DIGESTIVE SYSTEM

WHAT IS DIGESTION
Digestion is the process by which food is broken
down into smaller pieces so that body can use
them to build and nourish cells and to provide
energy. Digestion involves mixing of food , its
movement through the Digestive tract, and the
chemical breakdown into smaller nutrients that
body can absorb.
Digestive tract in adult is about 30 feet long. It
starts from Mouth, teeth, Salivary glands,
Tounge. Oropharynx, Oesophagus, Stomach,
Small intestine, Large intestine, Liver, Gall
baldder, Pancreas, Rectum And Anus.
THE DIGESTIVE TRACT
Travel path of the Food
Mouth

Oesophagus

Stomach

Small intestine

Liver

Large intestine

Gall bladder

Pancreas

Rectum

Anus
FUNCTIONS OF DIGESTIVE SYSTEM
Food undergoes 3 types of processes in the body
Digestion

Absorption

Elimination

Digestion and absorption occur in the digestive

tract. After the nutrients are absorbed, they are
available to the cells in the body and are utilized
by body cells in metabolism.
ACTIVITIES OF DIGESTIVE SYSTEM
The Digestive system prepares nutrients for
utilization by body cells through 6 activities
Ingestion: The First activity of the digestive
system is to take in food through the mouth. This
has to take place before anything else can
happen.
Mechanical Digestion: the large pieces of food
that are ingested have to be broken into smaller
particles that can be acted upon by various
enzymes. This is mechanical digestion, which
begins in the mouth with chewing or mastication
and continues with churning and mixing actions
in the stomach.
 Chemical Digestion: The Complex molecules of
carbohydrates, proteins and fats are transformed by
chemical digestion into smaller molecules that can be
absorbed and utilized by the cells. Chemical digestion,
through a process called hydrolysis, uses water and
digestive enzymes to break down the complex molecules.
Movements: after ingestion and mastication, food

particles moves from Mouth into the pharynx, then into

the esophagus. This movement is deglutition, or
swallowing. Mixing movements occurs in the stomach as
result of smooth muscle contraction. These repetitive
contractions usually occurs in the small segments of the
digestive tract and mix the food particles with enzymes
and other fluids. The movement that propel the food
particles through the digestive tract are called
peristalsis. These are rhythmic waves of contractions
that move the food particles through the various
regions.
 Absorption: the simple molecules that result from
chemical digestion pass through the cell
membranes of the lining in the small intestines
into the blood or lymph capillaries. This process
is called absorption
Elimination: the food molecules that cannot be
digested or absorbed need to be eliminated from
the body. The removal of indigestible wastes
through the anus, in the form of feces, is called
defecation or elimination.
GENERAL STRUCTURE OF THE
DIGESTIVE SYSTEM
The long continuous tube that is the digestive
tract is abt 9 meter long. It opens at both the
ends. Although there are variations in each
region, the basic structure of the wall is the same
throughout the entire length of the tube.
The wall of the digestive tract has four layers or
tunics
Mucosa

Submucosa

Muscular layer

Serous layer or Serosa

 The mucosa or mucus membrane layer is the
innermost tunic of the wall. It lines the lumen of the
digestive tract. The mucosa consist of the epithelium,
an underlying loose connective tissue layer called
Lamina Propria, and a thin layer of smooth muscle
called the muscularis mucosa. In certain regions
Mucosa develops folds that increase the surface area.
Certain Cells in the mucosa secrete mucus, digestive
enzymes, and hormones. In the mouth and anus,
where thickness for protection against abrasions is
needed, the epithelium is stratified squamous tissue.
The stomach and intestine have a thin simple
columnar epithelial layer for secretion and absorption
Submucosa is a thick layer of connective tissue that

surrounds the mucosa. This layer contains blood

vessels, lymphatic vessels and nerves. Glands may be
embedded in this layer.
 The smooth muscle responsible for movements of
the digestive tract is arranged in two layers, an
inner circular layer and outer longitudinal layer.
The myenteric plexus is between two muscular
layer.

