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69-412: In human beings, the duodenum is a hollow jointed tube about 25–38 centimetres (10–15 inches) long connecting the stomach to the middle part of the small intestine . It begins with the duodenal bulb and ends at the suspensory muscle of duodenum . Duodenum can be divided into four parts: the first (superior), the second (descending), the third (transverse) and the fourth (ascending) parts. The duodenum

138-410: A high triglyceride content remain in the stomach the longest. Since enzymes in the small intestine digest fats slowly, food can stay in the stomach for 6 hours or longer when the duodenum is processing fatty chyme. However, this is still a fraction of the 24 to 72 hours that full digestion typically takes from start to finish. Although the absorption in the human digestive system is mainly a function of

207-401: A leafy-looking appearance, which is a histologically identifiable structure. Brunner's glands , which secrete mucus , are only found in the duodenum. The duodenum wall consists of a very thin layer of cells that form the muscularis mucosae . Ulcers of the duodenum commonly occur because of infection by the bacteria Helicobacter pylori . These bacteria, through a number of mechanisms, erode

276-485: A loan-translation of Greek dodekadaktylon, literally "twelve fingers long." The intestine part was so called by the Greek physician Herophilus (c. 335–280 BCE) for its length, about equal to the breadth of 12 fingers. Many languages retain a similar etymology for this word. For example, German Zwölffingerdarm , Dutch Twaalfvingerige darm and Turkish Oniki parmak bağırsağı . Stomach The stomach

345-418: A moment when the patient is on a gluten-containing diet. Duodenal cancer is a cancer in the first section of the small intestine. Cancer of the duodenum is relatively rare compared to stomach cancer and colorectal cancer ; malignant tumors in the duodenum constitute only around 0.3% of all the gastrointestinal tract tumors but around half of cancerous tissues that develop in the small intestine. Its histology

414-407: A protective layer of mucus and bicarbonate . Additional cells present include parietal cells that secrete hydrochloric acid and intrinsic factor , chief cells that secrete pepsinogen (this is a precursor to pepsin- the highly acidic environment converts the pepsinogen to pepsin), and neuroendocrine cells that secrete serotonin . Glands differ where the stomach meets the esophagus and near

483-403: A suitable environment for handling the digestion of food for uptake of nutrients. Highly stomach-specific proteins include gastrokine-1 expressed in the mucosa; pepsinogen and gastric lipase , expressed in gastric chief cells ; and a gastric ATPase and gastric intrinsic factor , expressed in parietal cells . In the early part of the development of the human embryo , the ventral part of

552-401: Is a muscular, hollow organ in the upper gastrointestinal tract of humans and many other animals, including several invertebrates . The stomach has a dilated structure and functions as a vital organ in the digestive system . The stomach is involved in the gastric phase of digestion , following the cephalic phase in which the sight and smell of food and the act of chewing are stimuli. In

621-442: Is a narrow tubular region, the proventriculus , lined by fundic glands, and connecting the true stomach to the crop . Beyond lies the powerful muscular gizzard , lined by pyloric glands, and, in some species, containing stones that the animal swallows to help grind up food. In insects , there is also a crop. The insect stomach is called the midgut . Information about the stomach in echinoderms or molluscs can be found under

690-519: Is a term that is also used to describe the removal of the heart . A gastrectomy may be carried out because of gastric cancer or severe perforation of the stomach wall. Fundoplication is stomach surgery in which the fundus is wrapped around the lower esophagus and stitched into place. It is used to treat gastroesophageal reflux disease (GERD) . The word stomach is derived from Greek stomachos ( στόμαχος ), ultimately from stoma ( στόμα ) 'mouth'. Gastro- and gastric (meaning 'related to

759-429: Is between 2 and 4 litres, although volumes of up to 15 litres have been observed in extreme circumstances. The human stomach can be divided into four sections, beginning at the cardia followed by the fundus, the body and the pylorus. The cardia is defined as the region following the "z-line" of the gastroesophageal junction , the point at which the epithelium changes from stratified squamous to columnar . Near

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828-411: Is churned by the stomach through peristaltic muscular contractions of the wall – reducing the volume of the bolus, before looping around the fundus and the body of stomach as the boluses are converted into chyme (partially digested food). Chyme slowly passes through the pyloric sphincter and into the duodenum of the small intestine , where the extraction of nutrients begins. Gastric juice in

