the right gastric blood vein this one drains into the superior mesenteric vein so the venous drainage of the stomach finally stomach finally drains into the portal vein left gastric and right gastric drain into the portal vein directly short gastric and left gastroepiploic drain into the spleenic which drain into the portal right gastroepiploic vein drains into the superior mesenteric vein the nervous supply of the stomach and lymph drainage of the stomach Of course, the stomach is supplied by autonomic nerves, sympathetic and parasympathetic. this is the celiac plexus around the celiac artery and these are the celiac ganglia okay celiac ganglia so we have sympathetic and the parasympathetic sympathetic is from the celiac plexus and the greater splanchnic nerves, parasympathetic from the right and left vagus which are called anterior and posterior gastric nerves. So anterior and posterior gastric nerves, left vagus and right vagus.
Regarding the lymph drainage, we know that lymphatics run with the arteries, so the stomach finally drains into the cilia lymph nodes. So for those authors, this is the link in the notes. okay just reminding you that the stomach gives the attachment to four ligaments one ligament along the lesser curvature lesser momentum and one ligament and three ligaments attached to the greater curvature gastrofrenic gastros and the greater momentum regarding the greater momentum you should know the attachment of the greater momentum and the contents of the greater momentum the greater momentum extends from the greater curvature of the stomach to the transverse colon okay it contains left the gastroepipelic vessels right gastroepipelic vessels plus lymph nodes, sympathetic fibers and fat so this is the gluteal momentum containing the left gastro-epiphyloid, right gastro-epiphyloid vessels lymph nodes accompanying these vessels plus autonomic nerves and fat this is the gluteal momentum attachments and contents it connects the lesser curvature of the stomach with the fissure for ligamentum venosum of the liver and the portiabets contents we have contents along the lesser curvature of the stomach and the contents in the free margin of the lesser momentum along the lesser curvature of the stomach to arteries okay left gastric artery and right gastric artery left gastric and right gastric in the free margin of the lesser momentum the prince the princess and the bodyguard hepatic artery bile duct and the portal vein behind the two lymph nodes of course then autonomic nerves sympathetics and fat again this is the free margin of the lesser momentum which is anterior to the epiploic foramen okay so we have left gastric artery here right gastric artery here okay in the free margin of the lesser momentum the prince the princess and the bodyguard hepatic artery anterior and to the left bile duct anterior and to the right portal vein behind the two and the epiphyloid foramen separates the three structures or separates the portal vein from the inferior vena cava okay this is the lesser momentum and this is the greater momentum thank you very much and good luck and see you again