Above the Diaphragm, the outermost layer of the

digestive tract is a connective tissue called
adventitia. Below the diaphragm, it is called as
serosa.
ORGANS OF THE DIGESTIVE
SYSTEM

The Alimentary tract: Mouth,

Pharynx, esophagus, stomach,
small and large intestines, rectum
and anus.
Associated with alimentary tract
are the accessory organs such as
Salivary glands, Liver, Gall
Bladder and Pancreas.
MOUTH OR ORAL CAVITY
The mouth or oral cavity is the first part of the
digestive tract. It is adapted to receive food by
ingestion, break it into small particles by
mastication, and mix it with saliva. The lips,
cheeks, and palate form the boundaries. The oral
cavity contains the teeth and tongue and receives
the secretions from the salivary glands.
MOUTH
 Lips and cheeks: the lips and cheeks help hold
food in the mouth and keep it in place for
chewing. They are also used in the formation of
words for speech. The lips contain numerous
sensory receptors that are useful for judging the
temperature and texture of the foods.
Palate: Palate is the roof of the oral cavity. The
anterior portion is the hard palate, is supported
by bone. The Posterior portion, Soft palate is
skeletal muscle and connective tissue. Posteriorly
soft palate ends in a projection called the Uvula.
During swallowing soft palate and uvula moves
upward to direct the food away from the nasal
cavity and into the oropharynx.
TONGUE (L: LINGUA, GK: GLOSSA)
It is a muscular hydrostat on the floor of the mouth
which manipulates food for the mastication.
It is the primary organ of taste, as much of the upper

surface of the tongue is covered in papillae and taste

buds.
It is sensitive and kept moist by saliva, and is richly

supplied with nerves and blood vessels.

Its secondary function is phonetic articulation.

The average length of the tongue from oropharynx to

the tip is 10cm.
It also assists with mastication (chewing), deglutition
(Swallowing), Articulation(speech), and oral cleaning.
GROSS ANATOMY
It is attached by muscles to the hyoid bone, mandible, styloid
processes, and pharynx.
From anterior to posterior, tongue has 3 surfaces tip, body

and base. The tip is highly mobile, pointed anterior portion of

the tongue. Posterior to the tip is lies the body of the tongue,
which has dorsal and ventral surface
The tip or apex usually rests against the incisors and
continues each side into the margin.
The dorsum extends from the oral cavity into the oropharynx.
A v-shaped groove, the sulcus terminalis, runs laterally and
anteriorward from a small pit, the foramen cecum. The sulcus
terminal is the boundary between the oral part or anterior
2/3rd and the pharyngeal part, or posterior 1/3 rd of the tongue.
The foramen cecum, which present indicates the site of the
origin of the embryonic thyroglossal duct.
 The oral part of the dorsum may show a shallow median
groove. The mucosa has numerous minute lingual papillae
The filiform papillae: the narrowest and most numerous

Fungiform papillae: with rounded heads and containing taste

buds.
Vallate papillae: about a dozen large projections arranged in a

V-shaped row in front of the sulcus terminalis and containing

numerous taste buds.
Folia: inconstant grooves and ridges at the margin posteriorly.

The pharyangeal part of the dorsum faces posteriorly. The

base of the tongue forms the anterior wall of the oropharynx

and can be inspected by downward pressure on the tongue
with a spatula or by mirror.
Lymphatic follicles in the sub mucosa are collectively known
as the lingual tonsil. The mucosa is reflected onto the anterior
aspect of the epiglottis (median glossoepiglottic fold)and onto
the lateral wall of the pharynx (lateral glosso-epiglottic fold)
The depression on each side of the median glosso-epiglottic

fold is termed as the Vallecula.

 The inferior surface of the tongue is connected to
the floor of the mouth by the frenulum, lateral to
which deep lingual vein can be seen through the
mucosa. Lateral to the vein is a fringed fold, the
plica fimbriata. The tongue contains a number of
lingual glands.