897-425: Is fused with the duodenal wall, causing duodenal ulceration. About 20,000 protein coding genes are expressed in human cells and 70% of these genes are expressed in the normal duodenum. Some 300 of these genes are more specifically expressed in the duodenum with very few genes expressed only in the duodenum. The corresponding specific proteins are expressed in the duodenal mucosa, and many of these are also expressed in

966-447: Is in response to food products in the liver and gall bladder, which have not yet been absorbed. The stomach needs to push food into the small intestine only when the intestine is not busy. While the intestine is full and still digesting food, the stomach acts as storage for food. Epidermal growth factor (EGF) results in cellular proliferation, differentiation, and survival. EGF is a low-molecular-weight polypeptide first purified from

1035-663: Is often observed to be adenocarcinoma , meaning that the cancerous tissue arises from glandular cells in the epithelial tissue lining the duodenum. Inflammation of the duodenum is referred to as duodenitis . There are multiple known causes. Celiac disease and inflammatory bowel disease are two of the known causes. The name duodenum is Medieval Latin , short for intestīnum duodēnum digitōrum , meaning intestine of twelve finger-widths (in length), genitive pl. of duodēnī, twelve each, from Latin duodeni "twelve each" (from duodecim "twelve"). Coined by Gerard of Cremona (d. 1187) in his Latin translation of "Canon Avicennae," "اثنا عشر" itself

1104-434: Is passed to the lateral hypothalamus and limbic system in the brain as a palatability signal through the vagus nerve . The stomach can also sense, independently of tongue and oral taste receptors, glucose , carbohydrates , proteins , and fats . This allows the brain to link nutritional value of foods to their tastes. This syndrome defines the association between thyroid disease and chronic gastritis, which

1173-427: Is responsible for moving the semi-digested food towards the pylorus of the stomach through muscular shortening. To the outside of the muscular layer lies a serosa , consisting of layers of connective tissue continuous with the peritoneum . Smooth mucosa along the inside of the lesser curvature forms a passageway - the gastric canal that fast-tracks liquids entering the stomach, to the pylorus. The mucosa lining

1242-407: Is the gastric mucosa a mucous membrane that forms the lining of the stomach. the membrane consists of an outer layer of columnar epithelium , a lamina propria , and a thin layer of smooth muscle called the muscularis mucosa . Beneath the mucosa lies the submucosa , consisting of fibrous connective tissue . Meissner's plexus is in this layer interior to the oblique muscle layer. Outside of

1311-467: Is the first part of the duodenum and is slightly dilated. The duodenal bulb is a remnant of the mesoduodenum, a mesentery that suspends the organ from the posterior abdominal wall in fetal life. The first part of the duodenum is mobile, and connected to the liver by the hepatoduodenal ligament of the lesser omentum . The first part of the duodenum ends at the corner, the superior duodenal flexure . Relations: The second part , or descending part , of

1380-475: Is the first section of the small intestine in most higher vertebrates , including mammals , reptiles , and birds . In fish , the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine may be used instead of duodenum. In mammals the duodenum may be the principal site for iron absorption. In humans, the duodenum is a C-shaped hollow jointed tube, 25–38 centimetres (10–15 inches) in length, lying adjacent to

1449-403: The anterior gastric, posterior , superior and inferior , celiac and myenteric), which regulate both the secretory activity of the stomach and the motor (motion) activity of its muscles. The stomach is distensible , and can normally expand to hold about one litre of food. In a newborn human baby the stomach will only be able to hold about 30 millilitres. The maximum stomach volume in adults

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1518-424: The celiac artery , superior mesenteric artery , and inferior mesenteric artery . The areas supplied by these arteries are used to define the foregut , midgut , and hindgut . The surrounded sac becomes the primitive gut. Sections of this gut begin to differentiate into the organs of the gastrointestinal tract, and the esophagus, and stomach form from the foregut. As the stomach rotates during early development,

1587-436: The greater curvature of the stomach. Two sphincters keep the contents of the stomach contained; the lower esophageal sphincter (found in the cardiac region), at the junction of the esophagus and stomach, and the pyloric sphincter at the junction of the stomach with the duodenum. The stomach is surrounded by parasympathetic (inhibitor) and sympathetic (stimulant) plexuses (networks of blood vessels and nerves in

