Parts of the body inside the stomach: Diagram, stomach, intestines, and more
Diagram, stomach, intestines, and more
The stomach is located in the upper part of the abdomen. The digestive organs in the abdomen work together to absorb nutrients and move food through the digestion process. They include the stomach, gallbladder, liver, pancreas, intestines, and urinary system.
The digestion process is interdependent and a problem with one organ may disrupt the function of another. For example, gallstones can block the bile duct, affecting liver function. They may also block the pancreatic duct, causing pancreatitis and severe illness.
Issues with the digestive organs can include pain, weight gain or loss, digestive problems, fever, and jaundice.
This article examines each of the digestive organs in the abdomen, how they work together, and common health problems.
The digestive organs in the abdomen do not work alone. They depend on organs in the mouth and chest, such as the esophagus and tongue, to help chew, move food, and perform primary digestive functions.
The abdomen also includes the urinary system. The pelvis, the lower portion of the abdomen, contains reproductive structures.
Food travels to the stomach from the esophagus. Once it arrives, the stomach helps digest food via contractions and chemical enzymes.
The stomach has three layers: the oblique layer, the middle circular layer, and the external longitudinal layer, which breaks down food mechanically.
Acids such as hydrochloric acid further digest food into a liquid substance called chyme. A network of cells — including parietal cells, chief cells, G-cells, mucous neck cells, and D-cells — help chemically digest food by secreting stomach acids.
The stomach can also hold food until it moves further along the digestive tract.
The gallbladder is a small, pear-shaped organ next to the liver in the upper right abdomen. The liver forms bile, which helps digest fat and cholesterol and kill bacteria. The gallbladder stores this bile then releases it when the body needs it for digestion.
Bile is especially important for digesting fats, excreting cholesterol, and even possessing antimicrobial activity.
Bile drains into the gallbladder via the common hepatic duct, then drains into the cystic duct.
The gallbladder then releases bile through the common bile duct, passing through the pancreatic duct and eventually into the small intestine. A person can live without a gallbladder.
The liver is vital for a person to survive. It uses a group of lobes to help the body digest and store nutrients. It is a large organ in the upper right side of the abdomen, next to and under the ribs. It works closely with the pancreas and gallbladder.
One of its main functions is to make and release bile into the gallbladder. Bile also helps make some proteins that support blood clotting, filters toxins such as alcohol out of the blood, digests old red blood cells, stores glycogen, and stores some vitamins.
Another vital organ necessary for survival, the pancreas, is in the abdomen’s upper center to the right portion. It is long and narrow and works closely with the gallbladder and liver. An issue with either of these organs may affect the pancreas.
One of its most important functions is to release insulin, which removes glucose from the blood, and glucagon, which stimulates the release of glucose into the blood.
The pancreas also releases the hormone somatostatin. This maintains the body’s sugar-to-salt balance and vasoactive intestinal peptide, which helps control the secretion and absorption of water in the intestines.
Food travels from the stomach to the small intestine, where most of the nutrient absorption occurs. The small intestine uses enzymes from the liver and pancreas to aid nutrient absorption. Its various glands produce hormones and enzymes such as gastrin, secretin, and pro-glucagon to support digestion and absorption of various nutrients.
It is located in the middle to lower portion of the abdomen, below the stomach, and takes up a significant portion of the stomach. It contains three different portions:
- Duodenum: This processes liquid food from the stomach and digestive enzymes from the liver and pancreas.
- Jejunum: This portion performs most chemical digestion and nutritional absorption.
- Ileum: This opens to the ileocecal valve, which allows food to flow into the large intestine.
The large intestine is wider than the small intestine and rests at the lower portion of the stomach, extending down into the rectum and anus. Undigested food waste passes into the large intestine, becoming a bowel movement. The large intestine also absorbs some water and electrolytes, and its bacteria helps break down some nutrients, including vitamin K.
The large intestine includes the cecum, transverse colon, ascending colon, descending colon, and sigmoid colon. A small, finger-like projection from the large intestine, the appendix, can become infected, causing appendicitis.
Learn more about how the intestines work here.
Several organs in the abdomen form the digestive system, working together to absorb nutrients and eliminate waste.
The stomach is in the upper portion of the abdomen. Food travels here after moving down the esophagus. The liver, located on the left upper side of the abdomen, and the pancreas, located in the middle to the right side of the abdomen, release digestive enzymes that help digest food. The gallbladder, next to the liver, stores and releases bile.
Food moves to the small intestine from the stomach, which absorbs water and some nutrients. Digestive enzymes from the liver and pancreas travel to the small intestine to aid this process. Food moves to the large intestine and eventually to the anus and rectum, where people will have a bowel movement.
Portions of the urinary tract are also located in the abdomen. The kidneys, which reside near the middle of the abdomen toward the back, are bean-shaped organs that help filter and process waste.
From there, urine travels down the ureters and into the bladder, lying at the bottom of the abdomen, in the pelvis. The bladder holds urine until it travels out of the body through the urethra.
