Stomach
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2. Definition
Page 2 – Definition
Definition |
– The stomach is a muscular, hollow organ in the gastrointestinal system that lies between the esophagus and duodenum. |
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It serves as a reservoir and mixer for ingested food, initiating mechanical and chemical digestion, particularly of proteins.
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Structurally, it consists of four regions (cardia, fundus, body, and pylorus), and is lined by glandular mucosa that secretes acid, enzymes, and mucus.
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It also functions as a controlled gatekeeper, regulating emptying into the duodenum via the pyloric sphincter.
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Diseases include gastritis, ulcers, gastric cancer, and gastroparesis.
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Diagnosed via endoscopy, imaging (e.g., CT, upper GI series), and biopsy, and treated medically or surgically depending on etiology. |
Core Element |
Summary |
Structure |
Muscular, J-shaped organ with rugae; four regions; surrounded by omentum |
Function |
Receives ingested material → mechanically and chemically digests → exports chyme to duodenum |
Common Diseases |
Gastritis, peptic ulcer disease, gastric cancer, gastroparesis |
Diagnosis |
Endoscopy, barium swallow, CT, biopsy |
Treatment |
PPIs, antibiotics (for H. pylori), surgery (e.g., resection, gastrectomy) |
3. Anatomy
Page 3 – Normal
🔹 Table 1 – U-SSPCT–C (Structural Anatomy)
Component |
Detail |
Units (U) |
Cardia, fundus, body (corpus), antrum, pylorus |
Size (S) |
25–30 cm long; holds ~1.5–2.5 liters postprandially |
Shape (S) |
J-shaped organ with greater and lesser curvatures |
Position (P) |
Left upper quadrant; intraperitoneal; between esophagus (above) and duodenum (below) |
Character (C) |
Mucosa: glandular epithelium with gastric pits and glands; muscularis externa with 3 layers (longitudinal, circular, oblique); rugae allow distention |
Time (T) |
Formed from embryologic foregut; active digestion starts shortly after birth |
Connections – Arterial Supply |
Left gastric, right gastric, left gastroepiploic, right gastroepiploic, and short gastric arteries (from celiac trunk) |
Connections – Venous Drainage |
Left and right gastric veins → portal vein; gastroepiploic and short gastric veins → splenic vein |
Connections – Lymphatic Drainage |
Gastric, gastroepiploic, and celiac lymph nodes |
Connections – Nerve Supply |
Parasympathetic: vagus nerve; sympathetic: celiac plexus |
Connections – Ducts |
None (not a gland with excretory duct) |
🔹 Table 2 – Function (Receive → Process → Export)
Stage |
Description |
Receive |
Receives food from the esophagus via the lower esophageal sphincter |
Process |
Mechanically churns and mixes food with gastric secretions (HCl, pepsin, intrinsic factor); converts food into chyme |
Export |
Gradually releases chyme into the duodenum through the pyloric sphincter under neural and hormonal control |
4. Disease and Diagnosis
Table 1 – Disease Categories and Structural Effects (U-SSPCT–C)
Disease Category |
Examples |
Anatomic Change |
Affected U-SSPCT–C Element |
Inflammatory |
Gastritis (H. pylori, autoimmune) |
Mucosal erythema, edema |
Character |
|
|
Glandular atrophy |
Character |
Infectious |
H. pylori, CMV gastritis |
Mucosal erosion |
Character |
|
|
Nodularity or lymphoid aggregates |
Character, Units |
Neoplastic – Benign |
Hyperplastic polyps, adenomas |
Discrete mucosal growths |
Unit |
|
|
Smooth, rounded shape |
Shape |
Neoplastic – Malignant |
Adenocarcinoma, lymphoma |
Mass lesion, ulceration |
Unit |
|
|
Wall thickening, invasion |
Character, Shape |
|
|
Regional lymph node involvement |
Connections – Lymphatics |
Mechanical |
Gastric outlet obstruction |
Pyloric narrowing |
Position |
|
|
Dilated stomach, delayed emptying |
Size, Time |
Trauma |
Perforated ulcer |
Wall defect, free air |
Unit, Character |
|
|
