Stomach Anatomy, Physiology, Pathology & Osteopathic Management – Lecture Review

These flashcards cover key anatomical, physiological, pathological, and osteopathic concepts related to the stomach, providing a comprehensive review for exam preparation.

What is the peritoneal status of the stomach?

The stomach is intraperitoneal.

What are the four main functions of the stomach?

Filling, Storage, Mashing/Grinding, and Emptying.

Name the four main ligaments attaching the stomach.

Hepatogastric, Gastrophrenic, Gastrosplenic, and Gastrocolic ligaments.

What are the three histological regions of the stomach?

Fundus, Body, and Pyloric antrum.

What does the hepatogastric ligament connect?

The esophagus and lesser curvature of the stomach to the porta hepatis (liver).

Where is the stomach located anatomically?

In the left hypochondrium, just below the liver, spanning approximately T9–L2.

What does the gastrophrenic ligament connect?

The fundus (greater curvature) to the diaphragm.

Which vertebral levels mark the cardia and pylorus?

Cardia: T7–T11. Pylorus: L1.

What does the gastrosplenic ligament connect?

The fundus and greater curvature to the spleen.

What does the gastrocolic ligament connect?

The inferior part of the greater curvature to the transverse colon; it becomes part of the greater omentum.

What is the primary function of the cardia?

Acts as the junction between the esophagus and the stomach.

What vessels run inside the hepatogastric ligament?

Left and Right gastric arteries.

What is the primary function of the pylorus?

Controls outflow of chyme into the duodenum.

Which parts of the stomach are fixed?

The cardia and pylorus.

Describe the edges of the stomach.

Right edge: lesser curvature (cardia to pylorus). Left edge: greater curvature (greater to lesser tuberosity).

Which vessels run inside the gastrocolic ligament?

Right and Left gastro-omental (gastroepiploic) arteries.

Which vessels run in the gastrosplenic ligament?

Short gastric arteries and the left gastroepiploic artery.

Which artery supplies the lesser curvature and abdominal esophagus?

Left gastric artery (LGA).

The lesser tuberosity lies at which vertebral level?

Approximately L2.

List the anterior relations of the stomach.

Diaphragm, costal margin, left lobe of liver, pleura, and lung.

From which trunk does the left gastric artery arise and with what does it anastomose?

Branch of the celiac trunk; anastomoses with the right gastric artery.

Which artery supplies the right side of the lesser curvature?

Right gastric artery (branch of the common hepatic artery).

Which artery supplies the left side of the greater curvature?

Left gastroepiploic (gastro-omental) artery from the splenic artery.

List the posterior relations of the stomach.

Pancreas, omental bursa, left kidney, left adrenal gland, and spleen.

Which artery supplies the right side of the greater curvature?

Right gastroepiploic (gastro-omental) artery from the gastroduodenal artery.

Which arteries supply the fundus?

Short gastric arteries from the splenic artery.

What part of the stomach faces the lesser sac (omental bursa)?

The posterior wall.

Which ribs correspond to the greater tuberosity of the stomach?

Around rib 8, near the splenic flexure.

Which parts of the stomach move with the diaphragm during breathing?

The fundus and greater tuberosity.

Which veins drain the lesser curvature?

Left gastric vein → portal vein; Right gastric vein → portal vein.

Which veins drain the greater curvature?

Left gastro-omental vein → splenic vein; Right gastro-omental vein → superior mesenteric vein.

What percentage of fundus/abdominal esophagus drains to the hemiazygos vein?

About one-third (≈33%).

Which region of the stomach acts as a reservoir?

Fundus and body.

Which region is chiefly responsible for mixing and grinding?

Antrum and pylorus.

What protects the stomach epithelium from autodigestion?

A mucus layer rich in bicarbonate (HCO₃⁻).

Which cells secrete hydrochloric acid?

Parietal cells in the fundus and body.

List four effects of hydrochloric acid in the stomach.

Destroys bacteria, activates pepsin, denatures proteins, and maintains acidic pH for digestion.

Which hormone directly stimulates HCl secretion?

Gastrin produced by G cells in the antrum.