1656-414: The nervous system . Chyme from the stomach is slowly released into the duodenum through coordinated peristalsis and opening of the pyloric sphincter. The movement and the flow of chemicals into the stomach are controlled by both the autonomic nervous system and by the various digestive hormones of the digestive system: Other than gastrin, these hormones all act to turn off the stomach action. This

1725-466: The stomach (and connecting it to the small intestine). It is divided anatomically into four sections. The first part lies within the peritoneum but its other parts are retroperitoneal . The first part , or superior part , of the duodenum is a continuation from the pylorus to the transpyloric plane. It is superior (above) to the rest of the segments, at the vertebral level of L1 . The duodenal bulb , about 2 cm ( 3 ⁄ 4  in) long,

1794-458: The vertebral column . The superior mesenteric artery and vein are anterior to the third part of the duodenum. This part may be compressed between the aorta and SMA causing superior mesenteric artery syndrome . The fourth part , or ascending part , of the duodenum passes upward, joining with the jejunum at the duodenojejunal flexure . The fourth part of the duodenum is at the vertebral level L3, and may pass directly on top, or slightly to

1863-412: The actions of hydrochloric acid, and the enzyme pepsin . The stomach can also produce gastric lipase , which can help digesting fat. The contents of the stomach are completely emptied into the duodenum within two to four hours after the meal is eaten. Different types of food take different amounts of time to process. Foods heavy in carbohydrates empty fastest, followed by high-protein foods. Meals with

1932-468: The arterial supply is from the superior mesenteric artery (SMA), and its branch the inferior pancreaticoduodenal artery supplies the 3rd and 4th sections. The superior and inferior pancreaticoduodenal arteries (from the gastroduodenal artery and SMA respectively) form an anastomotic loop between the celiac trunk and the SMA; so there is potential for collateral circulation here. The venous drainage of

2001-419: The bacteria, and endoscopy to confirm ulceration and take a biopsy . If managed, these are often managed through antibiotics that aim to eradicate the bacteria, and proton-pump inhibitors and antacids to reduce the gastric acidity. The British Society of Gastroenterology guidelines specify that a duodenal biopsy is required for the diagnosis of adult celiac disease . The biopsy is ideally performed at

2070-400: The body of the stomach and increasing in force as they reach the pylorus. The pylorus, which holds around 30 mL of chyme, acts as a filter, permitting only liquids and small food particles to pass through the mostly, but not fully, closed pyloric sphincter . In a process called gastric emptying , rhythmic mixing waves force about 3 mL of chyme at a time through the pyloric sphincter and into

2139-540: The cardia is the lower esophageal sphincter. The stomach bed refers to the structures upon which the stomach rests in mammals. These include the tail of the pancreas , splenic artery , left kidney , left suprarenal gland , transverse colon and its mesocolon , and the left crus of diaphragm , and the left colic flexure . The term was introduced around 1896 by Philip Polson of the Catholic University School of Medicine, Dublin. However this

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2208-431: The developing liver . In the adult, these connective structures of omentum and mesentery form the peritoneum , and act as an insulating and protective layer while also supplying organs with blood and lymph vessels as well as nerves. Arterial supply to all these structures is from the celiac trunk , and venous drainage is by the portal venous system . Lymph from these organs is drained to the prevertebral celiac nodes at

2277-439: The digesting and readsorbing ability, and lastly, similar ability to form iodotyrosines by peroxidase activity, where iodide acts as an electron donor in the presence of H 2 O 2 . In the following years, many researchers published reviews about this syndrome. A series of radiographs can be used to examine the stomach for various disorders. This will often include the use of a barium swallow . Another method of examination of

2346-415: The digestive activities of salivary amylase continue until the food begins mixing with the acidic chyme. Ultimately, mixing waves incorporate this food with the chyme, the acidity of which inactivates salivary amylase and activates lingual lipase . Lingual lipase then begins breaking down triglycerides into free fatty acids, and mono- and diglycerides. The breakdown of protein begins in the stomach through

2415-403: The dorsal and ventral mesentery rotate with it; this rotation produces a space anterior to the expanding stomach called the greater sac, and a space posterior to the stomach called the lesser sac. After this rotation the dorsal mesentery thins and forms the greater omentum , which is attached to the greater curvature of the stomach. The ventral mesentery forms the lesser omentum, and is attached to