Some common problems of the digestive organs in the abdomen include:
- Appendicitis: Inflammation or infection in the appendix that, left untreated, may cause the appendix to rupture.
- Gallstones: These are stones in the gallbladder that break loose and travel to the surrounding ducts.If the gallstones move into another part of the digestive system, a person may experience complications.
- Heartburn: Stomach acid that travels back up the esophagus may cause a burning feeling in the chest.
- Constipation: This consists of slow, hard, or infrequent bowel movements.
- Abdominal pain: This may happen due to various reasons, such as digestive pain from gas, ulcers, gallstones, and irritable bowel syndrome.
The digestive organs of the abdomen are complex and interact with one another. If there is a problem with one organ, this may cause pain or dysfunction in another.
The abdomen is also home to a wide range of muscles that may cause pain and bones, such as the ribs, which can experience injuries.
The stomach | Canadian Cancer Society
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What is stomach cancer
What is stomach cancer
Last medical review:
Diagram of the digestive system
Diagram of the stomach
The stomach is made up of several layers of tissue:
- The mucosa (mucous membrane) is the inner lining of the stomach. It is made up of glands and specialized cells that make mucus, hydrochloric acid and enzymes. The mucosa has ridges (rugae) when the stomach is empty. The ridges flatten out as the stomach fills with food.
- The submucosa is a layer of connective tissue that surrounds the mucosa. It contains larger blood and lymph vessels, nerve cells and fibres.
- The muscularis propria (muscularis externa) is the next layer that covers the submucosa. It is the main muscle of the stomach and is made up of 2 layers of muscle.
- The serosa is the fibrous membrane that covers the outside of the stomach. The serosa of the stomach is also called the visceral peritoneum.
When you see, smell or think of food, your central nervous system (CNS) sends a message to your stomach to make acids, enzymes and mucus for digestion (called gastric juice). Endocrine cells in the stomach release the hormone gastrin into the blood to help control the function of the stomach.
After food and liquids are swallowed, they travel through the esophagus to the stomach. The muscles of the stomach wall tighten (contract) and relax (expand), which mixes the food with the acids and enzymes. Mucus helps protect the lining of the stomach from the acids.
Food and liquids are broken down into a thick, acidic, soupy mixture called chyme. Once chyme is formed, the pyloric sphincter relaxes. Then the stomach muscles tighten and relax to help move the chyme into the duodenum where digestion continues and many nutrients are absorbed (taken up).
The stomach does not have a big role in absorption of food. It absorbs only water, alcohol and some drugs.
Ashley Stueck, MD, FRCPC
Martini FH, Timmons MJ, Tallitsch RB. Human Anatomy. 7th ed. San Francisco: Pearson Benjamin Cummings; 2012.
. Stomach cancer
. Merck Manual Professional Version
. Kenilworth, NJ
: Merck & Co, Inc
: https://www. merckmanuals.com/en-ca/professional.
Surveillance, Epidemiology and End Results (SEER) Program
. SEER Training Modules: Stomach
. Bethesda, MD: National Cancer Institute; https://training.seer.cancer.gov/. Thursday, January 31, 2019.
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Antrum: location and function
- 1 Antrum: location and function
- 1.1 Antrum: location and function
- 1.1.1 Where is the antrum located?
- 1.2 Anatomical features of the antrum
- 1.3 Why is the antrum needed?
- 1.4 Functions of the antrum
- 1.5 Digestion of food in the antrum
- 1.5.1 Anatomical structure of the gastric antrum
- 1. 5.2 Functions of the antrum in digestion of food
- 1.8 Helicobacter pyloric stenosis and its association with antrum
- 1.8.1 What is Helicobacter pylori stenosis?
- 1.8.2 How is Helicobacter pylori pyloric stenosis related to the gastric antrum?
- 1.8.3 How does H. pylori pyloric stenosis present?
- 1.8.4 How is Helicobacter pylori stenosis treated?
- 1.9 Diseases associated with dysfunction of the antrum of the stomach
- 1.10 Treatment of diseases of the antrum of the stomach
- 1.11 Restoration of the antrum of the stomach after diseases
- 1.12 Video on the topic:
- 1.13 Q&A:
- 1.13 .0.1 Where is the antrum located?
- 22.214.171.124 What are the functions of the antrum of the stomach?
- 126.96.36.199 What is the structure of the antrum of the stomach?
- 188.8.131.52 What happens to food in the antrum?
- 184.108.40.206 What foods are best for antrum problems?
- 1. 13.0.6 If pain occurs in the antrum, what should be done?
- 1.1 Antrum: location and function
The antrum is the part of the gastrointestinal tract located in the lower part of the stomach. Here, acidity decreases, and the foods consumed go through the initial stage of digestion. Learn more about the functions and structure of this section of the stomach in our article.
The stomach is one of the most important and complex organs of the digestive system, performing a number of important functions. One of its key parts is the antrum, which is located in the lower part of the stomach and plays an important role in the digestion of food.
The antrum of the stomach has a worm-like shape and is separated from the body of the stomach by a sphincter at the border between the pyloric and antrum. This area of the stomach has a special structure and functions that allow it to perform important digestive processes.