Peritoneal contamination |
Connections |
Metabolic |
Zollinger-Ellison syndrome |
Mucosal hypertrophy, increased folds |
Character, Shape |
Circulatory |
Ischemic gastritis |
Pale or hemorrhagic mucosa |
Character |
|
|
Portal hypertensive gastropathy |
Congested rugal folds |
Inherited |
Juvenile polyposis |
Multiple polyps |
Unit |
|
|
Risk of malignant transformation |
Time |
Infiltrative |
Linitis plastica (diffuse adenocarcinoma) |
Rigid wall, thickened stomach |
Character, Shape |
|
|
Loss of peristaltic compliance |
Function |
Idiopathic |
Gastroparesis |
Delayed gastric emptying |
Time, Function |
Iatrogenic |
Post-bypass strictures |
Altered anatomy, surgical anastomosis |
Unit, Connections |
Functional |
Functional dyspepsia |
Normal structure, abnormal sensation |
Character |
Psychiatric |
Anorexia, bulimia |
Delayed emptying, muscle atrophy |
Time, Character |
Table 2 – Clinical Signs and Symptoms
Symptom |
Interpretation |
Epigastric pain |
Ulcer, gastritis, malignancy |
Early satiety |
Cancer, gastroparesis |
Nausea/vomiting |
Obstruction, inflammation, delayed emptying |
Hematemesis / melena |
Ulcer, gastritis, varices, malignancy |
Weight loss |
Cancer, gastroparesis, chronic ulcers |
Bloating |
Functional disorder or motility issue |
🔹 Table 3 – Imaging Modalities
Modality |
Primary Use |
When/Why Used |
Endoscopy (EGD) |
Direct visualization and biopsy |
First-line for ulcers, gastritis, cancer |
Barium swallow / Upper GI series |
Evaluates filling defects, outlet obstruction |
Alternative to endoscopy in some cases |
CT abdomen/pelvis |
Tumor staging, perforation, mass effect |
Post-surgical or emergency evaluation |
PET/CT |
Oncology staging |
For assessing metastasis or recurrence |
Ultrasound |
Limited use |
May evaluate gastric distention or outlet obstruction in children |
🔹 Table 4 – Laboratory Tests
Test |
Purpose |
When Used |
CBC |
Detect anemia |
Chronic GI bleeding or malignancy |
H. pylori testing |
Antigen, urea breath, biopsy |
Diagnose infectious gastritis or ulcer |
Gastrin level |
Screen for Z-E syndrome |
Unexplained ulcers or gastric hypertrophy |
Tumor markers (e.g., CEA, CA 19-9) |
Surveillance |
Used in gastric cancer workup and follow-up |
🔹 Table 5 – Other Diagnostic Tools
Tool |
Use |
Indication |
Endoscopic ultrasound (EUS) |
Layered wall assessment |
For GISTs, submucosal tumors, cancer staging |
Gastric emptying scan |
Measures motility |
Suspected gastroparesis |
Capsule endoscopy |
Limited utility |
May visualize gastric mucosa in inaccessible patients |
Biopsy with histology |
Definitive diagnosis |
Inflammatory, infectious, and malignant diseases |
5. History and Culture
Page 5 – History, Culture, and Art
🔹 1. History of Anatomy
Contributor / Era |
Milestone |
Ancient Egypt and Greece |
Recognized abdominal cavity contents but unclear organ boundaries |
Galen |
Described the stomach as a vessel of digestion and emotion |
Ibn Sina (Avicenna) |
Wrote about gastric pain and disorders in The Canon of Medicine |
Andreas Vesalius (1543) |
Illustrated stomach anatomy with curvature and sphincters |
18th–19th century |
Identification of gastric regions and lining layers |
🔹 2. History of Physiology
Era |
Discovery |
1820s – William Beaumont |
Observed digestion in a patient with gastric fistula (Alexis St. Martin) |
19th century |
Hydrochloric acid identified as key digestive agent |
Early 20th century |
Pepsin and gastric hormones (gastrin) isolated |
Modern era |
Understanding of acid regulation, neurohormonal control, and motility refined |
🔹 3. History of Disease
Era |
Milestone |
Antiquity |
Gastric discomfort interpreted as imbalance of “humors” |
19th century |
Peptic ulcer identified; early surgeries performed |
1982 – Warren and Marshall |
Discovered Helicobacter pylori as cause of most ulcers |
Modern era |
Link between H. pylori and gastric cancer established; widespread eradication programs launched |
🔹 4. History of Diagnosis
Tool |
Milestone |
Early auscultation |
Used to assess borborygmi and gas movement |
Barium swallow |
