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Let’s continue our USMLE Review with Anatomy from the Gold Standard USMLE Step 1 Audio Review program.
Play USMLE Audio MP3 03 07 Anatomy Stomach 3 Below
Begin 03 07 Anatomy Stomach 3 Transcription
Now let’s go back to the nervous systems of the stomach.
We talked about the submucosal plexus, what is that called?
- Meissner’s plexus.
And this innervates what two types?
- Muscularis mucosa and the glands.
What is the nervous plexus between the outermost longitudinal muscle layers of the stomach and the middle circular muscle layers of the stomach called?
- The myenteric plexus.
What the other name for the myenteric plexus?
- Plexus of auerbach.
The myenteric plexus or plexus of auerbach innervates what structures?
- The outermost longitudinal muscle, the middle circular muscle and the innermost oblique muscle layers of the stomach.
What happens to the mucosa of the stomach after death?
- It undergoes autodigestion as the mucous cells stop producing mucin.
From what two structures is the stomach suspended by peritoneal tissue?
- The liver and the diaphragm.
When the stomach is full what two structures may it hang down and rest on?
- The bladder or uterus.
There are two layers of peritoneum coming down from around the liver which join together come down separate around the stomach passing both in front and in back and then come together again and go further down, now what is the name for these two layers of peritoneum, suspending the stomach that come from the liver to the stomach?
- The hepatogastric ligament.
At what three parts of the stomach does this hepatogastric ligament, two layers of peritoneum, hit the stomach and then separate to go both in front and in back?
- The cardia, the lesser curvature of the body and the pylorus.
This same sheet of two layers of peritoneum also suspends the first part of the duodenum, what is this portion called?
- The hepatoduodenal ligament.
Now the hepatoduodenal ligament and the hepatogastric ligament are actually just different parts of the same two layered sheet, these two ligaments together are called what?
- The lesser omentum.
And again, what two organs are suspended by the lesser omentum?
- The stomach and the duodenum.
After these two layers of peritoneum pass over the stomach they then come back together and help suspend another organ, what is the next organ that these two layers help suspend?
- The transverse colon.
This two layered sheet of peritoneum suspending the transverse colon from the stomach is called what?
- The gastrocolic ligament.
Just a note here while we’re here we’ll get into this more detail later, what other two layered sheet of peritoneum comes down from behind and suspends the transverse colon?
- The transverse mesocolon.
Now the posterior sheet of the transverse mesocolon and the anterior sheet of the gastrocolic ligament after passing over the transverse colon, come together and hang down like a curtain, and what’s the name of this curtain or blanket?
- The greater omentum.
Just a parenthetical note, most sources consider the gastrocolic ligament as part of the greater omentum.
From what part of the stomach does the gastrocolic ligament primarily come from?
- The greater curvature.
Now back at the beginning part of the duodenum, right after the pyloric valve, the hepatoduodenal ligament has a space behind it, which can be reached from the right hand side.
What is the name of this space?
- The epiploic foramen.
What’s another name for it?
- The foramen of winslow.
What organ related to the liver hangs directly anterior to the hepatoduodenal ligament, that part of the lesser omentum on the right?
- The gallbladder.
And what part of what organ overlies or is anterior to the cardia and fundus of the stomach?
- The left lobe of the liver.
And what organ is lateral to the left and somewhat posterior to the body of the stomach?
- The spleen.
And what structure is anterior to the lower pole of the spleen and is up against the greater curvature of the stomach?
- The left colic flexure.
In relation to the diaphragm, esophagus and stomach, where does the left side of the hepatogastric ligament, which is actually the left side of the lesser omentum, originate?
- Where the two layers of peritoneum from under the diaphragm have reflected around the esophagus at the cardiac portion of the stomach to begin the lesser omentum.
Finally, to the left of the esophagus the same two layers of peritoneum, from under the diaphragm are reflecting down over the fundus of the stomach and suspending that part of the stomach, what is the name for that portion?
- The gastrophrenic ligament.
The same two layers of peritoneum even further to the left, will suspend what other organ?
- The spleen.
And what is the name for the suspension of the spleen?
- The gastrosplenic ligament.
Now the peritoneum is a continuous sheet of tissue, which overlays some organs and structures that are against the posterior trunk wall, envelopes other organs in the abdominal cavity and help suspend them and also lines the inside of the abdominal wall. In front and on the sides.
Now the part of this continuous sheet of peritoneum which lines the inside of the abdominal walls in front and on the sides is called what layer?
- The parietal layer.
And where parts of this continuous sheet of peritoneum overlie organs it is called what layer?
- The visceral layer.
Between these two parts of the continuous sheet of peritoneum, known as the visceral layer and the parietal layer, there is a space, what is the name for this space?
- The peritoneal sac.
What type of cavity is this?
- A capillary cavity.
It is a capillary cavity closed on all sides so it is also called?
- A serous cavity .
The side of the peritoneum which faces into this serous cavity is covered by a shiny smooth serous layer of tissue, which is called?
- The serosa.
The serosa which overlies the visceral peritoneum which is overlying organs is called?
- The visceral serosa.
The serosa which lines the inside face of the parietal peritoneum is then called?
- The parietal serosa.
How much serous fluid is within the peritoneal sac or cavity?
- About 50 mL of fluid.
What is its purpose?
- As a lubricant to allow the organs to move in relation to each other.
Now organs which are enveloped between two layers of visceral peritoneum are termed?
Please note that intraperitoneal organs may be suspended in a pouch of peritoneum, or maybe enveloped by two layers of peritoneum which run to the organ, climb over and behind it and then run together again going further, much like something sealed in vacuum pack plastic.
When two layers of visceral peritoneum run to an organ to either envelope it or enclose it in a pouch, what structures run between these two layers to the organ also?
- Arteries, veins, lymphatics, nerves.
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