One of the key functions of the antrum of the stomach is the mechanical processing of food – it mixes food with gastric juice and forms chemical compounds necessary for the digestion of food. In addition, the antrum produces the hormone gastrin, which stimulates the stomach and pancreas to produce the necessary enzymes and juices.
Therefore, understanding the anatomy and functions of the antrum is an important aspect in understanding the digestive system and allows a better understanding of the causes of various diseases associated with the stomach and its functioning.
Antrum: location and function
Where is the antrum located?
The antrum is the lower part of the stomach, located at the end of the gastric region and in front of the esophagus. It is separated from the body of the stomach by the border of the anthrocardial sphincter and has the shape of a funnel.
The functions of the antrum of the stomach are associated with the digestion of food. Here are the glands that produce a service fluid containing hydrochloric acid and enzymes (pepsin, gastrin). The section is used there to diagnose the condition of the gastric mucosa, in which a small section of tissue puff is taken from the antrum with a special tool.
Location and characteristics of the antrum
|Location:||at the end of the stomach, in front of the esophagus, below the body of the stomach.|
|Shape:||funnel-shaped part of the stomach.|
|Functions:||digestion of food, production of pepsin, gastrin and other enzymes, control of the speed of food, passage into the duodenum.|
Anatomical features of the antrum of the stomach
The antrum is one of the parts of the stomach. It is located in the lower part of the stomach, immediately in front of and associated with the duodenum.
The antrum differs in its structure from other parts of the stomach. It has a thinner wall and more pronounced folds, which determines its ability to increase the contraction and movement of the contents into the intestine. In addition, in the antrum there are a large number of glandular cells that secrete a secret necessary for the digestion of food.
Thus, the antrum plays an important role in the process of digestion of food and allows the body to obtain all the necessary nutrients from dietary protein, fat and carbohydrates.
Why is the antrum needed?
The antrum is one of the most important parts of the gastrointestinal tract. It is located in front of the body of the stomach and is protected by the sphincter of the pyloric foramen. This department performs many functions that are necessary for normal digestion.
- Regulation of the digestive process : The antrum is involved in the regulation of the movement of food through the stomach, which allows optimal digestion and absorption of nutrients.
- Synthesis of the hormone gastrin : it is in the antrum that the synthesis and release of the hormone gastrin takes place, which stimulates the production of gastric juice and enhances the contractile activity of the stomach.
- Food storage : after passing through the cardia of the stomach, the food is stored in the antrum for subsequent partial processing and moving further along the digestive tract.
Thus, the antrum plays a vital role in the process of digestion and protects all other parts of the stomach, allowing for optimal digestion and absorption of nutrients.
Functions of the antrum of the stomach
The antrum of the stomach is one of the most important parts of the gastrointestinal tract, which performs several important functions.
- Grinding and mixing food
The antrum is responsible for the initial stage of food digestion. Here the food is ground and mixed with gastric juice to turn into a liquid mass. This occurs under the influence of a strong mechanical action of the walls of the stomach.
- Speed control
9 0002 The antrum of the stomach is also a regulator of the rate at which food enters the intestine. Here the body controls the amount of food mass that enters the intestines and maintains an optimal digestion rate.
- Hormone secretion 02 The antrum of the stomach releases several hormones such as gastrin and somatostatin. They are involved in the regulation of the production of gastric juice, the digestion of food and the nutrition of the cells of the gastric wall.
- Skin factor synthesis
The antrum is also responsible for the production of skin factor, a substance that ensures the absorption of vitamin B12 from food in the body.
In general, the antrum plays an important role in the digestive process, providing mechanical and metabolic processing of food, as well as regulating the rate of exit from the stomach.
Digestion of food in the antrum
Anatomy of the antrum
The antrum of the stomach is located in the middle between the cardiac opening and the pyloric sphincter. It consists of the lower part of the body of the stomach and the pyloric section. The walls of the antrum of the stomach have a thicker muscular membrane, which ensures its contractile function.
Functions of the antrum in the digestion of food
The main phase of food digestion occurs in the antrum of the stomach. The main task is to translate the contents of the stomach into a form convenient for further movement through the intestines. The muscles of the antrum of the stomach are engaged in mixing food masses with the secrets of the glands of the inner shell. This process is caused by muscle contraction caused by nerve impulses coming from the receptors of the outer wall of the stomach and the hormone gastrin. As a result of mixing and getting pepsin into food, its partial decomposition occurs.
In addition, the antrum contains the chief cells that produce gastrin. This hormone stimulates the production of gastric juice and increases the contractile function of the antrum. Gastrin also contributes to the production of a mucous membrane that protects the gastric wall from corrosion by hydrochloric acid, which is also secreted in the antrum of the stomach.
The role of the secretions of the glands of the antrum
The antrum, located in the lower part of the stomach, plays a very important role in the process of digestion. It produces special secrets that help break down food and absorb its beneficial substances.
However, besides this, the secretions of the glands of the antrum also play a role in protecting the gastric mucosa. They create a protective layer that prevents damage and inflammation of the walls of the stomach under the action of acidic secrets.