What stimuli trigger G cells to release gastrin?

Vagal stimulation, amino acids in the lumen, and gastric distension.

Name three major actions of gastrin.

Increases gastric motility, stimulates HCl secretion, and promotes mucosal growth (also constricts the LES).

Which cells secrete histamine in the stomach and what is its effect?

Enterochromaffin-like (ECL) cells; histamine stimulates parietal cells to secrete HCl.

Which cells produce somatostatin and what does it do?

D cells in stomach, pancreas, duodenum; somatostatin inhibits release of gastrin, HCl, and other hormones.

What provides parasympathetic innervation to the stomach?

Vagus nerve (CN X): left vagus to anterior wall, right vagus to posterior wall; increases motility, secretion, and opens pylorus.

What provides sympathetic innervation to the stomach?

Greater splanchnic nerves (T5–T9); decrease motility, cause vasoconstriction, and close the pyloric sphincter.

Which nerve supplies sensory innervation to the parietal peritoneum over the stomach?

Phrenic nerve.

Name the three muscle layers of the stomach wall.

Outer longitudinal, middle circular, and inner oblique (unique to stomach).

What are Interstitial Cells of Cajal?

Pacemaker cells in the myenteric plexus generating slow-wave contractions of the GI tract.

What structure connects the stomach to the liver?

Lesser omentum, comprising the hepatogastric and hepatoduodenal ligaments.

What structures run within the hepatoduodenal ligament?

The portal triad: hepatic artery, portal vein, and common bile duct.

What connects the stomach to the diaphragm?

Gastrophrenic ligament.

What connects the stomach to the spleen and which vessels does it carry?

Gastrosplenic ligament; contains short gastric arteries and the left gastroepiploic artery.

What connects the stomach to the transverse colon?

Gastrocolic ligament (part of the greater omentum).

What is intrinsic factor and its function?

A glycoprotein secreted by parietal cells; required for vitamin B₁₂ absorption in the terminal ileum.

What is ghrelin and its role?

A hormone from endocrine cells of the fundus that stimulates appetite and food intake.

What is pepsinogen and where is it secreted?

Inactive precursor of pepsin secreted by chief cells in the fundus; converted to pepsin by HCl.

What is the enteric nervous system (ENS)?

Intrinsic neural network of the gut comprising myenteric and submucosal plexuses controlling motility and secretion.

List at least five functions of the vagus nerve in the stomach.

LES contraction, stimulation of gastric secretion, enhancement of motility, pyloric opening, gastrin release, relaxation of fundus, and coordination with digestive enzymes.

How does the stomach initiate protein digestion?

By secreting pepsin (from pepsinogen) activated by acidic HCl.

List three causes of hypergastrinemia.

Zollinger-Ellison syndrome, Helicobacter pylori infection, and chronic proton-pump inhibitor use.

Name four damaging agents to gastric mucosa.

NSAIDs, alcohol, toxins, and H. pylori (plus stress via cortisol).

What does the stomach absorb?

Very little; mainly water, alcohol, and certain medications.

Define gastritis and two common causes.

Inflammation of the gastric mucosa; commonly due to H. pylori, NSAIDs, or alcohol.

List four symptoms of gastritis.

Epigastric pain, nausea, bloating, vomiting, and/or early satiety.

How is gastritis diagnosed?

Upper endoscopy and H. pylori testing (urea breath, stool antigen, or biopsy).

Define a gastroduodenal ulcer.

Ulceration of the stomach or duodenal lining, usually from H. pylori infection or NSAID use.

Name three major complications of peptic ulcers.

Bleeding, perforation, and pyloric stenosis (leading to peritonitis).

What is gastroesophageal reflux disease (GERD)?

Chronic reflux of stomach contents into the esophagus due to LES incompetence.

List common symptoms of GERD.

Heartburn, acid regurgitation, hoarseness, cough, and sore throat.

What is a hiatal hernia?

Protrusion of part of the stomach through the esophageal hiatus of the diaphragm into the thorax.

Differentiate sliding and paraesophageal hiatal hernias.

Sliding: cardia and fundus slide through hiatus (most common). Paraesophageal: fundus herniates beside esophagus; risk of strangulation.