The root of the tongue rests on the floor of the

mouth and is attached to the mandible and hyoid
bone. The nerves, extrinsic muscles, and vessels
enter or leave the tongue through its root.
TEETH
Teeth are grinding machine of the body and
important for mastication
TYPES OF TEETH
Upper teeth
Central incisor

Lateral incisor

Canine or eye tooth

Back teeth
First molar

Second Molar
PERMANENT TEETH
Front teeth
Central Incisor

Lateral incisor

Canine or Eye tooth

Back Teeth
First premolar

Second premolar

First molar

Second molar

Third molar or wisdom

tooth.
TEETH AND THEIR PARTS
Each tooth has two main parts, the crown and
the root
The crown and the root meets at the neck of the
tooth, which is normally just below the gum
margin.
THE CROWN
This is the part of the tooth that we see in the
mouth
It is made up of enamel, dentine and pulp.

The appearance of the teeth varies in shape and

size.
The front incisor teeth have a straight edge as a
cutting tool.
The canine or eye teeth are the pointed long teeth
between the incisor and premolar teeth.
The pre-molar and molar teeth are larger and
have cusps.
 A cusp is the raised pointed part of the chewing
surface of a tooth.
The presence of large cusps on pre molar and
molar teeth marks the main difference between
them and the front teeth.
Pre molar teeth have two cusps

Molar teeth each have four or more cusps

ENAMEL
The enamel is the white hard covering over the
crown of the tooth
It is shaped into cusps, fissure and pits in
premolar and molar teeth
It is the hardest material in the body and does
not have a nerve supply. Chipping or damage to
enamel only will not be painful
It also does not have a blood supply.

This results in a chipped tooth remaining exactly

as it is.
Enamel cannot heal or repair as bone or dentine
can
DENTINE
Dentine is a cream coloured hard material that makes up the
bulk of the tooth.
It is covered by enamel on the crown, and by cementum on the

roots.
The dentine surrounds and protect the nerves and blood

vessels in the crown and the roots

Dentine is alive or vital in as much as more dentine can be

formed, and it can register pain

A protective layer of secondary dentine can be layed down over

the pulp
This happens in response to caries, attrition, abrasion, erosion

or fracture of a tooth, when the dentine becomes exposed.

The tooth becomes sensitive to temperature changes and feels

painful, when the dentine is exposed in the above mentioned

ways.
PULP
The nerves and blood vessels of the tooth are
called the pulp
The pulp occupies the root canals, and the pulp
chamber in the crown of the tooth.
When it is exposed to infection by decay or injury
it will die and cause severe pain. An abscess will
develop on the root.
The tooth will have to be extracted if a root canal
treatment is not performed to save it.
THE ROOTS
The roots are embedded in the tooth socket in the
jaw bone.
The front incisor and eye teeth have a single root.

Pre-molar teeth (bicuspids) have one or two roots

The molar teeth can have two or three roots

Each root has a root canal for the nerves and

blood vessels to pass through
Roots are covered by cementum and held in place
by the periodontal ligament.
PERIODONTAL MEMBRANE OR
LIGAMENT
The periodontal ligament attaches the roots to
the alveolar bone of the jaw
It has both a nerve and blood supply

The ligament provides an elastic cushion between

the tooth and the bone. Slight movement of a
tooth is made possible by the ligament.
Teeth are not rigidly joined to bone. There is
flexibility.
SALIVARY GLANDS
Salivary glands are defined as compound, tubuloacinar,
merocrine, exocrine glands, whose ducts open into the
oral cavity. Compound refers to the fact that salivary
gland has more than one tubule entering the main
duct. Tubuloacinar describes the morphology of the
secreting cells. Merocrine indicates that only the
secretion of the cell is released and not the cytoplasm
Salivary glands are complex networks of hollow tubes