In general, it can be said that the secretions of the glands of the antrum are essential components of gastric juice, which carry out the process of digestion of food and protect the stomach from damage. Without them, the health of the stomach and digestive system as a whole becomes very vulnerable.
Structure of the antrum
The antrum is located in the lower part of the stomach, in front of the pyloric sphincter. This section differs from other parts of the stomach in that its walls are thicker and more clearly layered.
The contractions of the walls of the antrum of the stomach provide mixing of food masses and the creation of specific conditions for the work of digestive enzymes that break down proteins, fats and carbohydrates.
- Contractions of the gastric muscles occur due to the action of the nervous system, which controls the work of muscle fibers.
- Slow contraction of the walls of the antrum promotes mixing of food with gastric juice.
- The rapid contraction of the walls of the stomach ensures the movement of food masses in the direction of the pyloric sphincter.
As a result of such reductions, food turns into gruel – a chemically and mechanically processed product, ready to pass into the intestines for further digestion and assimilation.
Helicobacter pyloric stenosis and its relation to the antrum
What is Helicobacter pyloric stenosis?
Helicobacter pylori stenosis is a disease caused by the penetration of the bacterium Helicobacter pylori into the antrum of the stomach. The bacterium causes hypertrophy of the muscles of the mucous membrane of the pyloric part of the stomach, which leads to a decrease in the patency of the esophagus.
How is Helicobacter pyloric stenosis related to the antrum of the stomach?
The antrum of the stomach is where Helicobacter pylori is most commonly found. This bacterium can lead to the development of a disease that can affect the lining of the pyloric stomach. As a result, Helicobacter pyloric stenosis occurs – a narrow passage at the border of the stomach and duodenum.
How does H. pylori pyloric stenosis manifest itself?
Helicobacter pyloric stenosis may present with abdominal pain, nausea, vomiting, and anorexia. Often, patients with the disease constantly experience these symptoms after eating. The reason is that food is not able to pass into the intestines due to the narrow passage in the pyloric part of the stomach.
How is Helicobacter pylori stenosis treated?
Treatment for Helicobacter pylori stenosis is to kill the bacterium Helicobacter pylori and eliminate the symptoms of the disease. For this, antibiotics, drugs that reduce the acidity of the stomach and prokinetics are used – drugs that increase contractions of the muscles of the stomach and accelerate the processes occurring there.
Diseases associated with dysfunction of the antrum
The antrum plays an important role in the digestive process. Violation of the functions of this part of the stomach can lead to various diseases.
- Gastritis is an inflammatory disease of the gastric mucosa. One type of gastritis is antral gastritis, in which inflammation occurs in the antrum. Symptoms of gastritis: nausea, vomiting, abdominal pain, loss of appetite, heartburn.
- Gastric and duodenal ulcer is a mucosal defect resulting from tissue damage. Most often, an ulcer occurs in the antrum of the stomach or in the first section of the duodenum. Ulcer symptoms: abdominal pain (usually after eating), heartburn, nausea.
- Delayed evacuation of gastric contents is a dysfunction of the antrum, when the contents of the stomach linger in it for a long time. This can cause the stomach to expand, leading to a feeling of heaviness in the abdomen, belching, and nausea.
- Irritable bowel syndrome is a functional bowel disorder associated with a malfunction of the antrum of the stomach. Symptoms of the syndrome: abdominal pain, diarrhea or constipation, bloating, nausea.
In the event of such symptoms, it is necessary to consult a doctor and undergo a diagnosis in order to determine the cause of the disease and prescribe the correct treatment.
Treatment of diseases of the antrum
The antrum plays an important role in digestion, however, some diseases may require special treatment.
Vulnerability of the antrum to various injuries can lead to the development of gastric or duodenal ulcers. In this case, the optimal treatment is a combination of antibiotics, anti-inflammatory drugs and drugs that reduce the acidity of the stomach.
Some diseases of the antrum can be treated with non-pharmacological methods, such as changing the diet, eliminating bad habits from the diet and maintaining a healthy lifestyle. However, before starting treatment, it is necessary to conduct research to determine the cause of the disease and choose the most effective methods and drugs for the treatment of a particular case.
Restoration of the antrum of the stomach after diseases
The antrum of the stomach plays an important role in the process of digestion. It is responsible for the production of gastric juice, which contains the necessary enzymes and acids needed to break down food.
When the antrum of the stomach becomes ill, disturbances arise in its work that adversely affect digestion. To restore the functions of the antrum of the stomach, it is necessary to conduct a comprehensive treatment, including taking medications, diet and physiotherapy.
The process of recovery of the antrum can take a long time, so it is important to be patient and follow the doctor’s recommendations. The diet should be light and balanced, without spicy and fatty foods, alcohol and smoking. Physiotherapy includes nourishing masks and hardware methods of influencing the stomach area.
In the process of restoring the antrum of the stomach, it is necessary to completely exclude stress and physical activity, which can negatively affect the recovery process. It is also important to pay attention to the daily routine and observe the drinking regimen. After a full complex treatment, the antrum of the stomach will be restored and will start working normally.
