3.02.6.

1 Gross Anatomical Relationships

The stomach begins at the lower end of the esophagus about 2.5 mm to the left of the midline at a level between the 10th and 11th
thoracic vertebrae. It angles downward and to the right, across the midline, to end at the pylorus, which is to the right of the midline
at a level between the first and second lumbar vertebrae.

The stomach deviates from the shape of a tube by bulging out toward the left. Viewed from the front, the long convex outer edge
of this bulge forms the greater curvature (Fig. 5). The right border of the stomach forms a short concave edge called the lesser curvature.
The rounded upper end of the greater curvature is especially prominent as a bulge called the fundus. The fundus is in contact
with the overlying diaphragm and extends above the level of entrance of the esophagus. The area of stomach immediately
surrounding the esophageal entrance is called the cardiac portion.
Proceeding from the cardiac end to the pylorus, the posterior aspect of the stomach is in relationship to the diaphragm, spleen,
left kidney, pancreas, and superior mesenteric artery and vein. Anterior relations of the stomach are the left lobe of the liver, transverse
colon, diaphragm, and anterior abdominal wall. The cardiac portion and fundus are protected by the ribs whereas the
remainder of the body of the stomach has only the soft tissues of the anterior abdominal wall over it. The distal portion of the
stomach that narrows to join the duodenum is called the antrum or pyloric stomach. The opening of the stomach to the duodenum
is the pylorus.

3.02.6.2 Architecture and Cytology

Because the stomach lies within the abdominal cavity, its outer layer is visceral peritoneum. This serosa is continuous with a mesentery,
the lesser omentum, that suspends the stomach from the liver, which is in turn attached to the body wall.
The muscularis propria of the stomach consists of outer longitudinal, middle circular, and inner oblique layers of smooth
muscle. At the pyloric-duodenal junction, the circular layer is enlarged to form the pyloric sphincter.
The mucosa has a simple columnar epithelium that is extensively invaginated into the lamina propria to form the stomach
glands. The superficial segment of each tubular invagination is called a gastric pit. Each gastric pit branches at its base to form
the deeper cardiac, gastric, and pyloric glands proper. Thus, the gastric pits can in a sense be regarded as ducts of the deeper glands.
The pits themselves are also glandular, however, being lined by mucous cells. Undifferentiated stem cells are located at the bases of
gastric pits. These cells undergo mitosis and provide replacements for surface mucous cells that are lost as well as for other cells in
the deeper glands. Mucous cells at the stomach surface are replaced by stem cells approximately every 3-6 days. Parietal cells and
chief cells have a much slower turnover rate.
The cardiac glands of the stomach are situated near the junction with the esophagus. They are coiled tubular glands made up of
mucous cells.
The gastric (or fundic) glands are straight, branched tubular glands (Fig. 6) made up of mucous cells (in the neck), parietal cells
(or oxyntic cells; mainly in the neck, also in the base), chief cells (mainly in the base, also in the neck), and scattered enteroendocrine
cells.
Parietal cells secrete HCl, which creates an optimal pH for stomach enzymes and protects against many bacteria and viruses. They
also produce intrinsic factor, a glycoprotein necessary for absorption of vitamin B 12 by the ileal mucosa. They contain abundant
mitochondria, and a membrane compartment that in active cells exists as deep microvillus-lined canaliculi of the apical membrane,
and in inactive cells is mainly a tubulovesicular compartment in the apical cytoplasm. These membranes contain the proton pumps
(HþKþ-ATPase) that drive acid production.
Chief cells (or peptic cells) secrete pepsinogens, which are converted to pepsins at low pH. Pepsins are a family of proteolytic
enzymes that initiate protein digestion in the stomach. Chief cells contain abundant rough endoplasmic reticulum in the basal cytoplasm,
a prominent Golgi apparatus, and prominent secretory granules in the apical cytoplasm, reflecting their function as regulated
secretors of glycoprotein.
Enteroendocrine cells secrete hormones that influence gut function. Some have a free apical surface while others do not contact
the gut lumen. Their secretory granules are accumulated in the basal cytoplasm, since these cells exocytose their secretory product
through the basal membrane. Gastrin, a hormone secreted by enteroendocrine cells in the stomach, stimulates stomach motility
and HCl production by parietal cells.
Enterochromaffin-like (ECL) cells are a subcategory of histamine-secreting enteroendocrine cells that affect acid secretion either
via direct stimulation of parietal cells or indirectly by stimulation of gastrin-secreting cells (Boron and Boulpaep, 2009).
The pyloric glands, like the cardiac glands, are coiled tubular glands. They are mainly made up of mucous cells but enteroendocrine
cells are also present, and indeed are most numerous in this part of the stomach. Gastric pits are most prominent in the pyloric
region, being conspicuously longer in this region than in the cardiac region and body of the stomach.
The lining of the contracted stomach is thrown up into folds called rugae. They have a core of submucosa and flatten out when
the stomach is full, thereby allowing a degree of distensibility.
3.02.6.3 Blood Supply and Innervation
Blood supply to the stomach is from branches of the celiac trunk, itself a branch of the aorta at the level of the 12th thoracic vertebra
(Fig. 7). The lesser curvature is supplied by left and right gastric arteries, which anastomose within the curvature. The greater curvature
receives blood from the left and right gastroepiploic (or gastroomental) arteries. Venous drainage of the stomach is by the
splenic vein (greater curvature) and left and right gastric veins (lesser curvature), which join the inferior and superior mesenteric
veins to form the portal vein.
Parasympathetic innervation of the stomach is provided by the vagus nerve and sympathetic via the splanchnic nerves and the
celiac ganglion, all of which pass to the stomach along its blood vessels.