and secretory units that are found in specific location of

the mouth
In addition to three major paired salivary glands, 600-

1000 minor salivary gland line the oral cavity and

oropharynx, contributing a small portion of the salivary
production
PAROTID GLANDS
The parotid gland represents the largest salivary
gland, averaging 5.8 cm in width, and 3.4 cm in
length. The average weight of parotid gland is
14.8 gm. It is irregular, wedge shaped, and
unilobular, yellowish mass, lying largely below
the external acoustic meatus, between the
mandible and sternocleidomastoid. A detached
part of gland lies above the upper zygomatic arch.
The tail of the parotid overlies the upper 1/4 th of
the sternocleidomastoid muscle and extends
towards the mastoid process.
PAROTID GLAND RELATIONS
It has 5 processes (3 superficial and 2 deep)
Above: lies external auditory meatus and
temporomandibular joint.
anteriorly: it overflows the mandible with
overlying masseter.
Medially: lies the styloid process and its muscle
separating the parotid from internal juglar vein,
internal carotid artery, last four cranial nerves
and lateral wall of the pharynx
Branches of facial nerve emerges at the anterior,
upper and lower borders of gland.
PAROTID DUCT (STENSON DUCT)
About 5 cm long, this duct begins at the
confluence of the two main tributaries within the
anterior part of the gland, and then crosses the
masseter a finger breadth below the zygomatic
arch. It runs short obliquely forward and open
upon a small papilla opposite the second upper
molar crown.
The wall of parotid duct is thick, with an external
fibrous layer containing smooth muscle and
mucosa lined by low columnar epithelium. Its
caliber is about 2mm, although smaller at its oral
opening.
VESSELS AND NERVES
The parotid artery is supplied transverse facial
artery from the superficial temporal artery
providing blood to parotid gland, stensens duct.
The veins drain into the external jugular through
the local tributaries of retromandibular vein,
which lies deep to the facial nerve.
The lymph vessels end in the superficial and deep
cervical lymph nodes.
The nerve innervation is autonomic, consisting of
sympathetic fibers from the external carotid
plexus and parasympathetic fibers which reaches
it via the tympanic branch of the
glossopharyngeal nerve.
SUB MANDIBULAR GLANDS
It is situated in the anterior part of the digastrics triangle,
formed by the anterior and posterior bellies of the digastric
muscle and the inferior margin of the mandible.
The paired submandibular glands are irregular(roughly J)

in shape and about the size of walnuts (10gm). Each

consist of a large superficial duct, and a smaller deep part.
Although predominately serous, they are seromucous
glands.
Submandibualr Duct (whartons Duct): this duct is abt 5

cm long, and has a thinner wall than parotid duct. It

begins from numerous tributaries in the superficial part of
the gland, and opens into the floor of the mouth on the
summit of the sub lingual papilla at the side of the
frenulum of the tongue.
VESSELS AND NERVES FOR
SUBMANDIBULAR
It is supplied by facial artery. The veins drain
into the common facial or lingual vein. Lymph
passes to submandibular lymph nodes. Nerve
supply is from the branches of submandibular
ganglion.
SUB LINGUAL GLAND
This is the smallest of the major salivary glands.
The almond shaped gland lies just deep to the
floor of the mouth mucosa between the mandible
and genioglossus muscle. It is bounded inferiorly
by the mylohyoid muscle. Whartons duct and the
lingual nerve pass between the sub lingual gland
and the genioglossus muscle.
Unlike the parotid and submandibular glands, the

sub lingual gland lacks a single dominant duct.