Where is the antrum of the stomach located?
The antrum is located in the lower part of the stomach, in front of the small intestine.
What are the functions of the antrum of the stomach?
The antrum of the stomach plays an important role in the digestion of food, since it is there that the food mixes with gastric juice and the chemical breakdown of proteins occurs. In addition, the antrum of the stomach is responsible for the promotion of the food bolus into the small intestine and the speed of its passage through the gastrointestinal tract.
What is the structure of the antrum of the stomach?
The antrum of the stomach has a muscular wall consisting of three layers. The inner layer consists of striated muscle fibers, the middle layer consists of circular muscle fibers, and the outer layer consists of longitudinal muscle fibers.
What happens to food in the antrum of the stomach?
In the antrum of the stomach, gastric juice is released, which contains pepsin, which chemically breaks down proteins. In addition, mechanical mixing of food with gastric juice is performed in the antrum as a result of contractions of the muscles of the stomach wall.
What are the best foods to eat for problems with the antrum?
For problems with the antrum of the stomach, preference should be given to easily digestible food: cereals, dairy products, lean meat and fish. It is recommended to avoid spicy, fatty and fried foods, as well as foods high in fiber, such as fresh vegetables and fruits.
If pain occurs in the antrum, what should be done?
If you experience pain in the antrum of the stomach, you should consult a doctor for treatment. You should also follow a diet and avoid foods that cause an exacerbation of the disease.
Ultrasound of the stomach | Dobromed
Ultrasound of the stomach and esophagus
In order to be well versed in the results of ultrasound of the stomach and esophagus, it is necessary, first of all, to know the anatomy of these organs, which we will briefly summarize below.
Anatomy of the stomach and esophagus
The esophagus is a hollow tube that runs from the pharynx to the stomach. The esophagus is conditionally divided into three parts – the upper, middle and lower thirds, and the boundaries of each part are the physiological narrowing of the organ. So, the upper third of the esophagus starts from the pharynx and continues to the level of the second physiological narrowing, which lies at the level of the division of the trachea into the right and left main bronchus. The middle third of the esophagus (thoracic part) continues from the second physiological constriction to the level of the diaphragm. Finally, the lower third of the esophagus (abdomen) extends from the level of the diaphragm to its junction with the stomach.
The stomach is located in the upper abdomen between the esophagus and the duodenum (see Figure 1). The area of connection of the stomach with the esophagus is called the cardia (or simply the cardia), the upper part is the fundus of the stomach. Below the bottom is the body of the stomach, which passes into the pyloric (pyloric) part. The pyloric part, in turn, consists of the pylorus cave (sinus) and the pyloric canal. The cardia, bottom and body of the stomach form the digestive sac, and the pylorus cave and canal form the evacuation canal.
The anterior and posterior walls are isolated in the stomach itself. The anterior wall of the stomach is in contact with the diaphragm, the anterior abdominal wall, and the lower part of the liver. The posterior wall of the stomach is adjacent to the aorta, pancreas, spleen, upper pole of the left kidney and left adrenal gland, partly to the diaphragm and transverse colon. The lesser curvature is located on the anterior wall of the stomach, and the greater curvature is located on the posterior wall. The shape of the stomach varies depending on age, gender, its location, filling, functional state. However, normally, the stomach most often has the shape of either a horn or a hook. The size of the stomach also varies – its normal length is 20 – 25 cm, width – 12 – 14 cm, length of the lesser curvature – 18 – 19cm, the length of the greater curvature is 45 – 56 cm, the wall thickness is 2 – 5 cm, and the capacity is 1.5 – 3 liters.
Ultrasound findings of the stomach and esophagus
The esophagus is seen as a tube with characteristic physiological constrictions. Normally, the tube should be with a uniform wall, without bulges, fluid accumulations, thickenings, etc. The wall of the esophagus is about 6 mm thick. The abdominal esophagus is well visualized, visible as a tube with an outer hypoechoic muscle layer and an inner hyperechoic mucosa. Be sure to measure the diameter of the abdominal esophagus, which is normally 5-10 mm in children and adolescents, and in adults more than 10.5 mm. With the passage of a peristaltic wave or food, the lumen of the esophagus opens by 1–2 mm. The stomach is scanned on an empty stomach, without a water-siphon test. During the scan, the position and shape of the stomach, the fluid content on an empty stomach, the condition of the walls, peristalsis and evacuation capacity are necessarily determined. You should know that in the supine position it is possible to fully see the entire stomach only in thin patients, and in people with a dense build or overweight, it is possible to visualize only the outlet section of the stomach and its connection with the duodenum. The connection of the stomach with the intestine has a characteristic “hourglass” appearance.
