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INTRODUCTION

Test Taking Tips

Stomach questions remain high yield, and core knowledge of basic physiology and anatomy is essential. Know the stomach’s blood supply, including common aberrations and variations. The acid production with function/products of different cells is a favorite of the boards.

The stomach, with its variety of benign and malignant conditions, is also a rich ground for clinical questions. Study the etiology plus treatment of upper gastrointestinal (UGI) bleeding, types of ulcers, and gastrointestinal stromal tumor (GIST) and lymphoma. Regarding cancer, have knowledge of basic staging and treatment modalities.

ANATOMY

Where does the lesser curvature abruptly angle to the right and the body of the stomach ends and the antrum begins?

  • Angularis incisura

Term for where the fundus forms with the left margin of the esophagus:

  • Angle of His

What is the arterial blood supply to the stomach?

  • 4 main arteries: left gastric and right gastric arteries along the lesser curvature and left and right gastroepiploic arteries along the greater curvature; blood is also supplied to the proximal stomach by the inferior phrenic arteries and short gastric arteries and to the pylorus by the gastroduodenal artery

Approximate percentage that an aberrant left hepatic artery originates from the left gastric artery:

  • 15% to 20%

What is the largest artery to the stomach?

  • Left gastric artery

In general, what is the maximal number of arteries that can be ligated, provided that the arcades along the greater and lesser curvatures are intact, that will still supply enough blood flow for the stomach to survive?

  • 3 of 4 arteries can be ligated

Describe the venous drainage of the stomach:

  • Left gastric (coronary) and right gastric veins usually drain into the portal vein; left gastroepiploic vein drains into the splenic vein; right gastroepiploic vein drains into the superior mesenteric vein

FIGURE 14-1

Arterial blood supply to the stomach. a., artery; v., vein. (Reproduced with permission from Zuidema GD, Yeo CJ, Orringer MB, et al. Shackelford’s Surgery of the Alimentary Tract, 5th ed. Vol II. Philadelphia, PA: Saunders; 2002.)

What happens to the left vagus and right vagus at the gastroesophageal (GE) junction?

  • Left vagus becomes anterior and the right vagus becomes posterior (LARP mnemonic)

Where does the stomach receive its extrinsic parasympathetic and sympathetic innervation?

  • Parasympathetic via the vagus and sympathetic via the celiac plexus

Where does the sympathetic nerve supply to the stomach originate from?

  • From T5 to T10 (travels in splanchnic nerve to ...

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