Instead it is drained by approximately 10 small
ducts (Ducts of Rivinus), which exit the superior
aspect of the gland and open along the sublingual
fold on the floor of the mouth.
VESSELS AND NERVES FOR THE
SUB LINGUAL GLAND
The gland receives its blood supply from the
lingual and submental arteries.
The nerve supply is similar to that of
submandibular gland.
Lymphatic drainage goes to the sub mandibular
nodes.
MINOR SALIVARY GLANDS
These are located beneath the epithelium in
almost all parts of the oral cavity. These glands
usually consist of several small groups of
secretory units opening via short ducts directly
into the mouth. They lack a distinct capsule,
instead mixing with the connective tissue of
submucosa or muscle fibres or tongue or cheek. It
consist of labial and buccal glands, glossopalatine
glands, weber galnds(superior pole of tonsil), von-
ebner gland(base of tongue) and lingual gland.
HISTOLOGY
The secretory unit consists of the acinus,
myoepithelial cells, the intercalated duct, the
striated duct, and the excretory duct. All salivary
acinar cells contain secretory granules, in serous
glands, these granules contain amylase, and in
mucous glands, these granules contain mucin Acini
Depending upon the primary secretion, glands are

divided into 3 types

Serous (protein-Secreting): speherical cells rich in

zymogen granules
Mucous(Mucin-Secreting): more tubular shaped

cells, mucinogen granules are washed out on histo

preparations giving an empty cell preperation
 Mixed: serous demilunes or predominantly mucous acinar
cells capped by a few serous acinar cells.
Mucous cells: they contain large translucent mucinogen

granules consisting of precursor of mucin and appear pale

or translucent. It forms a viscous secretion containing
mucin, a useful lubricant for food and oral mucosa
Serous Cells; they contain opaque small zymogen

granules consisting of a precursor of ptyalin. It forms a

thin watery secretion containing ptyalin which initiates
digestion of starch to maltose.
The parotid gland is a purely serous salivary gland.

Ofnote, the parotid gland is unique in that it contains

many fat cells, in fact, the adipocyte to acinar cell ratio in
the parotid is 1:1
The sub mandibular cell is mixed, but predominately

serous, Approximately 10% of its acini are mucinous

The sub lingual gland is mixed, but predominately

mucous
SALIVA
Saliva is a clean, tasteless, odorless, slightly acidic viscous
fluid, consisting of secretions from the parotid, sublingual,
submandibular salivary glands and mucosal glands of oral
cavity.
Composition: Mixed saliva contains 99.5% water and 0.5%

solids. Solids are organic substances and inorganic

substances. Apart from these gases are also found in saliva.
Organic Substances: salivary proteins: Mucin and

albumin, Salivary Enzymes: Amylase, maltase, lysozyme,

phosphates and carbonic anhydrase Blood group components:
antigens, free amino acids, non protein nitrogenous
substances like urea, uric acid, creatinine and hypoxanthine.
Inorganic Substances: Sodium, Calcium, Potassium,

bicarbonate, bromide, chloride, fluoride and Phosphate.

Gases: Oxygen, Carbon dioxide and nitrogen.
PROPERTIES OF SALIVA
It is also called as liquid enamel as it is a rich
source of various minerals.
Total amount: 1200-1500ml in 24 hrs. A large
proportion of this volume is secreted at meal time
when the secretory rate is highest.
Consistency; Slightly cloudy because of the
presence of cells and mucin
Reaction: Usually slightly acidic PH(6.02 7.05)

Specific Gravity: 1.002 to 1.02

FUNCTIONS OF SALIVA
8 Major functions
Moistens oral mucosa. In fact, the mucin layer on the
oral mucosa is thought to be the most imp
nonimmune defense mechanism in the oral cavity.
Moistens dry food and cools hot food