2484-409: The duodenal epithelium in response to acidic and fatty stimuli present there when the pylorus opens and emits gastric chyme into the duodenum for further digestion. These cause the liver and gallbladder to release bile , and the pancreas to release bicarbonate and digestive enzymes such as trypsin , lipase and amylase into the duodenum as they are needed. The villi of the duodenum have

2553-408: The duodenum activates receptors that inhibit gastric secretion. This prevents additional chyme from being released by the stomach before the duodenum is ready to process it. The fundus stores both undigested food and gases that are released during the process of chemical digestion. Food may sit in the fundus of the stomach for a while before being mixed with the chyme. While the food is in the fundus,

2622-412: The duodenum begins at the superior duodenal flexure. It goes inferior to the lower border of vertebral body L3, before making a sharp turn medially into the inferior duodenal flexure , the end of the descending part. The pancreatic duct and common bile duct enter the descending duodenum, through the major duodenal papilla . The second part of the duodenum also contains the minor duodenal papilla,

2691-430: The duodenum follows the arteries. Ultimately these veins drain into the portal system , either directly or indirectly through the splenic or superior mesenteric vein and then to the portal vein. The lymphatic vessels follow the arteries in a retrograde fashion. The anterior lymphatic vessels drain into the pancreatoduodenal lymph nodes located along the superior and inferior pancreatoduodenal arteries and then into

2760-436: The duodenum. Like other structures of the gastrointestinal tract , the duodenum has a mucosa , submucosa , muscularis externa , and adventitia . Glands line the duodenum, known as Brunner's glands , which secrete mucus and bicarbonate in order to neutralise stomach acids. These are distinct glands not found in the ileum or jejunum, the other parts of the small intestine. The duodenum's close anatomical association with

2829-405: The duodenum. Release of a greater amount of chyme at one time would overwhelm the capacity of the small intestine to handle it. The rest of the chyme is pushed back into the body of the stomach, where it continues mixing. This process is repeated when the next mixing waves force more chyme into the duodenum. Gastric emptying is regulated by both the stomach and the duodenum. The presence of chyme in

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2898-401: The embryo abuts the yolk sac . During the third week of development, as the embryo grows, it begins to surround parts of the yolk sac. The enveloped portions form the basis for the adult gastrointestinal tract. The sac is surrounded by a network of vitelline arteries and veins . Over time, these arteries consolidate into the three main arteries that supply the developing gastrointestinal tract:

2967-409: The entrance for the accessory pancreatic duct . The junction between the embryological foregut and midgut lies just below the major duodenal papilla. The third part , or horizontal part or inferior part of the duodenum is 10~12 cm in length. It begins at the inferior duodenal flexure and passes transversely to the left, passing in front of the inferior vena cava , abdominal aorta and

3036-497: The esophagus opening directly into the intestine. These animals all consume diets that require little storage of food, no predigestion with gastric juices, or both. The gastric lining is usually divided into two regions, an anterior portion lined by fundic glands and a posterior portion lined with pyloric glands. Cardiac glands are unique to mammals , and even then are absent in a number of species. The distributions of these glands vary between species, and do not always correspond with

3105-468: The head of the pancreas and duodenum, eventually joining with the anterior and posterior branches of the inferior pancreaticoduodenal artery . The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery . These arteries, together with the pancreatic branches of the splenic artery , form connections or anastomoses with one another, allowing blood to perfuse the pancreas and duodenum through multiple channels. The artery supplies

3174-424: The intestines. In humans, many bariatric surgery procedures involve the stomach, in order to lose weight. A gastric band may be placed around the cardia area, which can adjust to limit intake. The anatomy of the stomach may be modified , or the stomach may be bypassed entirely . Surgical removal of the stomach is called a gastrectomy , and removal of the cardia area is a called a cardiectomy . "Cardiectomy"

3243-452: The left, of the aorta . The duodenum receives arterial blood from two different sources. The transition between these sources is important as it demarcates the foregut from the midgut. Proximal to the 2nd part of the duodenum (approximately at the major duodenal papilla – where the bile duct enters) the arterial supply is from the gastroduodenal artery and its branch the superior pancreaticoduodenal artery . Distal to this point (the midgut)