Introduced in early 1900s |
Endoscopy (EGD) |
Became routine in mid-20th century |
Histopathology |
Allowed precise diagnosis of malignancy and gastritis subtypes |
🔹 5. History of Imaging
Modality |
Use |
Barium studies |
Detected ulcers, strictures, masses |
Endoscopy |
Visualized mucosa, ulcers, varices, cancer |
CT / MRI |
Staging gastric malignancies, detecting perforation |
PET-CT |
Advanced oncology staging in modern practice |
🔹 6. History of Laboratory Testing
Test |
Milestone |
Use |
Gastric pH testing |
20th century |
Evaluated acid output |
H. pylori testing |
1980s |
Revolutionized ulcer diagnosis |
Gastrin levels |
Used to diagnose Z-E syndrome |
|
Tumor markers |
CA 19-9, CEA |
Adjuncts in cancer monitoring |
🔹 7. History of Therapies
Therapy |
Era |
Details |
Dietary change |
Ancient remedy |
“Soft foods” prescribed for stomach pain |
Antacids |
20th century |
Symptom relief without addressing cause |
Antibiotics + PPIs |
1990s onward |
Eradicated H. pylori and healed ulcers |
Gastrectomy |
20th century |
Surgical removal of cancer or refractory ulceration |
Endoscopic therapy |
Modern |
Ablation, dilation, or stent placement |
🔹 8. Cultural Meaning
Culture |
Symbolism |
Traditional medicine |
Seen as the center of nourishment and health |
Chinese medicine |
Stomach = part of Earth element, center of digestion |
Popular idioms |
“Gut feeling,” “stomach turning,” “stomaching the truth” |
🔹 9. Artistic Representations
Medium |
Example |
Meaning |
Medieval drawings |
Alimentary tract schematics |
Emphasized hierarchy of digestion |
Anatomical models |
Teaching tools in 17th–20th century |
Showed food passage and gastric chambers |
Surrealist imagery |
Twisted or distorted stomach forms |
Represent anxiety and inner turmoil |
🔹 10. Literary References
Author / Work |
Context |
Theme |
Shakespeare – “I can scarce digest this…” |
Emotional rejection |
|
Dante’s Inferno |
Gluttony punished in the third circle |
Stomach as metaphor for excess |
Kafka’s Hunger Artist |
Voluntary starvation |
The stomach as identity and rebellion |
Folklore and fairy tales |
“Swallowed whole” motifs |
Hunger, consumption, and fear |
🔹 11. Music and Performing Arts
Context |
Link to Stomach |
Notes |
Opera/vocal projection |
Requires diaphragmatic support and gastric relaxation |
Tension in abdominal cavity affects performance |
Choreography and dance |
Center of gravity often described as the “core” |
Visualized near the stomach |
Satire and lyrics |
“Stomach this” used metaphorically |
Reflects difficulty with emotional digestion |
🔹 12. Athletics and Performance
Context |
Role of Stomach |
Examples |
Endurance sports |
Gastric emptying affects performance |
Delayed emptying = cramping, nausea |
Pre-event nerves |
Sympathetic stimulation reduces gastric motility |
“Butterflies in the stomach” |
Nutrition in training |
Carb-loading and meal timing critical |
Risk of GERD or bloating with poor timing |
🔹 13. Culinary and Nutritional Use
Use |
Region |
Details |
Tripe (stomach lining) |
Global – Italy, Mexico, Asia |
Popular traditional dish (e.g., menudo, pho, andouille) |
Stomach-stuffed meats |
Scotland (haggis), Middle East |
Organ serves as cooking vessel |
Symbol of fullness |
“Stuffed to the stomach” |
Universal concept of satiety |
🔹 14. Notable Individuals with Stomach Disease
Name |
Condition |
Note |
Napoleon Bonaparte |
Believed to have died of gastric cancer |
|
Ulysses S. Grant |
Died from gastric cancer |
|
Carl Jung |
Experienced lifelong digestive issues |
|
Randy Pausch |
Carnegie Mellon professor, died of stomach cancer; gave famous “Last Lecture” |
|
🔹 15. Famous Quotes and Sayings
Quote |
Meaning |
“No guts, no glory.” |
Courage metaphor through abdomen |
“Butterflies in the stomach.” |
Performance anxiety |
“Hard to stomach.” |
Emotionally difficult to accept |
“A gut feeling.” |
Instinctive knowledge |
“Stomach turning.” |
Disgust or revulsion |
8. Memory Image
MCQ 1 – Basic Science
Which of the following cell types in the stomach secretes hydrochloric acid?