Provides a medium for dissolved foods to stimulate

the taste buds.
Buffers Oral Cavity contents, Saliva has a high
concentration of bicarbonate ions.
Digestion: Alpha-amylase contained in saliva, breaks
1-4 glycoisde bonds, while lingual lipase helps break
down of fats. Ptyaline converts cooked starch into
maltose.
 Controls bacterial flora of the oral cavity.
Mineralization of new teeth and repair of
precarious enamel lesions. Saliva is high in
calcium and Phosphate.
Protects the teeth by forming a protective
Pellicle. This signifies a saliva protein coat on
the teeth which contains antibacterial
compounds. Thus, Problem with the salivary
glands generally result in rampant dental caries.
PAROTID GLAND RELATIONS
SALIVARY GLANDS
ESOPHAGUS
The esophagus or gullet is a muscular canal. It is about 23 to
25cm long extending from the pharynx to the stomach. It begins
in the neck at the lower border of the cricoid cartilage, opposite
the sixth cervical vertebra, descends along the front of the
vertebral column, through the posterior and superior mediastina,
passes through the diaphragm and enters the abdomen, & ends at
the cardiac Orifice of the stomach, opposite the 11 th cervical
vertebra.
The general direction of esophagus is vertical, but it presents two

slight curves in its course. At its commencement it is placed in the

middle line, but it inclines to the left side as far as the root of the
neck, gradually passes to the middle line again at the level of the
5th thoracic vertebra & finally deviates to the left as it passes
forward to the esophageal hiatus in the diaphragm. It is the
narrowest part of the digestive tube, and is most contracted at its
commencement, and at the point where it passes through the
diaphragm
RELATIONS OF ESOPHAGUS
Cervical Portion:
Anteriorly: Trachea, thyroid gland(lower part of
the neck)
Posteriorly: Vertebral Column

Either side: common carotid artery (especially to

the left, as it inclines to the lt side), lobes of the
thyroid gland and recurrent nerves

Thoracic Portion:
It is first situated in the superior mediastinum

Anterior: Trachea
 Posterior: Vertebral Column, a little to the lt side of
median line
It then passes behind and to the right of the aortic arch

Then descends into the posterior mediastinum along the rt

side of the descending aorta, then runs infront and a little

to the left of the aorta
It enters the abdomen at the level of the 10 th thoracic

vertebra.
While perforating the diaphragm, there is distinct

dilatation,
Anterior: Trachea, lt bronchus, pericardium and the

diaphragm
Behind: Vertebral column, Rt aortic intercostal arteries,

thoracic duct
Lt side: ascending Aorta, lt subclavian artery, thoracic duct

and Lt pleura, Lt recurrent nerve

Rt side: Rt Pleura,
 Abdominal Portion;
It lies in the esophagus groove on the posterior
surface of the left lobe of the liver. It measures
about 1.25 cm in length and only its front and left
aspects are covered by peritoneum, it is
somewhat conical with its base applied to the
upper orifice of the stomach, and is known as
antrum cardiacum.
STRUCTURE OF ESOPHAGUS
4 coats
External or fibrous, Muscular, submucous or areolar and an internal

or mucous coat
Muscular coat (tunica Mucosa) is composed of two planes of

considerable thickness, an external of longitudinal and an internal of

circular fibers.
Areolar or sub mucosa(tela Submucosa) coat connects loosely the

mucous and muscular coats. It contains blood vessels, nerves and

mucous glands
Mucous Coat(tunica mucosa) is thick of reddish color above, and pale

below. It is covered throughout with a thick layer of stratified

squamous epithelium.
Muscularis Mucosa; between it and the areolar coat, is a layer of

longitudinally arranged non-striped muscular fibres.

Esophageal glands are small compound racemose glands of the

mucous type, they are lodged in the submucous tissue, and each opens
upon the surface by a long excretory duct.
VESSELS AND NERVES
Artery: inferior thyroid branch of the
thyrocervical trunk for cervical region, from the
descending thoracic aorta from the lt gastric
branch of the celiac artery for thoracic region,
and from the lt inferior phrenic of the abdominal
aorts for abdomen region
The nerves are derived from the vagi and from
the sympathetic trunks, they form a plexus
 A fibrous covering
B divided fibres of longitudinal muscular

