Parts and topography of the stomach
The shape and borders of the organ are defined by two curvatures: the lesser curvature (lesser curvature) along the medial margin and the greater curvature (greater curvature) along the lateral margin. Anatomically, the stomach is divided into five parts:
- Cardia (cardia): the initial part adjacent to the heart and the left dome of the diaphragm.
- Fundus (fundus): the rounded upper part located posteriorly and superiorly to the cardia. Since this is the most dorsal structure of the organ, in the supine position barium suspension flows precisely here during fluoroscopy.
- Body (corpus): the largest part. It ends at the angular notch (incisura angularis), a characteristic angle along the lesser curvature.
- Antrum (antrum): begins from an imaginary line drawn perpendicular to the axis of the stomach from the angular notch. Directed posteriorly.
- Pylorus (pylorus): a short muscular cylinder connecting the stomach to the duodenum. Together with the antrum, it fixes the second part of the duodenum in the retroperitoneal space.
Histological structure of the wall
The stomach wall consists of four classic layers:
- Mucous membrane (mucosa): the epithelium forms multiple invaginations called gastric pits. The deepest layer of the mucosa is the muscularis mucosae. The lamina propria (loose connective tissue) contains vessels, lymphatic channels, and autonomic nerves.
- Submucosa (submucosa): contains neurovascular plexuses and lymphoid follicles.
- Muscular coat (muscularis propria): a powerful muscular framework. It includes an inner oblique, middle circular, and outer longitudinal layer. The circular layer thickens in the distal part, forming the pyloric sphincter, a valve regulating the evacuation of food into the duodenum.
- Serous coat (serosa): the outer covering that smoothly transitions into the peritoneal ligaments (gastrocolic, gastrosplenic, and hepatogastric ligaments).
Secretory apparatus and macrorelief
The functions of different parts of the stomach directly depend on the localization of secretory cells. Parietal cells (producing hydrochloric acid) and chief cells (producing pepsin precursors) are located in the fundus and body. Gastrin is secreted in the antrum, and ghrelin is predominantly secreted in the fundus.
During radiological examinations, two elements of the mucosal relief are evaluated:
- Gastric folds (rugae gastricae): smooth longitudinal elevations 3–5 mm thick formed by the mucosa and submucosa. In pathology, they thicken and become nodular.
- Gastric areas (areae gastricae): flat polygonal elevations (2–3 mm in the antrum, 3–5 mm in the body and fundus) separated by grooves. In double-contrast imaging, they appear as a fine mesh. They are detected in 70% of patients (more often in the elderly) and serve as a marker of adequate contrast coating of the walls.
Basics of diagnostic imaging
Although modern practice frequently utilizes CT (e.g., MSCT with tightly filled water stomach) and endoscopy, fluoroscopy remains an important diagnostic tool.
- Double-contrast imaging: the patient takes a gas-producing agent and a barium suspension. The physician rotates the patient 360° so that the contrast covers the entire mucosa. The method is ideal for studying fine details (gastric areas).
- Single-contrast imaging: tight filling with barium to assess contours, compression, and relief.
- Water-soluble contrast: used strictly when ulcer perforation or anastomotic leakage is suspected. Barium is contraindicated in such cases.
Special patient positions are used for a detailed evaluation of the organ. For example, the left posterior oblique projection better demonstrates the body and antrum, while the right lateral projection shows the fundus, cardia, and retrogastric space (in this projection, a smooth gastric wall impression from the adjacent spleen can be seen).
Briefly: answers to topical questions
Which arteries supply blood to the stomach?
Lymphatic drainage and extraorgan vessels of the stomach are associated with gastric blood vessels. Sources mention:
- gastric blood vessels — running along the lesser curvature;
- gastroepiploic vessels — running along the greater curvature;
- short gastric vessels — also running along the greater curvature.
Which organs are adjacent to the posterior wall of the stomach?
The pancreas is adjacent to the posterior wall of the stomach, separated from it by the cavity of the lesser sac (omental bursa). The visceral surface of the spleen is connected to the fundus and greater curvature of the stomach. The inferior recess of the omental bursa is located between the stomach, the visceral surface of the spleen, and the pancreas.
Where does lymphatic drainage from the stomach go?
Lymphatic drainage from the stomach occurs via efferent vessels that follow the course of blood vessels to regional lymph nodes.
- From the lesser curvature (cardia and body) — lymph drains to first-tier nodes in the lesser omentum, and then to second-tier nodes at the celiac trunk.
- From the greater curvature — drainage proceeds along the gastroepiploic and short gastric vessels.
Regional lymph nodes of the stomach include:
- Perigastric nodes (along the greater and lesser curvatures).
- Paracardial nodes (right and left).
- Suprapyloric and infrapyloric nodes.
- Nodes along the left gastric, common hepatic, celiac, and splenic arteries.
- Hepatoduodenal nodes.
How to remember the layers of the muscular coat (from outside inwards)? The LCO rule: Longitudinal, Circular, Oblique. Thickening of the middle (circular) layer specifically forms the pylorus.
Class and exam questions
Why is barium sulfate contraindicated when gastric perforation is suspected?
When entering the abdominal cavity, barium causes granuloma formation and pronounced peritoneal fibrosis. In such situations, only water-soluble contrast is safe to use.
What determines the anatomical position of the stomach in the abdominal cavity?
It depends on the length of the mesenteric attachments and body habitus: in asthenics and geriatric patients, the stomach is positioned more vertically, whereas with developed musculature or obesity, it is horizontal.
Where does the barium suspension accumulate if the patient is lying on their back?
In the supine position, the contrast fills the fundus of the stomach, as anatomically this is the most dorsally located part of the organ.
What else to study on this topic
- Methodology of double-contrast fluoroscopy
- Secretory cells of the stomach: histology and functions
- Topographic anatomy of stomach ligaments and omenta
- Formation and role of the esophagogastric junction (OGJ)
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