A. Chief cells
B. G cells
C. Parietal cells
D. Mucous neck cells
Correct Answer Table
Correct Answer |
Explanation |
C. Parietal cells |
Parietal cells in the gastric glands secrete hydrochloric acid and intrinsic factor. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. Chief cells |
Secrete pepsinogen, not acid |
B. G cells |
Secrete gastrin, not acid |
D. Mucous neck cells |
Secrete mucus, not acid |
🔹 MCQ 2 – Basic Science
Which region of the stomach is primarily responsible for mixing and grinding food into chyme?
A. Cardia
B. Fundus
C. Body
D. Antrum
Correct Answer Table
Correct Answer |
Explanation |
D. Antrum |
The antrum is the distal stomach region responsible for strong contractions that grind food before it enters the duodenum. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. Cardia |
Entry point, not involved in grinding |
B. Fundus |
Stores gas and food, not grinding |
C. Body |
Secretes acid and enzymes but does not perform major grinding |
🔹 MCQ 3 – Clinical
A 45-year-old patient with chronic epigastric pain and recent melena is found to have a duodenal ulcer. Which organism is most likely responsible?
A. E. coli
B. H. pylori
C. CMV
D. Candida
Correct Answer Table
Correct Answer |
Explanation |
B. H. pylori |
Helicobacter pylori is the most common cause of duodenal and gastric ulcers. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. E. coli |
Causes diarrhea and UTIs, not ulcers |
C. CMV |
Causes ulcers only in immunocompromised |
D. Candida |
Can infect the stomach but not typically associated with ulcers |
🔹 MCQ 4 – Clinical
Which of the following is most suggestive of gastric carcinoma?
A. Intermittent heartburn relieved by antacids
B. Sharp postprandial pain in upper abdomen
C. Unintended weight loss and early satiety
D. Hemorrhoids and bright red rectal bleeding
Correct Answer Table
Correct Answer |
Explanation |
C. Unintended weight loss and early satiety |
These are common signs of a gastric mass restricting gastric capacity or motility. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. Heartburn |
More indicative of GERD |
B. Postprandial pain |
Suggestive of ulcer |
D. Rectal bleeding |
Localized to lower GI tract, not stomach |
🔹 MCQ 5 – Radiologic
On upper GI series, which finding is characteristic of a gastric ulcer?
A. Apple core lesion
B. Filling defect with smooth borders
C. Ulcer crater with radiating folds
D. Beak sign at pylorus
Correct Answer Table
Correct Answer |
Explanation |
C. Ulcer crater with radiating folds |
Classic radiologic sign of a benign gastric ulcer. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. Apple core lesion |
Indicates colon cancer |
B. Smooth filling defect |
Often a polyp |
D. Beak sign |
Associated with achalasia, not ulcers |
🔹 MCQ 6 – Radiologic
What is the most appropriate first-line imaging test for suspected gastric outlet obstruction?
A. Chest X-ray
B. Abdominal ultrasound
C. Upper GI barium series
D. MRI abdomen
Correct Answer Table
Correct Answer |
Explanation |
C. Upper GI barium series |
Best non-invasive method to evaluate passage through the stomach and duodenum. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. Chest X-ray |
May show air-fluid levels but not diagnostic |
B. Ultrasound |
Limited for gas-filled stomach |
D. MRI abdomen |
Too expensive and not first-line |
🔹 MCQ 7 – Radiologic
Which of the following is best for staging gastric cancer?
A. CT scan
B. Endoscopy
C. PET-CT
D. Abdominal X-ray
Correct Answer Table
Correct Answer |
Explanation |
C. PET-CT |
Used for detecting metastatic spread in staging gastric carcinoma. |
Incorrect Answer Table
Option |
Reason It Is Incorrect |
A. CT scan |
Good for local assessment but less sensitive than PET for distant disease |
B. Endoscopy |
Used for diagnosis, not staging |
D. Abdominal X-ray |
No role in cancer staging |
Structure
2. Definition
3. Anatomy
4. Disease and Diagnosis
5. History and Culture
8. Memory Image