fibres
C transverse muscular fibre

D sub mucous or areolar layer

E Muscularis Mucosa

F Mucous Membrane with vessels and part

of lymphoid nodule
G stratified epithelial lining

H mucous Gland

I gland duct

M Stratified muscular fibre Cut

STOMACH
It is the most dilated part of the digestive tube,
and is situated between the end of the esophagus
and the begeinning of the small intestine. It lies
in epigastric, umbilical, and left hypochondriac
regions of the abdomen.
It is bounded by the upper abdominal viscera,
and completed in front and on the left side by the
anterior abdominal wall and the diaphragm.
The shape and position of the stomach are so
greatly modified by changes within itself and in
the surrounding viscera, hence not typical
 Chief modifications are determined by
1) the amount of the stomach contents

2) the stage which the digestive process has

reached
3) degree of development of the gastric
musculature
4) the condition of the adjacent intestines

However it broadly can be described as having

2 Openings

2 Boundaries or Curvatures

2 Surfaces
 Openings
Cardiac Orifice; the opening by which the
esophagus communicates with the stomach is
known as the cardiac orifice, which is situated on
the left of the middle line at the level of 11th
thoracic vertebra. The right margin of the
abdominal esophagus is continuous with lesser
curvature of the stomach, while the left margin
joins the greater curvature at an acute angle,
termed incisura cardiaca.
Pyloric Orifice: it communicated with the
duodenum, and its position is usually indicated
on the surface of the stomach by a circular
groove, the duodenopyloric constriction. This
orifice lies to the right of the middle line at the
level of the upper border of the first lumber
vertebra.
CURVATURES
Lesser Curvature: extending between the cardiac
orifice and the pyloric orifice, forms the right or
posterior border of the stomach. It descends as a
continuation of the right margin of the esophagus in
front of the diaphragm, turning to the right it crosses
the 1st lumber vertebra and ends at the Pylorus.
Lesser curvature gives attachment to the two layers of
the hepatogastric ligament, and between these two
layers are the lt gastric artery and the Rt Gastric
artery branch of the hepatic artery.
Nearer its pyloric end is a well marked notch, Incisura

angularis, which varies in position with the State,

distension of the viscus, it serves to separate the Rt
and left portion
GREATER CURVATURE
It is directed mainly forward, and is four or five times as
long as the lesser curvature.
Starting from the cardiac orifice at the incisura cardiaca, it

forms an arch backward, upward, and to the left, the

highest point of the convexity is on level with the sixth left
costal cartilage. From this level it may be followed
downward and forward, with a slight convexity to the left
as low as the cartilage of 9th rib, it then turns to the rt to
the end of the pylorus.
Directly Opposite Incisura angularis of the lesser

curvature the greater curvature presents a dilatation,

which is the Left extremity of the pyloric part, this
dilatation is limited on the rt side by the groove, Sulcus
intermedius, which is abt 2.5 cm from duodenoplyoric
constriction
 The portion between the sulcus intermedius and
the duodenopyloric constriction is termed as
Pyloric antrum.
At Commencement it is covered by the
Peritoneum from the front side of the organ
Lt part of the curvature gives attachment to the
gastrolineal ligament
Anteriorly two layers of greater Omentum and
gastroepiploic vessels
STOMACH SURFACES
When the stomach is in the contracted condition,
its surfaces are directed upward and downward
respectively, but when the viscus is distended
they are forward, and backward. They may
therefore be described as antero-superior and
postero-inferior surfaces.
ANTERO-SUPERIOR SURFACE
The left half of this surface is in contract with the
diaphragm, which separates it from the base of
the lt lung, pericardium, and the 7th, 8th, and 9th,
and intercostal spaces of the left side.
The Rt half is in relation with the lt lobe of the
liver.
When the stomach is empty, transverse colon may
lie on the front part of this surface.
Whole surface is covered by peritoneum.
POSTERO-INFERIOR SURFACE
It is in relation with the diaphragm, the spleen, Lt
suprarenal gland, Upper part of the front of Lt kidney,
anterior surface of the pancreas, Lt colic flexure and
the upper layer of the transverse mesocolon. these
structure forms a shallow bed, Stomach Bed.
Transverse mesocolon separates the stomach from the