3312-738: The mouse submandibular gland, but since then found in many human tissues including the submandibular gland , and the parotid gland . Salivary EGF, which also seems to be regulated by dietary inorganic iodine , also plays an important physiological role in the maintenance of oro-esophageal and gastric tissue integrity. The biological effects of salivary EGF include healing of oral and gastroesophageal ulcers, inhibition of gastric acid secretion, stimulation of DNA synthesis, and mucosal protection from intraluminal injurious factors such as gastric acid, bile acids, pepsin, and trypsin and from physical, chemical, and bacterial agents. The human stomach has receptors responsive to sodium glutamate and this information

3381-427: The origin of the celiac artery from the aorta . In the human digestive system , a bolus (a small rounded mass of chewed up food) enters the stomach through the esophagus via the lower esophageal sphincter . The stomach releases proteases (protein-digesting enzymes such as pepsin ), and hydrochloric acid , which kills or inhibits bacteria and provides the acidic pH of 2 for the proteases to work. Food

3450-401: The pancreas creates differences in function based on the position and orientation of the organs. The congenital abnormality, annular pancreas, causes a portion of the pancreas to encircle the duodenum. In an extramural annular pancreas, the pancreatic duct encircles the duodenum which results in gastrointestinal obstruction. An intramural annular pancreas is characterized by pancreatic tissue that

3519-408: The protective mucosa of the duodenum, predisposing it to damage from gastric acids. The first part of the duodenum is the most common location of ulcers since it is where the acidic chyme meets the duodenal mucosa before mixing with the alkaline secretions of the duodenum. Duodenal ulcers may cause recurrent abdominal pain and dyspepsia , and are often investigated using a urea breath test to test for

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3588-420: The pyloric lymph nodes (along the gastroduodenal artery). The posterior lymphatic vessels pass posterior to the head of the pancreas and drain into the superior mesenteric lymph nodes. Efferent lymphatic vessels from the duodenal lymph nodes ultimately pass into the celiac lymph nodes. Under microscopy , the duodenum has a villous mucosa . This is distinct from the mucosa of the pylorus , which directly joins

3657-412: The pylorus. Near the gastroesophageal junction lie cardiac glands , which primarily secrete mucus. They are fewer in number than the other gastric glands and are more shallowly positioned in the mucosa. There are two kinds - either simple tubular glands with short ducts or compound racemose resembling the duodenal Brunner's glands . Near the pylorus lie pyloric glands located in the antrum of

3726-458: The pylorus. They secrete mucus, as well as gastrin produced by their G cells . About 20,000 protein-coding genes are expressed in human cells and nearly 70% of these genes are expressed in the normal stomach. Just over 150 of these genes are more specifically expressed in the stomach compared to other organs, with only some 20 genes being highly specific. The corresponding specific proteins expressed in stomach are mainly involved in creating

3795-545: The respective articles. Superior pancreaticoduodenal artery The superior pancreaticoduodenal artery is an artery that supplies blood to the duodenum and pancreas . It is a branch of the gastroduodenal artery , which most commonly arises from the common hepatic artery of the celiac trunk , although there are numerous variations of the origin of the gastroduodenal artery. The pancreaticoduodenal artery divides into two branches as it descends, an anterior and posterior branch. These branches then travel around

3864-414: The rest of the intestines. In the human digestive system , the stomach lies between the esophagus and the duodenum (the first part of the small intestine ). It is in the left upper quadrant of the abdominal cavity . The top of the stomach lies against the diaphragm . Lying behind the stomach is the pancreas . A large double fold of visceral peritoneum called the greater omentum hangs down from

3933-409: The same regions as in humans. Furthermore, in many non-human mammals, a portion of the stomach anterior to the cardiac glands is lined with epithelium essentially identical to that of the esophagus. Ruminants , in particular, have a complex stomach, the first three chambers of which are all lined with esophageal mucosa. In birds and crocodilians , the stomach is divided into two regions. Anteriorly

4002-452: The small intestine, some absorption of certain small molecules nevertheless does occur in the stomach through its lining. This includes: The parietal cells of the human stomach are responsible for producing intrinsic factor , which is necessary for the absorption of vitamin B12 . B12 is used in cellular metabolism and is necessary for the production of red blood cells , and the functioning of