Define pyloric stenosis and its hallmark symptom.

Congenital hypertrophy of the pyloric sphincter in infants, causing projectile (non-bilious) vomiting.

What is dyspepsia?

Non-specific indigestion with no structural cause on investigation.

Name four risk factors for dyspepsia.

Smoking, alcohol, stress, NSAID use, and rapid eating.

According to Barral, which shoulder issues may relate to stomach restrictions?

Left rotator cuff syndrome, scapulohumeral periarthritis, and frozen shoulder.

Which thoracic segments are often involved in cervicobrachialgia linked to stomach dysfunction?

T1 and upper thoracic segments (thoracic outlet influence).

Give two examples of osteopathic treatment goals for gastroptosis.

Lift the greater omentum and improve ligamentous/diaphragmatic tone.

What are common patient reactions after visceral stomach treatment?

Yawning, fatigue, dizziness, sweating, feeling cold, chills, or emotional release.

What can portal vein congestion lead to regarding the stomach?

Visceral dysfunction increasing risk of GERD, gastritis, H. pylori infection, and ulcer formation.

List key osseous restrictions associated with stomach dysfunction.

T5 (sympathetic chain), T11 (cardia), L1 (pylorus), left sacroiliac joint, and cervical levels (C3–C6 for vagal/phrenic roots).

Why manipulate gastric mucosa during irritative syndromes?

To stop visceral spasms, promote drainage, and improve gastric transit.

Describe an osteopathic technique for releasing an air pocket in the fundus.

Mobilize the fundus with fingers against the gastric wall, rotate the patient’s trunk, encourage burping to release trapped air.

What information can percussion over the fundus provide?

Fundus position and detection of gastric dilation or air bubble.

What benefit does releasing a gastric air pocket provide?

Improves cardiorespiratory symptoms, gastric transit, and reduces abdominal pressure.

What is the stomach motility induction technique?

Gentle amplification of the stomach’s dominant natural motion in multiple planes without causing pain.

Briefly outline the Finet stomach technique.

Patient supine; gentle manual pressure follows natural motility rhythms toward the epigastric area to free tension and improve mobility.

How does osteopathy view a hiatal hernia?

As loss of stomach mobility with real displacement related to esophageal attachments, diaphragm tone, and costal mobility.

List at least three red-flag symptoms in stomach dysfunction requiring medical referral.

Unexplained weight loss, hematemesis/melena, nocturnal pain, persistent vomiting, fever, or supraclavicular swelling.

Describe the manipulation for gastroesophageal junction issues (GERD/hiatal hernia).

Direct technique in supine: push cardia downward and posteriorly to restore position and ease diaphragmatic tension.

How is gastric ptosis manipulated osteopathically?

With patient seated, osteopath pushes antrum/greater curvature posterosuperiorly to improve position and transit.

What patient advice precedes stomach treatment?

Avoid food 2–3 h before, limit trigger foods (wine, chocolate, citrus) in GERD/HH, small meals in ptosis, avoid tight belts and overhead arm movements.

Explain seated AP manipulation of the cardia.

One hand behind T11, the other under costal margin lifting anteriorly to free a sunken or restricted cardia (useful in GERD/ptosis).

How is a gastric air bubble assessed via percussion?

Percuss left lower anterior ribs starting at the mid-clavicular line toward the fundus listening for tympany.

What does increased tympany with abdominal distention suggest?

Gastric dilation.

Name two named visceral mobilization techniques for the stomach.

Barral technique and Finet technique (plus curvature/fundus specific methods).

Which stomach-related ligaments are commonly treated osteopathically?

Hepatogastric, Gastrophrenic, Gastrosplenic, Gastrocolic, Phrenicoesophageal, and Aerogastric ligaments.

Which syndrome is associated with loss of tone in the lower esophageal sphincter?

Hiatal hernia.

Which side of the body is more commonly involved in stomach restrictions?

The left side (due to stomach position, vagus/phrenic origin, and fundus location).

Which cranial nerve is most important for stomach regulation?

The Vagus nerve (CN X).