Evaluation and Management of Stomach and Duodenal Injuries

Cardia

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  Superior part of the stomach that contains the cardiac sphincter

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  Situated at T11 vertebra level

Fundus

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  Part of the stomach superior and left of the cardia

Body

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  Largest part of the stomach

Antrum

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  Below the body of the stomach

Pylorus

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  Inferior part of the stomach that connects to the duodenum.

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  Divided into the antrum, pyloric canal, and pyloric sphincter

Pancreas

Lesser sac

Left kidney

Left adrenal

Spleen

Splenic artery

Left portion of the transverse colon

Lesser curvature

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  Left gastric artery: branch from the celiac trunk

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  Right gastric artery: branch from the proper hepatic artery

Greater curvature

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  Right gastroepiploic artery: branch from the gastroduodenal artery

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  Left gastroepiploic artery: branch from the splenic artery

Fundus

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  Short gastric arteries from the splenic artery

Veins run parallel to the arteries.

Right and left gastric veins drain into the portal vein.

Short left gastric veins and right gastroepiploic veins drain into the superior mesenteric vein.

Grade I

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  Contusion/intramural hematoma

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  Partial-thickness laceration

Grade II

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  Laceration <2 cm in gastroesophageal (GE) junction or pylorus

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  Laceration <5 cm in proximal 1/3 stomach

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  Laceration <10 cm in distal 2/3 stomach

Grade III

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  Laceration >2 cm in GE junction or pylorus

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  Laceration >5 cm in proximal 1/3 stomach

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  Laceration >10 cm in distal 2/3 stomach

Grade IV

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  Tissue loss or devascularization <2/3 stomach

Grade V

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  Tissue loss or devascularization >2/3 stomach

  Advance one grade for multiple lesions up to Grade III .