In the position of the patient on his side, you can also consider the lesser and greater curvature, the pyloric part of the stomach, the fundus of the stomach. Normally, the stomach is located under the lower edge of the liver. The position of the stomach is determined by the lower border of the greater curvature and the pylorus, which is clearly visible on ultrasound and can have a different position, depending on the posture and physique of the patient. In people with a normal (normosthenic) physique in the prone position, the pylorus is usually located above the navel, and in the standing position it drops by about 3–5 cm. The pylorus is usually visible on ultrasound in the form of a rounded formation with a diameter of 2–2.5 cm with walls 4– 5 mm, with a hypoechoic peripheral rim and an echogenic central part. The peripheral rim reflects the wall of the stomach, and the central part reflects the folds of the mucous membrane. During the study, due to peristaltic contractions, the shape of the stomach and the thickness of its walls are constantly changing. In the process of ultrasound, various parameters of the empty stomach are measured, which are normally the following:
- outer diameter of the cross section of the gastric outlet – 14 – 21 mm;
- thickness of the wall of the outlet section of the stomach – 4 – 5 mm;
- distance between the walls of the outlet section of the stomach – 5 – 10 mm;
- length of the outlet section of the stomach – 42. 8 ± 1.9 mm;
- image coefficient (ratio of wall thickness to minimum distance between walls) – 0.4 – 1.0;
- lower limit of the greater curvature of the stomach in the supine position – above the navel by 63.7 ± 3.9mm;
- pylorus in the prone position – above the navel by 67.5 ± 5.4 mm;
- pylorus in the standing and sitting position – above the navel by 46.2 ± 3.6 mm;
- the lower limit of the greater curvature of the stomach in the standing and sitting position is 37.6 ± 2.9 mm above the umbilicus;
- pylorus in the supine position, standing and sitting – 30 – 40 mm to the right of the midline of the abdomen;
- stomach angle – 45 – 70 o.
Normally, on an empty stomach, the stomach can contain up to 40 ml of liquid, which indicates a normal evacuation function. If the stomach contains more than 40 ml of fluid, this indicates a violation of the evacuation function, which may be due to gastric atony, pyloric stenosis, pylorospasm. After filling the stomach with water, when performing an ultrasound with a water-siphon test, the organ takes an oval-elongated or pear-shaped shape. Stretching the stomach with water allows you to study in more detail the uniformity and thickness of the walls, as well as evaluate peristalsis. At the same time, attention is paid to the size and shape of the stomach cavity, the depth, frequency and frequency of peristalsis waves are monitored. After taking the liquid, ultrasound in the stomach shows anechoic water, hyperechoic mobile air bubbles in it, as well as three layers of the organ wall. The inner mucous and outer serous membranes form, as it were, two hyperechoic lines, between which the hypoechoic contents of the muscle layer are enclosed. Normal parameters of the stomach filled with water, measured during ultrasound, are as follows:
- the lower limit of the greater curvature of the stomach in the supine position is 33.1 ± 3.5 mm above the umbilicus;
- pylorus in the prone position – above the navel by 45. 6 ± 3.8 mm;
- pylorus in the standing and sitting position – above the navel by 24.7 ± 3.1 mm;
- pylorus in the supine position, standing and sitting – 40 – 50 mm to the right of the midline of the abdomen.
If, according to ultrasound data, a thickening of the wall of an empty or water-filled stomach of more than 5 mm is detected, then it is necessary to determine the localization of such an area, its maximum thickness, the shape and shape of the external and internal contours, the distance between the walls in the area of this area, the presence of layering of the wall, its uniformity and echogenicity. It is also necessary to determine the presence of free or encapsulated liquid, gas near the affected area, pain or sensitivity when pressing the sensor on the skin over the pathological focus.
Norm of ultrasound of the stomach
In the conclusion of an ultrasound of a normal unaffected stomach, it is necessary to indicate that there is no pathological symptom of the affected organ, the accumulation of free fluid is not detected. In the conclusion of an ultrasound of a normal esophagus, the thickness of its walls, the absence of bulges, neoplasms and signs of an inflammatory process are indicated.
Pathology of the stomach and esophagus on ultrasound
Types of pathological changes in the stomach on ultrasound
qualitative information about the state of the stomach, on the basis of which various pathologies are detected.
Ultrasound signs of stomach pathology are the following:
- change in the shape of the organ;
- change in the diameter of the lumen of the stomach;
- change in wall thickness;
- the presence of irregularities on the inner or outer surface of the wall of the stomach;
- the presence of bulges on the wall of the stomach;
- lack of peristalsis;
- the presence of antiperistalsis.
The main sign of stomach pathology is thickening of its walls and expansion/narrowing of the lumen of the organ. Thickening of the walls of the stomach with characteristic uneven echogenicity, when the outer part of the wall is hypoechoic compared to the hyperechoic inner, is called a symptom of a hollow organ lesion. Currently, in the world medical literature, the terms “target”, “lesion halo”, “pseudo-kidney”, “bull’s eye”, “pathological type of cockade” are also used as synonyms for the term “symptom of a hollow organ lesion”. All the above terms denote the same pathological condition of the stomach, and therefore can be used as equivalent. However, in the countries of the former USSR, the term “symptom of the affected hollow organ” is most commonly used, which we will also use.