dudenojejunal flexure and small intestine. Postero

inferior surface is covered by peritoneum, except over
the small area close to the cardiac orifice, which is
limited by the lines of attachment of gastrophrenic
ligament, and lies in opposition with the diaphragm
and closer to the upper portion of the lt suprarenal
gland.
PARTS OF THE STOMACH
A plane passing through the incisura angularis on
the lesser curvature and the left limit of the
opposite dilatation on the greater curvature
divides the stomach into a lt portion or body and a
rt or pyloric portion
The lt portion of the body is known as the Fundus,

and is marked off from the remaining body by a

plane passing horizontally through the cardiac
Orifice
The Pyloric portion is divided by a plane through

the sulcus intermedius at Rt angles to the Long

axis of this portion, Portion to the Rt of this plane
is the Pyloric antrum.
STOMACH PARTS
POSITION OF THE STOMACH
Position of stomach varies with the posture,
amount of the stomach contents, and with the
condition of the intestine on which it rests.
In erect Posture the empty stomach is somewhat
J shaped, part above the cardiac orifice is usually
distended with gas, Pylorus distended to the level
of first lumber vertebra and the most dependent
part of the stomach is at the level of the
umbilicus.
Variation in the amount of its contents affects
mainly the cardiac portion, pyloric portion
remaining is more or less in contracted condition
in the process of digestion.
ANATOMY OF STOMACH WALL
The wall of stomach consist of four coats
Serous Coat(tunica Serosa) derived from the

peritoneum, and covers entire surface of the organ,

except at greater and lesser curvature at the point
of attachment of greater and lesser omenta, where
the 2 layers of peritnoeum leave a small triangular
space , along which the nutrient vessels and
nerves pass.
Muscular coat(tunica muscularis) is situated

immediately beneath the serous covering, with

which it is closely connected. It consist of three set
of smooth muscle fibers: Longitudinal, circular and
oblique
 Longitudinal fibers are the most superficial, and
are arranged in two sets.
Circular fibers form a uniform layer over the
whole extent of the stomach beneath the
longitudinal fibers. At Pylorus they are most
abundant, and are arranged into a circular ring,
which projects into lumen, and along with the
mucous membrane covering at its surface forms
the Pyloric valve.
Oblique fibers internal to the circular layer are
limited chiefly to the cardiac end of the stomach,
where they are disposed as a thick uniform layer,
covering both surfaces.
Areolar or Submucous coat consist of a loose,
areolar tissue, connecting the mucous and
muscular layer
 Mucous Membrane is thick and its surface is
smooth, soft and velvety. In a fresh state it is of a
pinkish tinge at the pyloric end, and of a red or
reddish brown color over the rest of its surface. It
is thin at cardiac extremity, but thicker towards
the pylorus.
During the contracted stage of the organ, it is
thrown into numerous plaits or rugae. These
folds are entirely obliterated when the organ
becomes distended.
GASTRIC GLANDS
These are of three kinds
Pyloric; these are found in the pyloric position of
the stomach. They consist of 2 or 3 short closed
tubes opening into a common duct or mouth.
Cardiac Glands: few in number, occur close to the
cardiac orifice. They are again sub divided into
two types
Simple tubular glands resembling those of the
pyloric end of the stomach
Compound racemose glands resembling those
duodenal glands
 Fundus Glands: these are found in the body and
fundus of the stomach.

Vessels and Nerves:

Artery: Lt Gatric, Rt Gastric, Rt Gastroepiploic
branches of hepatic, Lt Gastroepiploic branches
of lineal.
Venous drainage: they end either in lineal or
superior mesentric veins or directly into the
portal vein
Lymphatics; deep and superficial set along the
curvatures
Nerves: terminal branches of rt and Lt vagi