4071-462: The small intestine, such as alanine aminopeptidase , a digestive enzyme, angiotensin-converting enzyme , involved in controlling blood pressure , and RBP2 , a protein involved in the uptake of vitamin A . The duodenum is largely responsible for the breakdown of food in the small intestine, using enzymes . The duodenum also regulates the rate of emptying of the stomach via hormonal pathways. Secretin and cholecystokinin are released from cells in

4140-415: The stomach a chemical breakdown of food takes place by means of secreted digestive enzymes and gastric acid . The stomach is located between the esophagus and the small intestine . The pyloric sphincter controls the passage of partially digested food ( chyme ) from the stomach into the duodenum , the first and shortest part of the small intestine, where peristalsis takes over to move this through

4209-524: The stomach also contains pepsinogen . Hydrochloric acid activates this inactive form of enzyme into the active form, pepsin. Pepsin breaks down proteins into polypeptides . Within a few moments after food enters the stomach, mixing waves begin to occur at intervals of approximately 20 seconds. A mixing wave is a unique type of peristalsis that mixes and softens the food with gastric juices to create chyme. The initial mixing waves are relatively gentle, but these are followed by more intense waves, starting at

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4278-476: The stomach is lined with gastric pits , which receive gastric juice , secreted by between 2 and 7 gastric glands . Gastric juice is an acidic fluid containing hydrochloric acid and digestive enzymes. The glands contains a number of cells, with the function of the glands changing depending on their position within the stomach. Within the body and fundus of the stomach lie the fundic glands . In general, these glands are lined by column-shaped cells that secrete

4347-484: The stomach') are both derived from Greek gaster ( γαστήρ ) 'belly'. Although the precise shape and size of the stomach varies widely among different vertebrates, the relative positions of the esophageal and duodenal openings remain relatively constant. As a result, the organ always curves somewhat to the left before curving back to meet the pyloric sphincter. However, lampreys , hagfishes , chimaeras , lungfishes , and some teleost fish have no stomach at all, with

4416-414: The stomach, is the use of an endoscope . A gastric emptying study is considered the gold standard to assess the gastric emptying rate. A large number of studies have indicated that most cases of peptic ulcers , and gastritis , in humans are caused by Helicobacter pylori infection, and an association has been seen with the development of stomach cancer . A stomach rumble is actually noise from

4485-488: The submucosa lies the muscular layer. It consists of three layers of muscular fibres, with fibres lying at angles to each other. These are the inner oblique, middle circular, and outer longitudinal layers. The presence of the inner oblique layer is distinct from other parts of the gastrointestinal tract, which do not possess this layer. The stomach contains the thickest muscular layer consisting of three layers, thus maximum peristalsis occurs here. The outer longitudinal layer

4554-490: The thyroid cells, such as primitive gastroenteric cells, migrated and specialized in uptake of iodide and in storage and elaboration of iodine compounds during vertebrate evolution. In fact, the stomach and thyroid share iodine-concentrating ability and many morphological and functional similarities, such as cell polarity and apical microvilli, similar organ-specific antigens and associated autoimmune diseases, secretion of glycoproteins (thyroglobulin and mucin) and peptide hormones,

4623-402: The upper portion of the greater curvature, is supplied by the short gastric arteries , which arise from the splenic artery. The two sets of gastric lymph nodes drain the stomach. Like the other parts of the gastrointestinal wall , the human stomach wall from inner to outer, consists of a mucosa , submucosa , muscular layer , subserosa and serosa . The inner part of the stomach wall

4692-406: Was brought into disrepute by surgeon anatomist J Massey. The lesser curvature of the human stomach is supplied by the right gastric artery inferiorly and the left gastric artery superiorly, which also supplies the cardiac region. The greater curvature is supplied by the right gastroepiploic artery inferiorly and the left gastroepiploic artery superiorly. The fundus of the stomach, and also

4761-420: Was first described in the 1960s. This term was coined also to indicate the presence of thyroid autoantibodies or autoimmune thyroid disease in patients with pernicious anemia, a late clinical stage of atrophic gastritis. In 1993, a more complete investigation on the stomach and thyroid was published, reporting that the thyroid is, embryogenetically and phylogenetically, derived from a primitive stomach, and that

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