Thus, thickening of the stomach wall, as a symptom of an affected hollow organ, can be diffuse and limited. With diffuse thickening on ultrasound, an increase in wall thickness is recorded along its entire length. And with limited thickening, the wall of the stomach turns out to be thicker than the norm only in a certain limited area. Unfortunately, the two main pathological signs of stomach diseases detected by ultrasound, namely, the symptom of the affected hollow organ and the expansion / narrowing of the lumen of the organ, are nonspecific. And this means that these pathological signs are inherent in many diseases, as a result of which it is impossible to accurately diagnose only according to ultrasound data.
In order to correctly diagnose a person’s disease of the stomach and choose one of the many pathologies that are characterized by a symptom of an affected hollow organ or a change in the lumen of an organ, it is necessary, in addition to the results of ultrasound, to also evaluate the clinical symptoms that disturb the patient. Only a combination of pathological changes on ultrasound with clinical symptoms will help to make the correct diagnosis. Below, for a general orientation in the problem, we will give a table in which we indicate which diseases of the stomach are characterized by the presence of a symptom of an affected hollow organ on ultrasound and changes in the lumen of the organ.
Diseases that show a hollow organ symptom on ultrasound with diffuse wall thickening Diseases that show a hollow organ symptom on ultrasound with limited wall thickening a stomach cavity Edema of the stomach wall Pyloric stenosis Scar stricture Chronic gastritis type B Carcinoma ulceration Inflammatory stenosis Menetrier’s disease Gastric ulcer Tumor stenosis Infiltrative carcinoma Varicose veins Violation of the evacuation of gastric contents Malignant lymphoma Gastric carcinoma
Edema of the stomach wall can be observed in acute pancreatitis, nephrotic syndrome, congestive heart failure, and protein deficiency in the body. Pyloric stenosis can be congenital or acquired due to inflammation, ulcers or tumors.
Ultrasound pattern in various diseases of the stomach
Currently, there are six main pathological processes of the stomach that can be accurately diagnosed using ultrasound – these are erosive and ulcerative lesions, polyps, pyloric stenosis, duodenogastric reflux, malignant tumors and malformations. Below we present the characteristic features of the ultrasound picture in the six different above-mentioned pathologies of the stomach, as well as damage to the organ.
Ultrasound picture for malformation “pyloric stenosis”. With congenital pyloric stenosis in an infant on the 2nd – 4th week of life, persistent vomiting of gastric contents appears. Ultrasound shows a pronounced symptom of the affected hollow organ, namely: a sharp thickening of the walls in the antrum, narrowing of the walls in the central part and a general appearance of the stomach as an “hourglass”, as well as the presence of contents in the stomach more than 24 hours after eating. Ultrasound picture with a malformation of “doubling of the stomach” With the help of ultrasound, it is possible to establish doubling of the stomach only when conducting a water-siphon test, so that both cavities are filled with water, and the doctor can clearly see them. A diverticulum is a protrusion of the wall of an organ.
Such diverticula can be single or multiple, they are visible on ultrasound only during a water-siphon test, when their lumen is filled with water and makes them visible. A water-filled diverticulum is an anechoic formation of any shape, protruding away from the stomach wall and connected to its cavity by a thin stalk. Damage to the stomach usually occurs due to mechanical impacts on the area of localization of the organ, for example, when hitting the stomach, falling from a height onto the stomach, etc. Such damage to the stomach can be manifested by bruises, tears and ruptures of the walls of the organ. Less commonly, there are chemical injuries, the picture of which on ultrasound is different from mechanical injuries.
Gastric contusion is characterized by limited, weakly echoic thickening or bulging of the wall in the area of injury. A bruise is better seen when conducting a water-siphon test than on an empty stomach. Rupture of the stomach wall is characterized by an uneven contour of the walls and their interruption in the area of the gap. When conducting a water-siphon test, a rupture is easily diagnosed, since an ultrasound immediately shows the place where water flows into the abdominal cavity. Chemical damage to the wall of the stomach is characterized by its thickening, doubling the contour (outside echo-negative band, and inside – echo-positive).
If a cicatricial narrowing of the stomach cavity has developed as a result of damage, then ultrasound will show liquid and food debris taken more than 14 hours ago. A stomach ulcer on ultrasound looks like a hyperechoic thickening of the wall with its deformation and narrowing of the lumen. In addition, an excess amount of liquid on an empty stomach is fixed, a symptom of damage to a hollow organ. The following sizes of various parts of the stomach according to ultrasound are characteristic:
- outer diameter 16 – 22 mm;
- thickening of the wall of the outlet section of the stomach from 6 to 10 mm;
- distance between the walls in the area of thickening – 7 – 12 mm;
- image ratio 0. 5 – 3.3 mm.
When performing a water-siphon test for a gastric ulcer, the following signs are characteristic:
- a clear, uneven contour of the wall in the area of the ulcer with hyperechoic inclusions;
- uneven thickening of the inner hyperechoic layer of the stomach up to 2-4 mm;
- the wall thickness in the area of the ulcer or erosion is always more than 5 mm;
- indistinct layering of the wall in the area of the ulcer;
- inactive peristalsis.
Ultrasound picture in gastritis The walls of the stomach are evenly thickened, their echogenicity is uneven, with alternating hypoechoic and hyperechoic areas, more than 40 ml of fluid is detected in the cavity on an empty stomach, the diameter of the pyloric section is more than 10 mm, signs of duodenogastric reflux. The peristalsis of the stomach is sluggish. Menetrier’s disease is a giant hypertrophic gastritis, in which the gastric mucosa forms huge folds with polypoid growths. On ultrasound, a strongly thickened wall with uneven echogenicity is visible. Peristalsis is sluggish. In the stomach, a large amount of liquid and food taken more than 14 hours ago is found.
Characteristic symptom of hollow organ lesion with thickening of the wall in the area of polyp localization up to 20-28 mm, clearance between the walls in the area of thickening 3-12 mm. There is also an uneven structure of the stomach wall in the area of thickening, the image coefficient in the polyp area is 0.9–9. The amount of fluid in the stomach on an empty stomach is normal. The structure of polyps is heterogeneous, there is no layering.
Ultrasound picture in malignant tumors of the stomach
There is always a symptom of a hollow organ lesion over the area of tumor localization. The wall is thickened unevenly (from 10 to 30 mm), the area of thickening is hypoechoic, heterogeneous, with disturbed layering. The outer contour of the stomach wall in the area of tumor localization is uneven, but clear. The lumen of the stomach in the area of the tumor is 2–16 mm. The lower limit of the greater curvature of the stomach is lower than normal. The amount of liquid in the stomach on an empty stomach is either within the normal range or slightly increased. When performing a water-siphon test, uneven filling of the cavity with water and its insufficient expansion are noted. Also characteristic is the rigidity of the thickened wall, sluggish peristalsis. The internal contour of the stomach is hyperechoic, fragmented and thickened by more than 3 mm. In the area of the tumor, the outer and inner contours of the stomach are uneven, but clear. Pyloric stenosis is a narrowing of the outlet section of the stomach, due to which the evacuation of food masses into the duodenum is disturbed.
The causes of pyloric stenosis are usually tumors or a long course of peptic ulcer, as a result of which scars are formed that tighten the walls of the stomach and reduce the lumen of its pyloric part. Pyloric stenosis is characterized by a shapeless hyperechoic formation with a sharp narrowing of the lumen of the affected area. At the initial stage, the walls of the stomach are thickened, but then they become thinner, and its cavity expands. The ultrasound shows that the stomach is enlarged and filled with contents of different age. The amount of liquid on an empty stomach is more than normal, and there is a sediment in it. The lower limit of the greater curvature of the stomach is significantly lower than normal. Peristalsis is either absent or weak. In the area of stenosis, there is a symptom of damage to a hollow organ, and the wall is thickened up to 7–22 mm, it has no stratification, and the image coefficient is 0.6–8.5. When performing a water-siphon test with pyloric stenosis, the patient can drink only a small amount of liquid – no more than 300 ml, due to a feeling of fullness in the abdomen, nausea and sometimes vomiting. At the moment the liquid enters the stomach, its contents are mixed, a sediment floats up.
The lower limit of the greater curvature falls even lower than in the study on an empty stomach. Peristalsis is sluggish or absent. It is impossible to visualize the normal layering of the stomach wall in the area of stenosis. Duodenogastric reflux is a pathological condition in which the contents of the duodenum are thrown into the stomach. Reflux is detected during a water-siphon test, and on an empty stomach it can be seen on ultrasound only if there is an accumulation of fluid in the patient’s stomach in an amount greater than normal. On ultrasound, reflux is seen by the retrograde movement of hyperechoic particles from the duodenum through the stomach up after filling it with water. The presence of fluid in the stomach on an empty stomach in an amount of more than 40 ml may indicate peptic ulcer, gastritis, pyloric stenosis or a malignant tumor. In order to accurately understand what disease the liquid in the stomach indicates in a particular case, it is necessary to take into account other signs on ultrasound, as well as the clinical symptoms that a person has.
Pathological changes in the esophagus and ultrasound picture in various diseases
Pathological changes in the esophagus on ultrasound are changes in the diameter, wall thickness, length of the abdominal part of the organ, as well as the angle of His. Consider what ultrasound signs are inherent in various pathologies of the esophagus. GER is a pathological reflux of stomach contents into the esophagus. And GERD is damage to the esophageal mucosa due to reflux. GER and GERD are characterized by an expansion of the lumen of the esophagus on ultrasound and a thickening of its wall. Chalazia is a weak peristalsis, as a result of which food stagnates in the esophagus, advancing only under the influence of gravity.
On ultrasound, chalazia of the esophagus is characterized by an expansion of the lumen of the organ and a thickening of its wall. Chalazia cardia is characterized by a gaping of the distal esophagus up to 6-14 mm, as well as a visible leakage of the contents of the stomach into the esophagus.
- Hormone secretion 02 The antrum of the stomach releases several hormones such as gastrin and somatostatin. They are involved in the regulation of the production of gastric juice, the digestion of food and the nutrition of the cells of the gastric wall.